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センター概要

0.5mm未満の超微小血管吻合技術(スーパーマイクロサージャリー)を用いた低侵襲外科治療であるリンパ管細静脈吻合術(Lymphaticovenular Anastomosis: LVA)や血管柄付きリンパ節移植術(Lymph Node Transfer: LNT)などのリンパ浮腫外科治療が特色です。6,000本以上のリンパ管を吻合し国内外多施設で招待手術・公開手術の実績のあるセンター長(センター長紹介参照)のもと、各種リンパ浮腫外科治療を併用して圧迫療法抵抗性のリンパ浮腫(がん治療後の二次性リンパ浮腫ならびに原因不明の原発性リンパ浮腫)に対して積極的に治療を行っております。

リンパ浮腫では適切な診断・評価が欠かせませんが、当センターではリンパ浮腫評価に用いられるすべての画像診断が可能で、「リンパシンチグラフィ」「SPECT-CT」「MR lymphography」「CT」「ICGリンパ管造影」「直接的リンパ管造影」を病態に応じて各種検査法を組み合わせてリンパ浮腫を包括的に評価した上で治療を行っております。

国内のみならず海外からも患者・医療従事者を広く受け入れて診療しております。国内外から医師が見学・修練(ACT参照)に来院するため、外来診療・入院・手術において外国人医師が同席ならびに診療を行うことがあります。今後のより良いリンパ浮腫診療のために臨床研究にも力を入れております。

ICGリンパ管造影によるリンパ流の評価

(リンパ浮腫の進行により造影所見がLinear → Splash → Stardust → Diffuseと変化する)

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  1. Yamamoto T, et al.
    Characteristic indocyanine green lymphography findings in lower extremity lymphedema: the generation of a novel lymphedema severity staging system using dermal backflow patterns. 
    Plast Reconstr Surg. 127(5):1979-86, 2011.

ICGリンパ管造影による重症度分類(DB stage)と治療方針

(適切な治療方針の検討に有用な病態評価方法)

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  1. Yamamoto T, et al.
    The earliest finding of indocyanine green (ICG) lymphography in asymptomatic limbs of lower extremity lymphedema patients secondary to cancer treatment: the modified dermal backflow (DB) stage and concept of subclinical lymphedema.
    Plast Reconstr Surg. 128(4):314e-21e, 2011.
  2. Yamamoto T, et al.
    Subclinical lymphedema: understanding is the clue to decision making. 
    Plast Reconstr Surg. 132(3):472e3e, 2013.

圧迫療法抵抗性のリンパ浮腫に対するLVA

(静脈にリンパ液が流れて透明になっている。術後、浮腫が改善し体重が7kg減少)

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スーパーマイクロサージャリーの技術を用いた選択的遊離穿通枝リンパ節弁移植術

(ICGリンパ管造影を用いた術中ナビゲーションにより上肢からのリンパ流・リンパ節を温存して側胸部よりリンパ節を採取し移植)

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スタッフ業績(英文論文)

