Lymphedema: responding to our patients' needs.
Lymphedema: responding to our patients' needs.
复制标题
淋巴水肿：满足患者的需求。
DOI：
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发表时间：
2004
影响因子：
1.9
通讯作者：
Esther Muscari
中科院分区：
文献类型：
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作者：
Esther Muscari
905淋巴水肿在每个可能的圈子里——从医疗保健提供者到有风险的患者——都被极大地误解了。淋巴水肿是淋巴系统受损导致的间质组织中过量水分、间质液、血浆蛋白、细菌和细胞废物的集合（Cheville, McGarvey, Petrek, Russo, Taylor, et al., 2003; International Society of lymph [ISL], 2003）。90%的间质液由循环系统排出，剩下的10%由淋巴管排出（Ridner， 2002年）。淋巴系统遍及我们每个人。它开始是皮肤表面下的一个细网络，然后会聚成组织深处的大血管。来自下肢的液体通过胸导管向上流动，流入腹部，并受到膈压力的影响。淋巴液通过淋巴结床向上移动，并在上腔静脉入口进入血管系统。液体交换发生在毛细血管-间质淋巴管界面。液体交换需要血液循环、组织通道、组织中的蛋白水解细胞和初始淋巴。这些“系统”中的每一个都与其他系统相互作用并调节以保持细胞外和细胞内环境。肌肉收缩、呼吸和外部压力变化导致淋巴液从组织中泵送和填充，通过内皮细胞连接处之间的许多开口进入初始淋巴管，而内皮细胞连接处又连接到集合淋巴管或淋巴管。淋巴流向心脏，有许多淋巴-静脉交通，包括胸管和右淋巴管，以及颈部的大静脉。
905 L ymphedema is greatly misunderstood in every possible circle—from healthcare providers to patients at risk. Lymphedema is a collection of excess water, interstitial fluid, plasma proteins, bacteria, and cellular waste products in the interstitial tissues as a result of an impaired lymphatic system (Cheville, McGarvey, Petrek, Russo, Taylor, et al., 2003; International Society of Lymphology [ISL], 2003). Ninety percent of interstitial fluid is removed by the circulatory system with the remaining 10% managed by the lymphatic vessels (Ridner, 2002). The lymphatic system is extensive throughout each of us. It begins as a fine network just under the skin surface and converges to become larger vessels deeper in the tissue. Fluid from the lower extremities moves up through the thoracic duct, running up the abdomen, and is affected by diaphragmatic pressures. Lymphatic fluid moves up through the nodal beds and dumps into the vascular system at the entrance of the superior vena cava. Fluid exchange occurs at the blood capillary-interstitiallymphatic vessel interface. Fluid exchanges requires blood circulation, tissue channels, proteolytic cells in the tissues, and initial lymphatics. Each of these “systems” interacts with and regulates the others to preserve the extracellular and intracellular environments. Muscular contractions, respiration, and external pressure changes cause pumping and filling of lymph fluid from the tissue into the initial lymphatics via the many openings between the endothelial cell junctions, which, in turn, connect to collecting lymphatics or lymph angions. Lymphatic flow proceeds in the direction of the heart with numerous lymph-venous communications, including the thoracic duct and right lymph duct, with the great veins of the neck.