General conditions of healthy volunteers.

ObjectiveThis study evaluated percutaneous lymphatic contrast-enhanced ultrasound (CEUS) for preoperative localization in preparation for lymphovenous anastomosis (LVA) microsurgery.MethodsFourteen healthy volunteers and 14 patients with lower limb lymphoedema were studied. SonoVue® (Bracco, Milan, Italy) was used to measure lymphatic vessel diameters and depths in the dorsal foot, ankle, and lower leg of the subjects. In the lymphoedema patients, lymphatic vessels were observed for continuity, distortion, dilation, interruption, and other abnormalities. On the basis of the CEUS images, the lower limb lymphatic vessels were categorized as normal, dilated, contracted, or sclerotic. In the lymphoedema patients, the locations of lymphatic vessels with good visibility were marked on the skin, and the accuracy of preoperative localization was evaluated based on the basis of surgical results. The data were analysed using IBM SPSS Statistics27.0 (IBM Corp., Armonk, NY, USA). Continuous data are expressed as the means ± standard deviations and were compared using paired t-tests, with P ResultsAmong the healthy volunteers, one had a 1–2 mm lymphatic vessel visible in the dorsal foot, whereas 13 had no lymphatic vessels visible in the dorsal foot; however, lymphatic vessels were visible in the ankle and lower leg in all volunteers, with an average diameter of 0.42 ± 0.09 mm, resulting in a 100% visualization success rate. In lymphoedema patients, CEUS achieved a 92.86% success rate (13/14) in visualizing lymphatic vessels within 1 minute in lymphedema patients, excluding one patient with primary lymphoedema; the average vessel diameter was 0.66 ± 0.24 mm. The most common type consisted of dilated lymphatic vessels with tortuous morphology and increased diameter, often accompanied by reflux and interstitial dispersion in lymphoedema patients. With the successful intraoperative identification of lymphatic vessels under the surface marking during LVA as the standard, the accuracy of preoperative lymphatic vessel localization by CEUS was 92.36%.ConclusionCEUS can accurately localize functional lymphatic vessels and serves as a valuable complementary method to indocyanine green for preoperative lymphatic vessel mapping in LVA.Objective 本研究旨在评估经皮淋巴管超声造影（CEUS）用于淋巴管静脉吻合术（LVA）显微手术术前定位的应用价值。 Methods 本研究纳入14名健康志愿者及14名下肢淋巴水肿患者。采用声诺维®（SonoVue®，意大利米兰博莱科公司）对受试者足背、踝部及小腿的淋巴管管径与深度进行测量。针对淋巴水肿患者，观察其淋巴管的连续性、扭曲、扩张、中断及其他异常表现。基于CEUS图像，将下肢淋巴管分为正常、扩张、收缩或硬化四类。对于淋巴水肿患者，将显像清晰的淋巴管位置标记于皮肤表面，并以手术结果为参照评估术前定位的准确性。所有数据采用IBM SPSS Statistics 27.0（美国纽约州阿蒙克市IBM公司）进行统计分析。计量资料以均值±标准差表示，组间比较采用配对t检验，以P<0.05为差异具有统计学意义。 Results 健康志愿者中，1名志愿者足背可见1~2mm的淋巴管，其余13名志愿者足背未探及淋巴管；但所有志愿者的踝部及小腿均可见淋巴管，平均管径为0.42±0.09mm，显像成功率达100%。对于淋巴水肿患者，排除1名原发性淋巴水肿患者后，CEUS在1分钟内完成淋巴管显像的成功率为92.86%（13/14），平均淋巴管管径为0.66±0.24mm。淋巴水肿患者中最常见的淋巴管表现为形态迂曲、管径扩张的淋巴管，常伴随反流及淋巴液间质弥散。以术中通过体表标记成功识别淋巴管作为金标准，CEUS术前淋巴管定位的准确率为92.36%。 Conclusion CEUS可精准定位功能性淋巴管，可作为吲哚菁绿术前淋巴管绘图的有效补充手段，用于淋巴管静脉吻合术（LVA）的术前准备。