Assuntos
Complicações Intraoperatórias , Lipectomia , Efeitos Adversos de Longa Duração , Extremidade Inferior , Vasos Linfáticos , Corantes/farmacologia , Feminino , Humanos , Verde de Indocianina/farmacologia , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/fisiopatologia , Complicações Intraoperatórias/prevenção & controle , Lipectomia/métodos , Lipectomia/normas , Efeitos Adversos de Longa Duração/etiologia , Efeitos Adversos de Longa Duração/fisiopatologia , Efeitos Adversos de Longa Duração/prevenção & controle , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/patologia , Extremidade Inferior/cirurgia , Linfangiogênese , Vasos Linfáticos/lesões , Vasos Linfáticos/cirurgia , Linfedema/diagnóstico , Linfedema/etiologia , Linfedema/cirurgia , Linfografia/métodos , Pessoa de Meia-IdadeRESUMO
A total of 9 glue embolization procedures of injured lymphatic vessels with a reversed approach from the lymphocele/lymphatic fluid collection in 8 patients were retrospectively reviewed. The approach routes were via the indwelling chest tube for pleural effusion (n = 2), the drainage catheter tract for abdominopelvic lymphocele/lymphatic fluid collection/thigh lymphocele (n = 4), and the direct puncture of the lymphatic fluid collection at the operation bed (n = 2). All the procedures were technically successful without complications. The mean daily leakage rate decreased from 465 mL/d before the procedure to 42 mL/d after the procedure, and the drainage catheters could be removed after 8 procedures, achieving a clinical success rate of 88.9% (8 of 9 procedures).
Assuntos
Embolização Terapêutica , Embucrilato/administração & dosagem , Vasos Linfáticos/lesões , Linfocele/terapia , Complicações Pós-Operatórias/terapia , Idoso , Idoso de 80 Anos ou mais , Pré-Escolar , Embolização Terapêutica/efeitos adversos , Embucrilato/efeitos adversos , Feminino , Humanos , Vasos Linfáticos/diagnóstico por imagem , Linfocele/diagnóstico por imagem , Linfocele/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Seul , Resultado do TratamentoRESUMO
OBJECTIVE: Obesity results in lymphatic dysfunction, but the cellular mechanisms that mediate this effect remain largely unknown. Previous studies in obese mice have shown that inducible nitric oxide synthase-expressing (iNOS+) inflammatory cells accumulate around lymphatic vessels. In the current study, we therefore tested the hypothesis that increased expression of iNOS results in nitrosative stress and injury to the lymphatic endothelial cells (LECs). In addition, we tested the hypothesis that lymphatic injury, independent of obesity, can modulate glucose and lipid metabolism. METHODS: We compared the metabolic changes and lymphatic function of wild-type and iNOS knockout mice fed a normal chow or high-fat diet for 16 weeks. To corroborate our in vivo findings, we analyzed the effects of reactive nitrogen species on isolated LECs. Finally, using a genetically engineered mouse model that allows partial ablation of the lymphatic system, we studied the effects of acute lymphatic injury on glucose and lipid metabolism in lean mice. RESULTS: The mesenteric lymphatic vessels of obese wild-type animals were dilated, leaky, and surrounded by iNOS+ inflammatory cells with resulting increased accumulation of reactive nitrogen species when compared with lean wild-type or obese iNOS knockout animals. These changes in obese wild-type mice were associated with systemic glucose and lipid abnormalities, as well as decreased mesenteric LEC expression of lymphatic-specific genes, including vascular endothelial growth factor receptor 3 (VEGFR-3) and antioxidant genes as compared with lean wild-type or obese iNOS knockout animals. In vitro experiments demonstrated that isolated LECs were more sensitive to reactive nitrogen species than blood endothelial cells, and that this sensitivity was ameliorated by antioxidant therapies. Finally, using mice in which the lymphatics were specifically ablated using diphtheria toxin, we found that the interaction between metabolic abnormalities caused by obesity and lymphatic dysfunction is bidirectional. Targeted partial ablation of mesenteric lymphatic channels of lean mice resulted in increased accumulation of iNOS+ inflammatory cells and increased reactive nitrogen species. Lymphatic ablation also caused marked abnormalities in insulin sensitivity, serum glucose and insulin concentrations, expression of insulin-sensitive genes, lipid metabolism, and significantly increased systemic and mesenteric white adipose tissue (M-WAT) inflammatory responses. CONCLUSIONS: Our studies suggest that increased iNOS production in obese animals plays a key role in regulating lymphatic injury by increasing nitrosative stress. In addition, our studies suggest that obesity-induced lymphatic injury may amplify metabolic abnormalities by increasing systemic and local inflammatory responses and regulating insulin sensitivity. These findings suggest that manipulation of the lymphatic system may represent a novel means of treating metabolic abnormalities associated with obesity.
