Jensen Mads R, Simonsen Lene, Karlsmark Tonny, Bülow Jens
Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, University Hospital of Copenhagen, Copenhagen NV, Denmark.
Clin Physiol Funct Imaging. 2010 Nov;30(6):389-98. doi: 10.1111/j.1475-097X.2010.00969.x. Epub 2010 Aug 16.
Lymphoedema of the lower extremities is a chronic debilitating disease that is often underdiagnosed. Early diagnosis and treatment is paramount in reducing the risk of progression and complications. Lymphoedema has traditionally been defined as interstitial oedema and protein accumulation because of a defect in the lymphatic drainage; however, some findings suggest that the interstitial protein concentration may be low in some types of lymphoedema. Primary lymphoedema is caused by an inherent defect in the lymphatic vessels or lymph nodes. Secondary lymphoedema is caused by damages to the lymphatic system most often caused by cancer or its treatment. Many of the underlying pathophysiological mechanisms have yet to be elucidated. Many methods have been developed for examination of the lymphatic system. Lymphoscintigraphy is presently the preferred diagnostic modality. Lack of consensus regarding protocol and qualitative interpretation criteria results in a too observer dependent outcome. Methods for objectifying the scintigraphy through quantification have been criticized. Depot clearance rates are an alternative method of quantification of lymphatic drainage capacity. This method however has mostly been applied on upper extremity lymphoedema. The aim of this review is to provide a literature-based overview of the aetiology and pathophysiology of lower extremity lymphoedema and to summarize the current knowledge about lymphoscintigraphy and depot clearance techniques. The abundance of factors influencing the outcome of the examination stresses the need for consensus regarding examination protocols and interpretation. Further studies are needed to improve diagnostic performance and understanding of pathophysiological mechanisms.
下肢淋巴水肿是一种慢性致残性疾病，常常未得到充分诊断。早期诊断和治疗对于降低病情进展及并发症风险至关重要。传统上，淋巴水肿被定义为由于淋巴引流缺陷导致的间质水肿和蛋白质积聚；然而，一些研究结果表明，在某些类型的淋巴水肿中，间质蛋白浓度可能较低。原发性淋巴水肿由淋巴管或淋巴结的先天性缺陷引起。继发性淋巴水肿则由淋巴系统受损所致，最常见的原因是癌症或其治疗。许多潜在的病理生理机制尚未阐明。已经开发出多种用于检查淋巴系统的方法。淋巴闪烁造影目前是首选的诊断方式。关于检查方案和定性解释标准缺乏共识，导致结果过于依赖观察者。通过量化使闪烁造影客观化的方法受到了批评。储库清除率是量化淋巴引流能力的另一种方法。然而，这种方法大多应用于上肢淋巴水肿。本综述的目的是基于文献对下肢淋巴水肿的病因和病理生理学进行概述，并总结当前关于淋巴闪烁造影和储库清除技术的知识。影响检查结果的因素众多，这凸显了在检查方案和解释方面达成共识的必要性。需要进一步研究以提高诊断性能并增进对病理生理机制的理解。
