探讨亚甲蓝淋巴管显影结合吲哚菁绿(ICG)造影在淋巴管-静脉吻合术(LVA)术前淋巴管定位中的应用效果。

选择2021年2月至2023年5月西安交通大学附属西安市中心医院烧伤整形美容外科收治的行LVA治疗下肢淋巴水肿患者53例。根据术前淋巴管定位方法将患者分为对照组(24例)和研究组(29例)，对照组术前淋巴管定位采用传统亚甲蓝淋巴管显影，研究组采用亚甲蓝淋巴管显影结合ICG造影。比较两组患者亚甲蓝内染色结果、寻找淋巴管时间、手术时间、每切口吻合淋巴管数、淋巴管外蓝色污染及表皮溃疡情况；对比两组术前及术后3、6个月下肢淋巴水肿指数(LELI)及下肢淋巴水肿功能、残疾和健康问卷(Lymph-ICF-LL)。

研究组寻找淋巴管时间[14(8，22)min]及手术时间[(185.93±33.43)min]均较对照组[20(13，30)min、(217.00±59.19)min]缩短，差异均有统计学意义(Z＝-3.592，P<0.001；t＝2.404，P＝0.020)。研究组亚甲蓝内染色成功率(65.52%)高于对照组(46.88%)，淋巴管外蓝色污染比例(4.31%)低于对照组(13.54%)，差异均有统计学意义(χ²＝7.451、5.761，P＝0.006、0.016)。两组每切口吻合淋巴管数差异无统计学意义(Z＝-1.757，P＝0.079)。术后3、6个月，两组患者LELI较术前明显下降(F＝112.889、136.113，P<0.001)，同时Lymph-ICF-LL评分也较术前降低(F＝71.956、113.342, P<0.001)，患者预后改善。

亚甲蓝淋巴管显影结合ICG造影应用于LVA术前淋巴管定位，可使亚甲蓝染色淋巴管更精准，缩短寻找淋巴管时间及手术时间。

To explore the application effect of methylene blue lymphangiography combined with indocyanine green angiography for the preoperative localization of lymphatic vessels in lymphaticovenular anastomosis (LVA).

Fifty-three cases of lower extremity lymphedema patients underwent LVA in the Department of Burn, Plastic and Cosmetic Surgery of Xi′an Central Hospital, Xi′an Jiaotong University from February 2021 to May 2023 were selected. The patients were divided into control group (24 cases) and study group (29 cases), according to different methods for preoperative lymphatic vessel localization in LVA. The control group used traditional methylene blue lymphangiography, while the study group used methylene blue lymphangiography combined with indocyanine green angiography for preoperative lymphatic vessel localization.Observed internal methylene blue staining, lymphatic vessel identification time, operation time, the number of anastomosed lymphatics per incision, extra-lymphatic blue contamination, epidermal ulceration of the patients. Lower extremity lymphedema index (LELI) and lymphoedema functioning, disability and health questionnaire for lower limb lymphoedema (Lymph-ICF-LL) before and 3, 6 months after operation were compared between the two groups.

The lymphatic vessel identification time [14 (8, 22) min] and the operative time [(185.93 ± 33.43) min] in the study group were both shorter than those in the control group [20 (13, 30) min, (217.00 ± 59.19) min], and the differences were statistically significant (Z=-3.592, P<0.001; t=2.404, P=0.020). The success rate of methylene blue staining in the study group (65.52%) was higher than that in the control group (46.88%), and the proportion of extra-lymphatic blue contamination (4.31%) was lower than that in the control group (13.54%), with statistically significant differences (χ²=7.451, 5.761; P=0.006, 0.016). There was no statistically significant difference in the number of anastomosed lymphatics per incision between the two groups (Z=-1.757, P=0.079). The LELI(F=112.889, 136.113; P<0.001) and Lymph-ICF-LL scores (F=71.956, 113.342; P<0.001) were significantly reduced in both groups at 3 and 6 months after surgery compared to preoperative, and the prognosis improved.

Methylene blue lymphangiography combined with indocyanine green angiography used in LVA for the preoperative localization of lymphatic vessels, can make methylene blue staining of lymphatic vessels more accurate and shorten the lymphatic vessel identification time and operation time.