Assuntos
Células Endoteliais/fisiologia , Óxido Nítrico Sintase Tipo II/metabolismo , Estresse Nitrosativo/imunologia , Tecido Adiposo/metabolismo , Animais , Dieta Hiperlipídica , Células Endoteliais/metabolismo , Glucose , Inflamação/metabolismo , Insulina/metabolismo , Resistência à Insulina/fisiologia , Metabolismo dos Lipídeos/fisiologia , Linfonodos/metabolismo , Linfonodos/fisiologia , Vasos Linfáticos/lesões , Vasos Linfáticos/metabolismo , Vasos Linfáticos/fisiologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Obesos , Óxido Nítrico Sintase Tipo II/genética , Estresse Nitrosativo/fisiologia , Obesidade/metabolismo , Obesidade/fisiopatologiaRESUMO
Lymphatic ascites after pelvic lymphadenectomy is a rare complication and is rarely reported after urologic surgery. We report a case of delayed and refractory lymphatic ascites following robotic-assisted laparoscopic radical prostatectomy.
Assuntos
Ascite/etiologia , Ascite Quilosa/etiologia , Vasos Linfáticos/lesões , Complicações Pós-Operatórias/etiologia , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Idoso , Ascite/diagnóstico por imagem , Ascite/terapia , Ascite Quilosa/diagnóstico por imagem , Ascite Quilosa/terapia , Óleo Etiodado/uso terapêutico , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Vasos Linfáticos/diagnóstico por imagem , Linfografia , Masculino , Paracentese , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/terapia , Recidiva , Procedimentos Cirúrgicos Robóticos , Filtros de Veia Cava , Veia Cava InferiorRESUMO
The lymphatic system is a vital network of lymphatic vessels that carries liquid fluids, long-chain fatty acids and proteins from capillaries back to the vascular system and clears interstitial debris and bacteria. Lymphatic leakage is a condition not uncommon after many abdominal surgeries. It can lead to immunodeficiency and nutritional abnormalities. Moreover, it has high morbidity and mortality, ranging between 40% and 70%, depending on the presence of an underlying condition. A few lymphatic leakage cases after bariatric surgery have been reported in the literature. We report the first case of lymphatic leakage after sleeve gastrectomy, which was treated with conservative treatment.
Assuntos
Cirurgia Bariátrica/efeitos adversos , Ascite Quilosa/terapia , Tratamento Conservador/métodos , Gastrectomia/efeitos adversos , Complicações Pós-Operatórias/terapia , Adulto , Cirurgia Bariátrica/métodos , Ascite Quilosa/diagnóstico , Ascite Quilosa/etiologia , Nutrição Enteral , Feminino , Gastrectomia/métodos , Fármacos Gastrointestinais/administração & dosagem , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/lesões , Linfografia , Obesidade Mórbida/cirurgia , Octreotida , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologiaAssuntos
Traumatismos Craniocerebrais/complicações , Hemorragia/cirurgia , Vasos Linfáticos/lesões , Vasos Linfáticos/cirurgia , Malformações Vasculares/cirurgia , Adulto , Traumatismos Craniocerebrais/diagnóstico por imagem , Feminino , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Humanos , Vasos Linfáticos/diagnóstico por imagem , Imageamento por Ressonância Magnética , Doenças Orbitárias , Sucção/instrumentação , Tomografia Computadorizada por Raios X , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/etiologiaAssuntos
Cavidade Abdominal/diagnóstico por imagem , Apendicite/diagnóstico , Obstrução Intestinal/etiologia , Vasos Linfáticos/lesões , Cavidade Abdominal/cirurgia , Apendicite/cirurgia , Oclusão com Balão/métodos , Quilo , Feminino , Humanos , Obstrução Intestinal/diagnóstico , Laparoscopia/métodos , Linfocintigrafia/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Recidiva , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
Resumo A formação de linfocele, resultante da transecção dos canais linfáticos durante procedimentos cirúrgicos ou traumas, é relativamente comum, sendo relatada em aproximadamente 30% dos pós-operatórios de ressecção de linfonodos. Ela pode evoluir assintomática ou pode apresentar complicações, como dor, infecção secundária, compressão de vasos sanguíneos, a qual evolui para estase, trombose e edema. Seu tratamento ainda é de difícil consenso. Este artigo propõe descrever três casos em que o tratamento foi realizado a partir de ecoescleroterapia com polidocanol. Sua relevância está na escassez de relatos na literatura.