  1. Yamamoto T, et al.
    Lambda-shaped anastomosis with intravascular stenting method for safe and effective lymphaticovenular anastomosis.
    Plast Reconstr Surg. 2011;127(5):1987-92.
  2. Yamamoto T, et al.
    The earliest finding of indocyanine green (ICG) lymphography in asymptomatic limbs of lower extremity lymphedema patients secondary to cancer treatment: the modified dermal backflow (DB) stage and concept of subclinical lymphedema.
    Plast Reconstr Surg. 2011;128(4):314e-21e.
  3. Yamamoto T, et al.
    Upper Extremity Lymphedema (UEL) Index: A Simple Method for Severity Evaluation of Upper Extremity Lymphedema.
    Ann Plast Surg. 2011 Jul 5 [Epub ahead of print]
  4. Yamamoto T, et al.
    Indocyanine green (ICG)-enhanced lymphography for upper extremity lymphedema: a novel severity staging system using dermal backflow (DB) patterns.
    Plast Reconstr Surg. 2011 Jun 15. [Epub ahead of print]
  5. Yamamoto T, et al.
    Indocyanine green (ICG)-enhanced lymphography for evaluation of facial lymphoedema.
    J Plast Reconstr Aesthet Surg. 2011 Jun 15 [Epub ahead of print]
  6. Yamamoto T, et al.
    Characteristic indocyanine green lymphography findings in lower extremity lymphedema: the generation of a novel lymphedema severity staging system using dermal backflow patterns.
    Plast Reconstr Surg. 2011;127(5):1979-86.
  7. Yamamoto T, et al.
    Lower extremity lymphedema index: a simple method for severity evaluation of lower extremity lymphedema.
    Ann Plast Surg. 2011 Mar 14 [Epub ahead of print].
  8. Yamamoto T, et al.
    Simultaneous multi-site lymphaticovenular anastomoses for primary lower extremity and genital lymphoedema complicated with severe lymphorrhea.
    J Prast Reconstr Aesthet Surg. 2011;64(6):812-5. Epub2010 Nov 17.
  9. Yamamoto T, et al.
    LEC score: A judgment tool for indication of indocyanine green lymphography.
    Ann Plast Surg. 2013;70(2):227-30.
  10. Yamamoto T, et al.
    Split intravascular stents for side-to-end lymphaticovenular anastomosis.
    Ann Plast Surg. 2013;71(5):538-40.
  11. Yamamoto T, et al.
    Indocyanine green velocity: Lymph transportation capacity deterioration with progression of lymphedema.
    Ann Plast Surg. 2013;71(5):591-4.
  12. Yamamoto T, et al.
    Minimally invasive lymphatic supermicrosurgery (MILS): indocyanine green-guided simultaneous multi-site lymphaticovenular anastomoses via millimeter skin incisions.
    Ann Plast Surg. 2012 Dec 13 [Epub ahead of print].
  13. Yamamoto T, et al.
    A modified side-to-end lymphaticovenular anastomosis.
    Microsurgery. 2013;33(2):130-3.
  14. Yamamoto T, et al.
    Sequential anastomosis for lymphatic supermicrosurgery: multiple lymphaticovenular anastomoses on one venule.
    Ann Plast Surg. 2012 Dec 13 [Epub ahead of print].
  15. Yamamoto T, et al.
    Dynamic indocyanine green lymphography for breast cancer-related arm lymphedema.
    Ann Plast Surg. (in press).
  16. Yamamoto T, et al.
    Side-to-end lymphaticovenular anastomosis through temporary lymphatic expansion.
    PLoS ONE. 2013;8(3):e59523. Epub 2013 Mar 25.
  17. Yamamoto T, et al.
    Indocyanine green lymphography for evaluation of genital lymphedema in secondary lower extremity lymphedema patients.
    J Vasc Surg Venous Lymphat Dis. 2013 July 18 [Epub ahead of print].
  18. Yamamoto T, et al.
    Near-infrared illumination system-integrated microscope for supermicrosurgical lymphaticovenular anastomosis.
    Microsurgery. 2013 Jul 9 [Epub ahead of print].
  19. Yamamoto T, et al.
    Subclinical lymphedema: understanding is the clue to decision making.
    Plast Reconstr Surg. 2013;132(3):472e3e.
  20. Yamamoto T, et al.
    Modified lambda-shaped lymphaticovenular anastomosis with supermicrosurgical lymphoplasty technique for a cancer-related lymphedema patient.
    Microsurgery. 2013 Sep 13 [Epub ahead of print].
  21. Yamamoto T, et al.
    Colourful indocyanine green lymphography.
    J Plast Reconstr Aesthet Surg. 2013 Oct 1 [Epub ahead of print].
  22. Yamamoto T, et al.
    Neo-valvuloplasty for lympahtic supermicrosurgery.
    J Plast Reconstr Aesthet Surg. 2014;67(4):587-8.
  23. Yamamoto T, et al.
    Ladder-shaped lymphaticovenular anastomosis using multiple side-to-side lymphatic anastomoses for a leg lymphedema patient.
    Microsurgery. 2014;34(5):404-8.
  24. Yamamoto T, et al.
    Upward retraction for lymphaticovenular anastomosis in the deep fat layer.
    Microsurgery. 2014;34(7):586-7.
  25. Yamamoto T, et al.
    Technical simplification of the supermicrosurgical side-to-end lymphaticovenular anastomosis using the parachute technique.
    Microsurgery. 2015 Feb;35(2):129-34.
  26. Yamamoto T, et al.
    Splash, stardust, or diffuse pattern: differentiation of dermal backflow pattern is important in indocyanine green lymphography.
    Plast Reconstr Surg. 2014;133(6):e887-8.
  27. Yamamoto T, et al.
    Navigation lymphatic supermicrosurgery for iatrogenic lymphorrhea: supermicrosurgical lymphaticolymphatic anastomosis and lymphaticovenular anastomosis under indocyanine green lymphography navigation.
    J Plast Reconstr Aesthet Surg. 2014;67(11):1573-9.
