Mortimer P S
Department of Physiological Medicine (Dermatology), St. George's Hospital Medical School, London, United Kingdom.
Cancer. 1998 Dec 15;83(12 Suppl American):2798-802. doi: 10.1002/(sici)1097-0142(19981215)83:12b+<2798::aid-cncr28>3.3.co;2-5.
All edemas result from an imbalance between capillary filtration and tissue (lymph) drainage. This basic approach was adopted to investigate mechanisms for chronic arm edema following breast carcinoma treatment.
A review of causes of lymphedema is presented plus the traditional pathophysiology of breast carcinoma related lymphedema (postmastectomy edema; PME). A summary of recent research that explored capillary filtration as a surrogate for lymph flow in the steady state is presented.
A reduced interstitial protein concentration (relative to plasma) argues against lymphatic obstruction. Evidence exists that total arm blood flow (in some patients) and vascular bed size are increased in PME.
The primary insult to the axillary lymphatic system by surgery and radiotherapy presumably is the root cause of PME; however, there is strong evidence to suggest that hemodynamic factors are contributory to the chronic swelling.
所有水肿均由毛细血管滤过与组织（淋巴）引流之间的失衡所致。采用这一基本方法来研究乳腺癌治疗后慢性手臂水肿的机制。
介绍了淋巴水肿的病因以及与乳腺癌相关的淋巴水肿（乳房切除术后水肿；PME）的传统病理生理学。总结了近期将毛细血管滤过作为稳态下淋巴流动替代指标的研究。
间质蛋白浓度相对于血浆降低表明不存在淋巴阻塞。有证据表明，PME患者的手臂总血流量（部分患者）和血管床大小增加。
手术和放疗对腋窝淋巴系统的原发性损伤可能是PME的根本原因；然而，有强有力的证据表明血流动力学因素导致了慢性肿胀。