Abstract Formation of lymphocele secondary to transection of lymphatic channels during surgical procedures or traumas is relatively common and is reported in the postoperative period of approximately 30% of lymph node resection procedures. The condition may be asymptomatic or can present with complications such as pain, secondary infection, and compression of blood vessels, which can cause stasis, thrombosis, and edema. There is no consensus on treatment. This article describes three cases in which treatment was provided using polidocanol echosclerotherapy. Its relevance lies in the scarcity of reports in the literature.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Linfocele/terapia , Escleroterapia/métodos , Polidocanol/uso terapêutico , Período Pós-Operatório , Escleroterapia/instrumentação , Vasos Linfáticos/lesões , EdemaRESUMO
The cardiac lymphatic vascular system and its potentially critical functions in heart patients have been largely underappreciated, in part due to a lack of experimentally accessible systems. We here demonstrate that cardiac lymphatic vessels develop in young adult zebrafish, using coronary arteries to guide their expansion down the ventricle. Mechanistically, we show that in cxcr4a mutants with defective coronary artery development, cardiac lymphatic vessels fail to expand onto the ventricle. In regenerating adult zebrafish hearts the lymphatic vasculature undergoes extensive lymphangiogenesis in response to a cryoinjury. A significant defect in reducing the scar size after cryoinjury is observed in zebrafish with impaired Vegfc/Vegfr3 signaling that fail to develop intact cardiac lymphatic vessels. These results suggest that the cardiac lymphatic system can influence the regenerative potential of the myocardium.
Assuntos
Coração/fisiologia , Linfangiogênese/fisiologia , Vasos Linfáticos/fisiopatologia , Miocárdio/metabolismo , Peixe-Zebra/fisiologia , Animais , Animais Geneticamente Modificados , Vasos Coronários/metabolismo , Vasos Coronários/fisiologia , Regulação da Expressão Gênica no Desenvolvimento , Coração/crescimento & desenvolvimento , Humanos , Linfangiogênese/genética , Vasos Linfáticos/lesões , Vasos Linfáticos/metabolismo , Mutação , Receptores CXCR4/genética , Receptores CXCR4/metabolismo , Regeneração/genética , Regeneração/fisiologia , Fator C de Crescimento do Endotélio Vascular/genética , Fator C de Crescimento do Endotélio Vascular/metabolismo , Receptor 3 de Fatores de Crescimento do Endotélio Vascular/genética , Receptor 3 de Fatores de Crescimento do Endotélio Vascular/metabolismo , Peixe-Zebra/genética , Proteínas de Peixe-Zebra/genética , Proteínas de Peixe-Zebra/metabolismoRESUMO
Secondary lymphedema is a common complication of cancer treatment resulting in progressive fibroadipose tissue deposition, increased risk of infections, and, in rare cases, secondary malignancies. Until recently, the pathophysiology of secondary lymphedema was thought to be related to impaired collateral lymphatic formation after surgical injury. However, more recent studies have shown that chronic inflammation-induced fibrosis plays a key role in the pathophysiology of this disease. In this review, we will discuss the evidence supporting this hypothesis and summarize recent publications demonstrating that lymphatic injury activates chronic immune responses that promote fibrosis and lymphatic leakiness, decrease collecting lymphatic pumping, and impair collateral lymphatic formation. We will review how chronic mixed T-helper cell inflammatory reactions regulate this process and how this response may be used to design novel therapies for lymphedema.