  28. Yamamoto T, et al.
    Triple supermicrosurgical side-to-side lymphaticolymphatic anastomoses on a lymphatic vessel end-to-end anastomosed to a vein.
    Microsurgery. 2014 Jul 15 [epub ahead of print]
  29. Yamamoto T, et al.
    Mono-canalization of adhered lymphatic vessels for lymphatic supermicrosurgery.
    J Plast Reconstr Aesthet Surg. 2014;67(11):e291-2. 2014 Jul 31 [epub ahead of print]
  30. Yamamoto T, et al.
    Lymph preserving lipectomy under indocyanine green lymphography navigation.
    J Plast Reconstr Aesthet Surg. 2015;68(1):136-7.
  31. Yamamoto T, et al.
    Supermicrosugical anastomosis of superficial lymphatic vessel to deep lymphatic vessel for a patient with cellulitis-induced chronic localized leg lymphedema.
    Microsurgery. 2015;35(1):68-71. 2014 Sep 8 [epub ahead of print]
  32. Yamamoto T, et al.
    Establishment of supermicrosurgical lymphaticovenular anastomosis model in rat.
    Microsurgery. 2014 Oct 3 [Epub ahead of print]
  33. Yamamoto T, et al.
    Multiple-In-One concept for lymphatic supermicrosurgery.
    Microsurgery. 2014 Oct 28 [epub ahead of print]
  34. Yamamoto T, et al.
    Efferent lymphatic vessel anastomosis (ELVA): supermicrosurgical efferent lymphatic vessel-to-venous anastomosis for the prophylactic treatment of subclinical lymphedema.
    Ann Plast Surg. 2014 Nov 1 [Epub ahead of print]
  35. Yamamoto T, et al.
    Indocyanine green lymphography findings in primary leg lymphedema.
    Eur J Vasc Endovasc Surg. 2015;49:95-102. 2014 Dec 3 [Epub ahead of print]
  36. Yamamoto T, et al.
    Supermicrosurgical deep lymphatic vessel-to-venous anastomosis for a breast cancer-related arm lymphedema with severe sclerosis of superficial lymphatic vessels.
    Microsurgery. 2015 Jan 17 [Epub ahead of print]
  37. Yamamoto T, et al.
    Relationship between lymphedema and arteriosclerosis: higher cardio-ankle vascular index in lymphedematous limbs.
    Ann Plast Surg. 2015 Feb 18 [Epub ahead of print]
  38. Yamamoto T, et al.
    Hands-free vein visualizer for selection of recipient vein with an intact valve in lymphatic supermicrosurgery.
    J Plast Reconstr Aesthet Surg. 2015 Feb 14 [Epub ahead of print]
  39. Yamamoto T, et al. A method of continuous indirect aspiration for field clearance in lymphatic supermicrosurgery.
    Microsurgery. 2015 May 19 [Epub ahead of print]
  40. Yamamoto T, et al.
    Lymphatic vessel grafting for prevention of venous reflux into a sclerotic lymphatic vessel in supermicrosurgical lymphaticovenular anastomosis.
    J Plast Reconstr Aesthet Surg. 2016 Jan 7 [epub ahead of print]
  41. Yamamoto T, et al.
    Microsurgical venous-branch-plasty for approximating diameter and vessels' position in lymphatic supermicrosurgery.
    J Plast Reconstr Aesthet Surg. 2016 Feb 17 [epub ahead of print]
  42. Yamamoto T, et al.
    Quadruple-component superficial circumflex iliac artery perforator (SCIP) flap: a chimeric SCIP flap for complex ankle reconstruction of an exposed artificial joint after total ankle arthroplasty.
    J Plast Reconstr Aesthet Surg. 2016 Jun 23 [epub ahead of print]
  43. Yamamoto T, et al.
    Complete lymph flow reconstruction: a free vascularized lymph node true perforator flap transfer with efferent lymphaticolymphatic anastomosis.
    J Plast Reconstr Aesthet Surg. 2016 Jul 2 [epub ahead of print]
  44. Yamamoto T, et al.
    Fusion lymphoplasty for diameter approximation in lymphatic supermicrosurgery using two lymphatic vessels for a larger recipient vein.
    J Plast Reconstr Aesthet Surg. 2016 Jul 9 [epub ahead of print]
  45. Yamamoto T, et al.
    Time to re-consider a gold standard of lymph flow imaging: importance of reliability to detect abnormal lymphodynamics in lymphedema screening after cancer treatments.
    Plast Reconstr Surg. 2016 Dec 9 [epub head of print]
  46. Yamamoto T, et al.
    Application of a multi-directional transformable retractor for lymphatic supermicrosurgery using SEKI method.
    Microsurgery. 2016 Dec 23 [epub ahead of print]
  47. Yamamoto T, et al.
    Indocyanine green lymphography for lymphedema screening following breast cancer treatment.
    Plast Reconstr Surg 2017 Feb 14 [Epub ahead of print]
  48. Yamamoto T, et al.
    Factors associated with lower extremity dysmorphia caused by lower extremity lymphedema.
    Eur J Vasc Endovasc Surg. 2017 Apr 6 [epub head of print]
  49. Yamamoto T, et al.
    Localized arm volume index: a new method for body type-corrected evaluation of localized arm lymphedematous volume change.
    Ann Plast Surg. 2017 May 31 [epub ahead of print]
  50. Yamamoto T, et al.
    Factors associated with lymphosclerosis: an analysis on 962 lymphatic vessels.
    Plast Reconstr Surg. 2017 June 12 [epub ahead of print]
  51. Yamamoto T.
    Congenital Vascular Malformation- Comprehensive Review on Current Management. Part V. Contemporary Diagnosis: Imaging Modalities.
    Chapter 25. Indocyanine Green (ICG) Lymphography. Springer.
  52. Yamamoto T.
    ICG Fluorescence imaging and navigation surgery.
    Chapter 44. Comprehensive Lymphedema Evaluation using Dynamic ICG Lymphography. Springer.