pelvic lymphography

The lymphatic system is an integral part of the circulatory system. In pathological conditions, microorganisms, toxins, and cancer cells can spread through lymphatic vessels or metastasize to draining lymph nodes. Lymphatic angiography is an examination method that shows the function of lymphatic vessels and lymph nodes under the X-ray after the contrast agent enters the lymphatic system. Lower extremity lymphography has been widely used since the 1940s to examine retroperitoneal lymph node lesions in pelvic tumors. This method is a kind of examination method for patients with malignant tumors with high accuracy, simplicity, safety and less complications in determining diagnosis, staging, localization, efficacy observation and follow-up. In the female genitalia, vulvar cancer, vaginal cancer, cervical cancer, endometrial adenocarcinoma, ovarian cancer, etc. can flow through the lymphatic network, from the collecting lymphatics to the deep and inferior lymph nodes of the inguinal region, and then enter the pelvic cavity to reach the outside of the sac, the obturator, the sac, The total lymph nodes are up and can be extended to the para-aortic lymph nodes and the left subclavian lymph nodes. Lymphangiography is the only X-ray diagnostic method that can observe the internal structure of lymph nodes. The diagnostic accuracy is high. It can help to formulate treatment plans, select appropriate surgical methods and radiotherapy doses, determine the stage, analyze the prognosis and improve the cure rate and reduce the recurrence rate. . Treatment of diseases: postmenopausal cervical cancer ovarian cancer Indication 1. Pelvic malignant tumors, such as ovarian cancer, cervical cancer, uterine body cancer, vulvar and vaginal cancer, suspected inguinal deep lymph nodes and pelvic lymph node metastasis. 2. Diagnose the nature of the disease and determine the location of the lesion: It can be confirmed whether the lesion of the lymph node is benign or malignant, and the lymph node of any part is abnormal. Estimate the prognosis and determine the stage. 3. After initial positioning, the biopsy lymph nodes can be guided through the inguinal or abdominal to further confirm the diagnosis. 4. In the pelvic lymphadenectomy, the X-ray film taken by lymphography can be used to determine whether there is residual lymph node in the lesion to improve the surgical cure rate. 5. For patients requiring radiation therapy, the scope and dose of radiation therapy are prescribed according to lymph node angiography. 6. Inject a certain amount of anticancer drugs, radionuclide and lipiodol complexes into the lymphatic vessels, which have both diagnostic effects and palliative or adjuvant treatment for certain cancers. Contraindications 1. There are soft tissue inflammation, especially between the toes, which needs to be treated with antibiotics. Severe cellulitis and lymphadenitis should be performed after 2 weeks of acute inflammation control. 2. Those who are allergic to iodine. 3. Patients with heart, lung, kidney and liver failure. Preoperative preparation 1. Perform an iodine allergy test before surgery. 2. Wash your feet before surgery to keep your feet clean. 3. Prepare the cleansing enema in advance, and stop taking heavy metal drugs 3 days before the angiography. 4. Exhausted urine before surgery. 5. Prepare local anesthetic and contrast agent 1% procaine, methylene blue solution (1% solution, 0.5 ml), 30% iodobenzene (myodil). 6. Prepare the instrument 1 to connect the No. 4 scalp injection needle of a polyethylene tube of about 30 cm in length, and after disinfection, rinse with isotonic saline. 2 microsurgical instruments. More than 32 times magnifying glass or microscope, ordinary syringe or semi-automatic, fully automatic lymphography ejector. 4X line camera device operating table. Surgical procedure 1. In the supine position, the legs are flat and relaxed. The skin of the foot is disinfected with iodine and ethanol, and the perforated towel is used for local anesthesia. 2. Intradermal injection of 1% methylene blue solution 0.5ml into the upper 1cm and the second toe, so that the dorsal lymphatics are blue-stained. After the injection, the lymphatic network is massaged in the direction of the calf, prompting blue dyeing as soon as possible. 3. Cut the skin after local anesthesia. The incision was chosen to be 2 cm below the two iliac crest or in the incision, carefully separating the blue lymphatic vessels. Generally, 2 to 3 thick and obvious lymphatic vessels can be seen. 4. The length of the free lymphatic vessels is about 1.5 to 2 cm, and two silk wires are placed in the proximal and the centrifugation ends respectively, and the centrifugal ends are ligated and the wires are pulled. 5. The scalp needle of No. 4 (or No. 412) with plastic tube is slowly inserted into the lymphatic vessel, toward the proximal end, the centrifugal end is pulled, and the lymphatic tube is straightened to facilitate successful puncture. Fix the needle and lymphatic tube near the heart end wire to prevent movement and leakage. 6. Slowly inject the contrast agent myodil 6 ~ 8ml. The speed control is less than 1ml per 5min, the action is light, the speed is slow, the needle does not move, and the micro-injection pump can also be used, and the injection speed is controlled at 0.1ml/min. 7. The push is smooth, no resistance, no leakage and local edema, pull out the needle, partially suture, cover with dressing. 8. After the operation of the lower limbs, immediately and 24 hours after the ingestion of the pelvis and abdominal plain film, you can also observe the lymphatic development under fluoroscopy, select the film. Add oblique or lateral slices if necessary. 9. Remove the local suture after 5 to 7 days.

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