Assuntos
Vasos Linfáticos/patologia , Linfedema/patologia , Fibrose , Humanos , Vasos Linfáticos/lesões , Linfedema/imunologia , Ativação Linfocitária/imunologia , Modelos Biológicos , Linfócitos T/imunologiaRESUMO
BACKGROUND: Lymphatic leakage is one of the severe complications after lymphadenectomy. However, efficient treatment it still unclear. MATERIALS AND METHODS: We employed inguinal lymphadenectomy and saphenous lymphatic vessel excision to establish a inguinal lymphatic leakage rabbit model. Rabbits with bilateral lymphatic leakage were divided in two groups, which were subject to negative pressure wound therapy (NPWT) on right sides and dressing change on left sides, respectively. Following 7-11 d of treatment, skin thickness and drainage volume were measured. Western blot and RT-PCR were used for analyzing the VEGF-C level. Tissues of wound were dissected and subject to anti-LYVE-1 immunohistochemical for lymphatic average positive staining area percentage and the ratio of lymphatic lumen area evaluation. RESULTS: Our lymphatic leakage model showed significant lymph stasis, delayed wound healing, and skin swelling and was confirmed by methylene blue instillation. Using this rabbit model, we found that NPWT could largely promote wound healing and resolution of skin edema. Compared with the dressing change group, the thickness of the dermis layer in the NPWT group was significantly reduced. Western blot and RT-PCR analysis showed a decrease of VEGF-C in the NPWT group. The immunohistochemical result of the NPWT group did not show a significant change in lymphatic average positive staining area percentage, whereas the ratio of lymphatic lumen area was significantly decreased, suggesting that NPWT treatment can significantly compress the dilated lymphatic vessels. CONCLUSIONS: We successfully established the first clinically relevant lymphatic leakage model in rabbits. NPWT can be an effective treatment for lymphatic leakage via reducing edema and lymphatic stasis by compressing dilated lymph vessels and promoting lymphatic drainage.
Assuntos
Excisão de Linfonodo/efeitos adversos , Vasos Linfáticos/lesões , Tratamento de Ferimentos com Pressão Negativa , Animais , Linfedema/etiologia , Linfedema/prevenção & controle , CoelhosRESUMO
Lymphatic complications following great and small saphenous vein surgery show a varying and non-negligible incidence in the literature. We undertook this study to investigate a new protocol to reduce lymphatic injuries in patients undergoing venous surgery. Eighty-six patients with lower limb venous insufficiency and varices were treated. Lymphoscintigraphy was performed preoperatively in 65 of them and postoperatively in 19. Blue dye was used in all patients and blue lymph nodes and lymphatics were identified intra-operatively and preserved or used to perform multiple lymphatic-venous anastomoses (MLVA). Patients were followed up fora period varying from 3 months to 6 years. Sixty-six patients were treated by greater saphenectomy and varicectomy, 12 patients had crossectomy and varicectomy, 4 patients underwent greater saphenectomy and varicectomy associated with MLVA, and 4 patients were treated by small saphenous vein stripping and varicectomy. No lymphatic complications occurred in any of the patients. A decrease of over 75% of excess volume was observed in 4 patients treated by MLVA. Lymphoscintigraphy showed normalization in the Transport Index in 4 patients treated with MLVA. Our results demonstrate that accurate diagnostic investigation and proper surgical technique is of paramount importance in the effort to avoid lymphatic complications during venous surgery.
Assuntos
Vasos Linfáticos/lesões , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Veias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Linfedema/complicações , Linfedema/diagnóstico , Linfedema/etiologia , Linfedema/cirurgia , Linfocintigrafia , Masculino , Microcirurgia/efeitos adversos , Microcirurgia/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Índice de Gravidade de Doença , Adulto JovemAssuntos
Embolização Terapêutica/métodos , Embucrilato/administração & dosagem , Vasos Linfáticos/lesões , Linfocele/terapia , Nefrectomia/efeitos adversos , Idoso , Carcinoma de Células Renais/cirurgia , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Embucrilato/farmacologia , Humanos , Neoplasias Renais/cirurgia , Vasos Linfáticos/efeitos dos fármacos , Linfocele/etiologia , Linfografia , MasculinoRESUMO
OBJECTIVE: This study aimed to examine an association between intrauterine manipulator (IUM) use and frequency of lymphovascular space invasion (LVSI) in women with endometrial cancer undergoing minimally invasive hysterectomy. METHODS: A retrospective case-control study was conducted among stage I-IV endometrial cancer patients who underwent hysterectomy between 2008 and 2015. Medical records were reviewed for patient demographics, surgical details, and tumor characteristics. Women who underwent total laparoscopic hysterectomy (TLH) with IUM use were compared with women who underwent total abdominal hysterectomy (TAH). Review of archived medical record for data collection and propensity score matching were performed to adjust for background differences between TLH-IUM and TAH groups. A systematic literature review with pooled analysis was performed to examine frequency of LVSI. RESULTS: There were 687 women who underwent hysterectomy for endometrial cancer. Of those, 419 women underwent TLH with IUM use and 194 women underwent TAH. The most common type of IUM was VCare (89.5%). There was no statistically significant difference in the frequency of LVSI between the 2 groups: 15.1% for TLH-IUM vs 19.9% for TAH (P = 0.14). After propensity score matching, frequencies of LVSI were similar between the 2 groups: 21.2% for TLH-IUM vs 19.6% for TAH (P = 0.78). Systematic literature review identified 1371 cases of TLH-IUM and 1246 cases of TAH performed for endometrial cancer, and frequencies of LVSI were similar between the 2 groups (15.0% vs 13.6%, P = 0.31). CONCLUSION: Our study suggests that IUM use during TLH for endometrial cancer is not associated with increased frequency of LVSI.
