Where do lymph and tissue fluid accumulate in lymphedema of the lower limbs caused by obliteration of lymphatic collectors?
Where do lymph and tissue fluid accumulate in lymphedema of the lower limbs caused by obliteration of lymphatic collectors?
复制标题
淋巴管闭塞引起的下肢淋巴水肿，淋巴液和组织液积聚在哪里？
作者：
W. Olszewski;P. J. G. Ambujam;M. Zaleska;M. Cakała
感染过程、创伤、肿瘤外科手术和照射导致肢体淋巴收集干的闭塞，导致组织中淋巴和组织液的潴留。对于合理的物理治疗来说，了解多余的淋巴在哪里产生并以组织液的形式积聚是必不可少的。到目前为止，这方面的知识是基于淋巴显像，超声和磁共振图像。这些模式都不能提供真皮、皮下和肌肉中扩张的淋巴管和液体扩张的组织空间的清晰图像。只有解剖解剖和活检材料的组织学处理才能显示淋巴网络的残余和流动组织液的积聚部位。我们可视化并计算了在淋巴水肿不同阶段的足、小腿和大腿的皮肤和皮下组织中的“组织液和淋巴”空间的体积，对在淋巴显微外科手术或组织减体积过程中获得的标本使用特殊的着色技术。当收集干被清除时，淋巴仅存在于皮下淋巴管中，而流动组织液积聚在皮下组织、小静脉周围和肌筋膜中自发形成的空隙中。皮下组织的变形由自由流体导致形成相互连接的通道。在收集器阻塞引起的阻塞性淋巴水肿中，淋巴主要存在于表皮下淋巴管，大量停滞的组织液积聚在纤维间隔和脂肪球之间以及肌肉筋膜上下的皮下。这些观察结果为设计气动装置和合理的手动淋巴按摩将停滞的组织液移动到非肿胀区域提供了有用的线索。
Obliteration of lymphatic collecting trunks of limbs by infective processes, trauma, oncologic surgery and irradiation bring about retention of lymph and tissue fluid in tissues. Knowledge as to where excess lymph is produced and accumulates as tissue fluid is indispensable for rational physical therapy. So far, this knowledge has been based on lymphoscintigraphic, ultrasonographic and MR images. None of these modalities provides distinct images of dilated lymphatics and fluid expanded tissue spaces in dermis, subcutis and muscles. Only anatomical dissection and histological processing of biopsy material can demonstrate the remnants of the lymphatic network and the sites of accumulation of mobile tissue fluid. We visualized and calculated the volume of the "tissue fluid and lymph" space in skin and subcutaneous tissue of foot, calf, and thigh in various stages of lymphedema, using special coloring techniques in specimens obtained during lymphatic microsurgical procedures or tissue debulking. When the collecting trunks were obliterated, lymph was present only in the subepidermal lymphatics, while mobile tissue fluid accumulated in the spontaneously formed spaces in the subcutaneous tissue, around small veins, and in the muscular fascia. Deformation of subcutaneous tissue by free fluid led to formation of interconnecting channels. In obstructive lymphedema caused by obliteration of collectors, lymph is present mainly in subepidermal lymphatics, and the bulk of stagnant tissue fluid accumulates in subcutis between fibrous septa and fat globules as well as above and underneath muscular fascia. These observations provide useful clues for designing pneumatic devices and rational manual lymphatic massage to move stagnant tissue fluid toward the non-swollen regions.