건강한 아시아인들의 하지 림프관 주행 분석 = Lymphatic Vessels Mapping in the Lower Extremities of a Healthy Asian Population

다국어 초록 (Multilingual Abstract)

Purpose: Intraoperative indocyanine green (ICG) lymphography is an effective tool to obtain real-time video images of functioning lymph vessels in edematous limbs. However, it is difficult to identify the course of lymph vessels in obese patients or patients with large dermal backflow. Without the image, surgeons have to rely on their experience when performing the skin incision to locate the lymphatic vessels. This study focused on elucidating lymphatic vessel flow patterns in healthy lower extremities in an Asian population to refer these findings for lymphedema treatment. Methods: ICG fluorescence lymphography was performed by injecting 0.2 mL of ICG into the first web space of the foot. After 4 hours, fluorescence images of lymphatic vessels were obtained and the lymphatic vessels were marked. Three landmarks were designated; the medial malleolus, the medial patellar border, and the groin femoral artery. Straight lines connecting the points were drawn, and the distance between the connected lines and the marked lymphatic vessels was measured in eight points. Results: Fifteen subjects with healthy lower extremities (15 right and 15 left) were included. The average course of the main lymph vessels passed 26.2±18.0 mm dorsally to the medial malleolus, 53.7±35.7 mm medially to the medial patellar border, and 25.5±19.2 mm medially to the three-quarters point of the upper landmark line. Conclusion: The main functioning lymphatic vessel largely follows the great saphenous vein course, passes in front of the medial malleolus, runs over the posterior border of the medial epicondyle at the knee level, and travels anteriorly toward the inguinal lymph nodes.

국문 초록 (Abstract)

목적: 수술 중 인도시아닌 그린(indocyanine green, ICG) 림프 조영술을 사용한 실시간 영상 촬영은 림프 부종 환자들의 림프관을 관찰하는 데 효과적인 방법이다. 하지만 비대하거나 어느 정도 진행된 림프 부종 환자들에서 이와 같은 방법으로 림프관 주행을 파악하는 것은 어려운 일이다. 영상이 없으면 외과의사들은 감에만 의존하여 절개를 해야 한다. 본 논문은 건강한 아시아인들의 하지 림프관 주행을 연구하여 위와 같이 영상을 얻을 수 없는 림프 부종 치료 시 참고할 수 있게 하고자 한다.
방법: 발의 첫 번째 지간 사이에 0.2 mL의 ICG를 주입한 후 ICG 형광(fluorescence) 림프 조영술을 실행하였다. 4시간 후, fluorescence image를 촬영하여 림프관 주행을 표시하였다. 세 부위의 랜드마크를 지정하였고 직선으로 그 점들을 연결하였다. 점들을 연결한 직선의 길이와 표시된 림프관들은 8가지 points로 측정하였다.
결과: 15명의 건강한 아시아인들의 하지(우측 15개, 좌측 15개)를 연구하였다. 평균적으로 림프관은 내측과의 배측 26.2±18.0 mm을 지나 슬개골 경계의 내측 53.7±35.7 mm을 지난 후 상단 랜드마크 라인의 3분의 4지점의 내측 25.5±19.2 mm을 지났다.
결론: 주 림프관은 대복재정맥의 주행을 따랐다. 내측과 앞을 지나, 무릎 높이에서 내측 상과의 뒷부분을 지나, 서혜부 림프절들로 이어졌다.

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