Assuntos
Carcinoma Endometrioide/cirurgia , Neoplasias do Endométrio/cirurgia , Histerectomia/efeitos adversos , Histerectomia/instrumentação , Complicações Pós-Operatórias/epidemiologia , Instrumentos Cirúrgicos/efeitos adversos , Útero/lesões , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Endometrioide/epidemiologia , Estudos de Casos e Controles , Neoplasias do Endométrio/epidemiologia , Feminino , Humanos , Histerectomia/estatística & dados numéricos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Laparoscopia/estatística & dados numéricos , Vasos Linfáticos/lesões , Vasos Linfáticos/patologia , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Neoplasias Uterinas/epidemiologia , Neoplasias Uterinas/cirurgia , Útero/irrigação sanguínea , Útero/patologia , Adulto JovemAssuntos
Cesárea/efeitos adversos , Quilo , Vasos Linfáticos/lesões , Período Pós-Parto , Fístula Urinária/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Hipofosfatemia Familiar/diagnóstico , Hipofosfatemia Familiar/urina , Piúria/diagnóstico , Piúria/urina , Remissão Espontânea , Fístula Urinária/etiologia , UrinaRESUMO
BACKGROUND: Severe compound tibial fractures are associated with extensive soft-tissue damage, resulting in disruption of lymphatic pathways that leave the patient at risk of developing chronic lymphedema. There are limited data on lymphatic response following lower limb trauma. Indocyanine green fluorescence lymphography is a novel, real-time imaging technique for superficial lymphatic mapping. The authors used this technique to image the superficial lymphatic vessels of the lower limbs in patients with severe compound tibial fracture. METHODS: Baseline demographics and clinical and operative details were recorded in a prospective cohort of 17 patients who had undergone bone and soft-tissue reconstruction after severe compound tibial fracture between 2009 and 2014. Normal lymphatic images were obtained from the patients' noninjured limbs as a control. In this way, the authors investigated any changes to the normal anatomy of the lymphatic system in the affected limbs. RESULTS: Of the 17 patients, eight had free muscle flaps with split-thickness skin grafting, one had a free fasciocutaneous flap, one had a full-thickness skin graft, six had local fasciocutaneous flaps, and one had a pedicled gastrocnemius flap. None of the free flaps demonstrated any functional lymphatic vessels; the fasciocutaneous flaps and the skin graft demonstrated impaired lymphatic vessel function and dermal backflow pattern similar to that in lymphedema. Local flaps demonstrated lymphatic blockage at the scar edge. CONCLUSION: Severe compound fractures and the associated soft-tissue injury can result in significant lymphatic disruption and an increased risk for the development of chronic lymphedema.
Assuntos
Fraturas Expostas/complicações , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/lesões , Lesões dos Tecidos Moles/etiologia , Lesões dos Tecidos Moles/cirurgia , Fraturas da Tíbia/complicações , Adulto , Idoso , Corantes , Feminino , Humanos , Verde de Indocianina , Linfografia , Masculino , Pessoa de Meia-Idade , Imagem Óptica , Estudos Prospectivos , Procedimentos de Cirurgia Plástica/métodosRESUMO
To explore the roles of mesenteric lymph on lung injury in heatstroke (HS), HS rat model was prepared in a prewarmed incubator. Vascular endothelium injury biomarkers (circulating endothelial cell [CEC] as well as von Willebrand factor [vWF] and thrombomodulin [TM]), proinflammatory factors (tumor necrosis factor-α [TNF-α], interleukin-1ß [IL-1ß], IL-6, and high mobility group box 1), and coagulant markers (activated partial thromboplastin time, prothrombin time, D-Dimer, and platelet count) were tested in HS and HS with mesenteric lymph duct ligation (LDL) rats. In addition, lung histopathology; arterial blood gas; Evans Blue dye (EBD) and protein lung permeability; intralung inflammatory parameters including bronchoalveolar lavage fluid (BALF) TNF-α, IL-1ß, and IL-6 levels; myeloperoxidase (MPO) activity; and vWF immune staining were analyzed. LDL prolonged HS onset time but not HS survival time. LDL significantly attenuated endothelial cell injury for decreased CEC counts as well as plasma vWF and TM concentrations; downregulated systemic inflammation for decreased plasma TNF-α, IL-1ß, IL-6, and high mobility group box 1 levels; and ameliorated coagulant disorders for decreased activated partial thromboplastin time, prothrombin time, and D-Dimer levels as well as increased platelet counts. LDL also significantly reduced acute lung pathological injury; improved lung function indexes including arterial blood PaO2, pH, PaCO2, and lactic acid; decreased BALF TNF-α, IL-1ß, and IL-6 levels and lung MPO activity; improved EBD and protein lung permeability; and inhibited lung vascular endothelium vWF expression. However, all of these parameters were not recovered to the normal states. In summary, LDL developed protection roles systemically and alleviated lung injury in HS rats which indicated that modulating mesenteric lymph flow may have some potential benefits in HS.
