淋巴水肿治疗的进展

邓景成　戴婷婷　综述　曹卫刚　审校



淋巴水肿治疗的进展

邓景成戴婷婷综述曹卫刚审校

【提要】淋巴水肿临床上并不罕见，其主要病因是淋巴管或淋巴结受到损害，导致淋巴液回流受阻，正常淋巴管一旦失去代偿能力，就会造成富含蛋白质的淋巴液在体内积聚，进而形成淋巴水肿。若不加以治疗，淋巴水肿可导致肢体进一步肿胀，皮下软组织纤维化、疼痛、感觉异常及感染等并发症。因此，早期发现淋巴水肿对其预后十分关键，早期治疗也可以明显降低淋巴水肿的并发症。本文就淋巴水肿治疗的进展进行综述。

【关键词】淋巴水肿巴液引流淋巴管再生

作者单位：200011上海市上海交通大学医学院附属第九人民医院整复外科。

Research Progress of Clinical Therapy for Lymphedema

DENG Jingcheng,DAI Tingting,CAO Weigang.

Department of Plastic and Reconstructive Surgery,Shanghai Ninth People's Hospital,Shanghai Jiaotong University School of Medicine, Shanghai 200011,China.Corresponding author:CAO Weigang(E-mail:wgcao@sina.com).

【Summary】Lymphedema is not rarely seen clinically,and the most common etiology for the forming of lymphedema is the impaired flow of lymph fluid through the draining lymphatic vessels or lymph nodes.If the uninjured lymphatic vessels are unable to accommodate the increased lymphatic load,an abnormal accumulation of protein-rich lymph fluid develops in the tissues spaces.Lymphedema,without intervention,can lead to progressive swelling,fibrosis of the soft tissues,pain, paresthesias and infection.Therefore,early identification of the signs and symptoms of lymphedema is the key factor of the patients’prognosis,and complications can be minimized by early treatment.In this paper,progress of treatment in lymphedema was reviewed.

【Key words】Lymphedema;Lymph drainage;Lymphangiogenesis

淋巴水肿分为原发性和继发性。原发性淋巴水肿是遗传性病因造成，包括：①淋巴结的数目减少或发育不良；②淋巴管曲张或发育不全；③淋巴系统的成分缺失；④淋巴结纤维化。继发性淋巴水肿是最常见的一种类型，主要病因有肿瘤放化疗、手术创伤、感染（丝虫、酵母菌、真菌等）、淋巴管堵塞以及慢性静脉功能不全等。乳腺癌相关性淋巴水肿（Breast cancer-related lymphedema，BCRL）是目前常见的继发性淋巴水肿，文献报道乳腺癌术后淋巴水肿的发生率为24%～49%，腋窝淋巴洁清扫、放疗、术后血肿等造成淋巴管的断裂和变形，是导致乳腺癌术后淋巴水肿最主要的原因[1-5]。

淋巴水肿可采用非手术治疗和手术治疗，非手术治疗包括手法引流、复合理疗、患肢按摩、加压包扎、烘绑、激光和微波照射等，大多不能根治，不少患者经反复治疗效果不佳，最终发展成严重纤维化，因此手术仍是淋巴水肿治疗中难以或缺的部分。……