组织工程与重建外科杂志

组织工程与重建外科杂志 ›› 2025, Vol. 21 ›› Issue (1): 10-.

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颈部Ⅱ/Ⅲ区淋巴管/结－静脉分流术治疗阿尔茨海默病的初步临床疗效观察

  

  • 出版日期:2025-02-25 发布日期:2025-03-06

Preliminary clinical efficacy observation of lymphatic/lymph node-venous shunt surgery in cervical region Ⅱ/Ⅲ for the treatment of Alzheimer’s disease·

  • Online:2025-02-25 Published:2025-03-06

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摘要：

　目的　提出颈部Ⅱ/Ⅲ区淋巴管/结－静脉分流术，探讨此术式治疗阿尔茨海默病（AD）的原理及疗效。方法患者接受颈部Ⅱ/Ⅲ区淋巴管/结－静脉分流术，并分别于术前和术后1个月，应用认知评估量表，包括简易精神状态检查量表（MMSE）、蒙特利尔认知评估量表（MoCA）和神经精神量表（NPI）评估患者症状改善情况；采用PET-CT定量分析颅内Aβ蛋白含量改变情况；应用彩色多普勒超声测量受区颈内静脉的通畅度及附壁血栓形成情况。术后1个月内持续随访观察切口愈合问题，切口内有无积血积液，是否出现淋巴漏，有无麻醉术后谵妄，有无头痛及其他不适。结果本研究纳入 7例 AD 患者，其中男性 3例，女性 4例；平均年龄 65（57~71）岁；7例均为 AD 伴痴呆。术后 1个月与术前相比，患者MMSE改善0（-2，1）分，P=0.581；Moca改善0（-1，1），P=1.000； NPI（频率×严重程度）改善9（9，20）分，P=0.043；NPI照料者苦恼程度量表改善 2（2，6）分，P=0.026；彩色多普勒检测提示，术后颈内静脉回流通畅，无附壁血栓；术后患者均未出现不良反应。其中，3例患者术后1个月PET-CT检测，提示全脑Aβ蛋白含量平均减少12.3%。结论　本研究提出的颈部Ⅱ/Ⅲ区淋巴管/结－静脉分流术可对颅内淋巴回流的颅外段实现分流，促进颅内病理蛋白排出，减少颅内Aβ蛋白含量，改善患者临床症状。颈部Ⅱ/Ⅲ区淋巴管/结－静脉分流术将有望成为AD治疗的选择之一，推动AD外科
治疗发展。

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Abstract:

Preliminary clinical efficacy observation of lymphatic/lymph node-venous shunt surgery in cervical region Ⅱ/Ⅲ for the treatment of Alzheimer’s disease LI Ke1 ， WEN Ke1 ， AI Songtao2 ， YAN Jia3 ， WANG Haiya4 ， LI Zan5 ， LI Bin6 ， MIN Peiru1 ， MENG Xinxian1 ， WANG Xueqian1 ， HAN Chengyao1 ， SUN Yuhao1 ， LIU Jiaqi7 ， WU Jingshu1 ， WEI Yanxue1 ， SONG Xingqi1 ， ZHANG Yixin1 . 1 Department of Plastic and Reconstructive Surgery， Shanghai Ninth People’s Hospital， Shanghai
Jiao Tong University School of Medicine， Shanghai 200011， China；2 Department of Radiology， Shanghai Ninth People’s
Hospital， Shanghai Jiao Tong University School of Medicine， Shanghai 200011， China；3 Department of Anesthesiology， Shanghai Ninth People’s Hospital， Shanghai Jiao Tong University School of Medicine， Shanghai 200011， China；4 Department of Geriatrics， Shanghai Ninth People’s Hospital， Shanghai Jiao Tong University School of Medicine， Shanghai 200011， China；5 Department of Oncoplastic Surgery， Hunan Cancer Hospital， Changsha 410008， China；6 Department of OtorhinolaryngologyHead and Neck Surgery， Sichuan Provincial People's Hospital， Sichuan Academy of Medical Sciences， Chengdu 610041， China；7 Department of Burn and Plastic Surgery， Shanghai Ruijin Hospital， Shanghai Jiao Tong University School of Medicine， Shanghai 200025， China. Corresponding author： ZHANG Yixin （E-mail： zhangyixin6688@163.com）.
therapeutic principles and efficacy of this method in treating Alzheimer’s disease （AD）. Methods Patients underwent the
lymphatic/lymph node-venous shunt surgery in the cervical Ⅱ/Ⅲ region. Cognitive assessments， including the MMSE，MoCA， and NPI， were conducted before and one month after surgery to evaluate symptom improvement. PET-CT was used to
quantitatively analyze changes in intracranial Aβ protein levels. Color Doppler ultrasound was employed to measure the patency of the internal jugular vein and detect wall-adherent thrombus formation. Postoperative follow-up within one month included monitoring wound healing， hematoma or fluid accumulation， lymphatic leakage， postoperative delirium，headaches， and other discomforts. Results This study included 7 AD patients （3 males and 4 females） with an average age of 65（57-71） years. All patients had AD with dementia. Compared to preoperative scores， one month postoperatively， MMSE improved by 0（-2，1） points （P=0.581）， MoCA improved by 0（-1，1） points （P=1.000）， NPI （frequency× severity） improved by 9（9，20） points （P=0.043）， and NPI caregiver distress improved by 2（2，6） points （P=0.026）. Color Doppler ultrasound indicated patent internal jugular venous flow without wall-adherent thrombus. No adverse reactions were observed. Three patients underwent PET-CT one month postoperatively， showing an average reduction of 12.3% in whole-brain Aβ protein levels. Conclusion The proposed lymphatic/lymph node-venous shunt surgery in the cervical Ⅱ/Ⅲ region can divert the extracranial segment of intracranial lymphatic drainage， promote the clearance of pathological proteins， reduce intracranial Aβ protein levels， and improve clinical symptoms. This procedure may become a viable treatment option for AD， advancing the development of surgical interventions for AD.

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