组织工程与重建外科杂志2025，Vol.21Issue(4)：362-368,7.DOI:10.3969/j.issn.1673-0364.2025.04.006
CDT治疗乳腺癌相关Ⅲ期淋巴水肿疗效的机制研究
Study on the mechanism of CDT in the treatment of breast cancer-related stage Ⅲ lymphedema
摘要
Abstract
Objective To explore the therapeutic mechanism of complex decongestive therapy(CDT)in improving lymphatic circulation function in patients with stage Ⅲ breast cancer-related lymphedema(BCRL)through indocyanine green(ICG)lymphography visualization technology,reveal the biological characteristics of CDT promoting lymphatic reflux remodeling,and provide a theoretical basis for its clinical application.Methods A prospective self-controlled study was conducted,enrolling 27 patients with unilateral stage Ⅲ BCRL who received 20 sessions of precision CDT.Before and after treatment,ICG lymphography was used to quantitatively analyze lymphatic vessel morphology(number of visualized vessels)and function(dynamic changes in visualization range).Meanwhile,the circumference of the affected limb(reflecting tissue fluid accumulation)and water content via bioelectrical impedance(reflecting extracellular fluid distribution)were monitored.A multi-dimensional evaluation system of"structure-function-clinical symptoms"was constructed to analyze the regulatory effect of CDT on the lymphatic system.Results ICG typing showed that 18.5%of patients had abnormal palmar lymphatic communicating branches,indicating potential compensatory drainage pathways in stage Ⅲ BCRL.After CDT,the visualization rate of lymphatic vessels significantly increased by 18.5%(to 70.4%,P=0.016),and the visualization range expanded by 196.8%,138.2%,and 84.4%immediately,5 minutes,and 15 minutes after contrast injection,respectively(all P<0.001),suggesting improved structural integrity and active drainage capacity of lymphatic vessels.Meanwhile,the circumference difference rate and water difference rate of the affected limb decreased by 69.1%and 66.6%,respectively(all P<0.001),showing a biphasic pattern:"rapid reduction of fluid accumulation in the early stage(Weeks 1-2)and a platform period of lymphatic function remodeling in the later stage(Weeks 3-4)".This confirms the sequential effect of CDT,which first relieves tissue edema and then promotes the reconstruction of lymphatic circulation homeostasis.Conclusion CDT improves stage Ⅲ BCRL through a dual mechanism:on the one hand,it accelerates the clearance of interstitial fluid to reduce edema load;on the other hand,it promotes the repair of lymphatic vessel structure and enhancement of function(e.g.,increased visualization rate and expanded drainage range),presenting compensatory drainage pathways.Ultimately,it achieves the synergistic improvement of the structure and function of the lymphatic system.ICG lymphography can dynamically capture this remodeling process,providing visual evidence for clarifying the therapeutic mechanism of CDT,and guiding the implementation of precision CDT,highlighting its important value in studying lymphatic circulation regulation.关键词
乳腺癌相关淋巴水肿/手法引流综合消肿治疗/ICG淋巴造影/继发性上肢淋巴水肿Key words
Breast cancer-related lymphedema/Complex decongestive therapy/ICG lymphography/Secondary upper limb lymphedema分类
医药卫生引用本文复制引用
高敏哲,于子优,汪立,陈佳佳,韩凌华,沈添怡,韩冬..CDT治疗乳腺癌相关Ⅲ期淋巴水肿疗效的机制研究[J].组织工程与重建外科杂志,2025,21(4):362-368,7.基金项目
上海市重中之重研究中心-上海市整形外科研究中心(2023ZZ02023). （2023ZZ02023）