Assuntos
Lesão Pulmonar Aguda/metabolismo , Lesão Pulmonar Aguda/cirurgia , Golpe de Calor/metabolismo , Golpe de Calor/fisiopatologia , Ligadura , Mesentério/lesões , Animais , Líquido da Lavagem Broncoalveolar , Interleucina-1beta/metabolismo , Interleucina-6/metabolismo , Vasos Linfáticos/lesões , Vasos Linfáticos/metabolismo , Masculino , Ratos , Ratos Wistar , Fator de Necrose Tumoral alfa/metabolismoAssuntos
Neoplasias da Mama/cirurgia , Complicações Intraoperatórias , Excisão de Linfonodo/métodos , Mastectomia , Biópsia de Linfonodo Sentinela/efeitos adversos , Linfonodo Sentinela , Axila , Neoplasias da Mama/patologia , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/fisiopatologia , Complicações Intraoperatórias/cirurgia , Vasos Linfáticos/lesões , Vasos Linfáticos/cirurgia , Mastectomia/efeitos adversos , Mastectomia/métodos , Pessoa de Meia-Idade , Reoperação/métodos , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Biópsia de Linfonodo Sentinela/métodos , Resultado do TratamentoRESUMO
BACKGROUND: Many attempts to prevent lymphatic complications following therapeutic lymph node dissection (TLND) have included modifications in surgical techniques through the use of ultrasonic scalpels (USS) or lymphostatic agents. Previous randomized studies that enrolled heterogeneous groups of patients attempted to confirm the efficacy of such techniques. The aim of the present study was to evaluate the efficacy of the USS following TLND. METHODS: Between 2009 and 2013, patients undergoing inguinal or axillary TLND or completion lymph node dissection after positive sentinel lymph node biopsy for melanoma, squamous cell carcinoma or sarcoma were randomized into two surgical dissection technique groups. In the USS dissection arm, surgery was conducted using a USS. These were compared with a control group whereby ligation and monopolar electrocautery was utilized. For axillary dissection, a standardized level III lymphadenectomy was performed. A complete inguinal lymphadenectomy including Cloquet's node was performed, and at the end of the procedure a Redon suction drain was routinely placed in the axilla and groin. The primary endpoint was to compare the time to drain removal in both groups, while the secondary endpoint was to evaluate the rate of complications (infection, fistula, lymphocele formation, wound dehiscence, lymphedema) between the two groups. RESULTS: A total of 80 patients were enrolled in this trial; 40 patients were randomly assigned to both the USS group and the control (C) group. No significant differences were observed in terms of duration of drainage (USS: 31 ± 20 vs. C: 32 ± 18; p = 0.83); however, a significantly increased rate of lymphedema (defined as an increased circumference of the operated limb of more than 10 %) was identified in the USS group (USS: 50 % vs. C: 27.5 %; p = 0.04). No other significant differences were recorded for postoperative complications, including surgical site infection (USS: 5 % vs. C: 7.5 %; p = 0.68), lymphatic fistula (USS: 5 % vs. C: 2.5 %; p = 0.62), lymphocele (USS: 32.5 % vs. C: 22.5 %; p = 0.33), and hematoma (USS: 5 % vs. C: 2.5 %; p = 0.62). CONCLUSION: The use of USS failed to offer any significant reduction in length of drain usage and operative complication, but it seems to increase the rate of lymphedema formation.