Roberts C C, Stanton A W, Pullen J, Bull R H, Levick J R, Mortimer P S
Department of Physiological Medicine, St. George's Hospital Medical School, London, UK.
Int J Microcirc Clin Exp. 1994 Nov-Dec;14(6):327-34. doi: 10.1159/000178851.
Breast cancer treatment often causes chronic arm oedema. Oedema depends on the balance between microvascular filtration and lymph drainage, but little is known about the microvessels in postmastectomy oedema (PMO). We investigated cutaneous capillary density in PMO, since capillary density is one of the factors influencing fluid load on the lymphatic system. Video-capillaroscopy allows the skin microcirculation to be examined in vivo and recorded for later analysis. Patient arm volumes, measured optoelectronically, increased by 30 +/- 13%. The forearm skin of each arm was examined in 7 normal subjects (mean age 22 years) and 15 PMO patients (mean age 61 years). Native capillaroscopy was found to underestimate capillary density. Venous congestion increased the number of capillaries detected by native capillaroscopy by 26-28%. Fluorescein detected 19-27% more capillaries than native capillaroscopy. Using fluorescein, no significant difference in mean capillary density was found between the right (50 mm-2) and left (48 mm-2) arms of normal subjects (p = 0.53). Surprisingly, cutaneous capillary density in the swollen arm (33 mm-2) was not significantly less than in nonswollen arms (35 mm-2) of patients, despite a mean 14% increase in skin area. Capillary density decreased significantly with age. Relative to the volume and area changes, the density results indicated that cutaneous neovascularization had occurred in the swollen arm.
乳腺癌治疗常常会导致慢性手臂水肿。水肿取决于微血管滤过和淋巴引流之间的平衡，但对于乳房切除术后水肿（PMO）中的微血管情况却知之甚少。我们对PMO中的皮肤毛细血管密度进行了研究，因为毛细血管密度是影响淋巴系统液体负荷的因素之一。视频毛细血管显微镜检查可在体内检查皮肤微循环并进行记录以供后续分析。通过光电测量，患者手臂体积增加了30±13%。对7名正常受试者（平均年龄22岁）和15名PMO患者（平均年龄61岁）的每只手臂的前臂皮肤进行了检查。发现传统毛细血管显微镜检查会低估毛细血管密度。静脉充血使传统毛细血管显微镜检查检测到的毛细血管数量增加了26%至28%。荧光素检测到的毛细血管比传统毛细血管显微镜检查多19%至27%。使用荧光素时，正常受试者的右臂（50mm²）和左臂（48mm²）之间的平均毛细血管密度没有显著差异（p = 0.53）。令人惊讶的是，尽管患者肿胀手臂的皮肤面积平均增加了14%，但其肿胀手臂的皮肤毛细血管密度（33mm²）并不显著低于未肿胀手臂（35mm²）。毛细血管密度随年龄显著降低。相对于体积和面积的变化，密度结果表明肿胀手臂中发生了皮肤新血管形成。
