外周淋巴水肿的治疗

The treatment of peripheral lymphedema

由于对淋巴系统的胚胎发育和生理功能，以及疾病的病理生理、发生后的归转了解得很不够，也因为缺少先进的、分辨率高的影像检查手段，淋巴水肿的治疗难有突破。早期的外科手术治疗大都带有盲目性，难以严格规范适应证。当前综合消肿治疗是主要的治疗手段。近年开展的多模态的淋巴显像新技术提升了淋巴循环障碍疾病诊断的准确性．对外周淋巴水肿的治疗也应该有新的要求和预期，有针对性的个性化的治疗应该成为终极目标。外周淋巴水肿的治疗需要考虑：①区分原发性与继发性的淋巴水肿，两者的淋巴系统功能和结构有本质的不同。原发性淋巴水肿的淋巴管再生和自我修复是一个有待探索的问题。②关注患病部位淋巴管本身的病理改变和演变，淋巴管（可能包括淋巴结）的病变（硬化）可能是不可逆的。③将淋巴水肿组织的病理改变纳入治疗目标，包括慢性炎性反应、组织纤维化和脂肪沉积等不可逆病变。在分子水平降低组织中相关联的炎性因子的表达并阻断其功能，有可能成为治疗淋巴水肿的新思路和新方法。

The treatment of lymphedema has been difficult due to the lack of understanding of the etiology and pathophysiology of the disease, as well as the embryology and physiology of the lymphatic system. The previous surgical treatment mostly has the blindness. Complete decongestion therapy （CDT） is the most popular treatment currently. The ultimate goal of lymphedema is the targeted and individualized treatment. New technology of muhimodality lymphatic imaging emerged in the recent years largely improves the diagnosis of lymphatic circulation disorders. The treatment of peripheral lymphedema is expected to have new achievement. The key points that should be noticed in peripheral lymphedema treatment are to distinguish between primary and secondary lymphedema as the function and structure of the lymphatic system are substantially different. The lymphatic vessel regeneration and self-repair has not be proved in primary lymphedema. lymphatic vessel （ possibly lymph node too） undergo a series pathological and degenerative changes in the affected limb. the pathological changes of lymphoedema tissue Including chronic inflammation, tissue fibrosis and fatty deposition, should be included in the treatment target. To decrease the expression and prevent the function of the key inflammatory factor may be a new way for the treat of lymphedema.