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 (4): 362-.

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CDT  治疗乳腺癌相关Ⅲ期淋巴水肿疗效的机制研究

  

  • 出版日期:2025-08-01 发布日期:2025-09-08

Study on the mechanism of CDT in the treatment of breast cancer-related stage Ⅲ lymphedema （ICG） lymphography

  • Online:2025-08-01 Published:2025-09-08

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摘要：

目的 通过吲哚菁绿（Indocyanine green，ICG）淋巴造影可视化技术，探索手法引流综合消肿治疗（Complexdecongestive therapy，CDT）改善Ⅲ期乳腺癌相关淋巴水肿（Breast cancer-related lymphedema，BCRL）患者淋巴循环功能的疗效机制，揭示CDT促进淋巴回流重塑的生理学特征，为其临床应用提供理论依据。方法 采用前瞻性自身对照研究，纳入 27 例单侧Ⅲ期 BCRL 患者，实施 20 次精准化 CDT 治疗。在治疗前后通过 ICG 淋巴造影定量分析淋巴管形态（显影数量）及功能（显影范围动态变化），同步监测患肢周径（反映组织液积聚程度）与生物电阻抗法水分含量（反映细胞外液分布情况），构建“结构-功能-临床症状”的多维度评估体系，解析CDT治疗对淋巴系统的调控效应。结果 ICG影像结果显示，本组中有 18.5% 患者存在手心异常淋巴交通支。经 CDT 治疗后，淋巴管显影率显著提升 18.5%（至70.4%，P=0.016），且显影范围在造影剂注射后即刻、5 min、15 min分别扩大196.8%、138.2%和84.4%（P＜0.001）；同时，患肢周径差异率与水分差异率分别下降69.1%和66.6%（P<0.001），呈现“早期（1～2周）快速减轻液体积聚、后期（3～4周）淋巴功能重塑平台期”的双相特征。结论 CDT综合消肿治疗通过双重机制改善Ⅲ期BCRL：一方面加速组织间液清除以减轻水肿负荷，另一方面促进淋巴管结构修复与功能增强（如显影率提升、引流范围扩大），呈现代偿性引流途径，最终实现淋巴系统形态与功能的协同改善。ICG淋巴造影可动态捕捉这一重塑过程，为阐明CDT疗效机制提供可视化证据，同时可指导精准化治疗实施，证明其在淋巴循环调控研究中具有重要价值。

关键词:

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.

Key words:

upper limb lymphedema