总论 各论淋巴介入的未来
返回首页

淋巴介入的未来

时间:2021-01-12 23:16来源:未知 作者:Mr.Editor
淋巴介入:未来 Lymphatic Interventions-Future 将导管进入胸导管,这一前所未有的技术,除了带来有关淋巴管疾病的新认识和新疗法,也给人们一些想象的空间,淋巴介入也许可以走的更远,包括 胸导管外引流 Externalization of the Thoracic Duct Gut-Lung s

淋巴介入:未来


Lymphatic Interventions-Future

将导管进入胸导管,这一前所未有的技术,除了带来有关淋巴管疾病的新认识和新疗法,也给人们一些想象的空间,淋巴介入也许可以走的更远,包括


胸导管外引流 Externalization of the Thoracic Duct

 
  • Gut-Lung syndrome
  • TD fluid sampling/harvesting
  • T-Cell depletion therapy

有人总结了20年来154篇文件,描述经由淋巴介入治疗的各类疾病,很多都不是我们先前栏目中介绍过得

 

Wang, H.-W., Escott, A. B. J., Phang, K. L., Petrov, M. S., Phillips, A. R. J., & Windsor, J. A. (2016). Indications, techniques, and clinical  outcomes of thoracic duct interventions in patients: a forgotten literature? The Journal of Surgical Research, 204(1), 213–227.
 


这是1950-2014年(每5年一个时期)淋巴介入在器官移植、器官衰竭,自身免疫性疾病和包括胰腺炎、肿瘤、感染、结核和梗阻性黄疸的其它应用

从文献分布角度看,为什么我们当时几乎会把包括胸导管介入给忘了?
  • 主要是对淋巴解剖缺乏理解Lack of understanding of the lymphatic anatomy
    - 不是所有的淋巴液被引流 Not all of the lymphatic fluid is drained
     
  • 外科技术复杂和困难 Complex and inconvenient surgical technique
外科手术外引流
Wang, H.-W., Escott, A. B. J., Phang, K. L., Petrov, M. S., Phillips, A. R. J., & Windsor, J. A. (2016). Indications, techniques, and clinical  outcomes of thoracic duct interventions in patients: a forgotten literature? The Journal of Surgical Research, 204(1), 213–227

外科外引流手术
Wang, H.-W., Escott, A. B. J., Phang, K. L., Petrov, M. S., Phillips, A. R. J., & Windsor, J. A. (2016). Indications, techniques, and clinical  outcomes of thoracic duct interventions in patients: a forgotten literature? The Journal of Surgical Research, 204(1), 213–227

Variation of the Thoracic Duct
 
   

胸导管变异给传统的淋巴外引流带来更大的困难




而介入技术的发展,给淋巴介入带来技术上的便利

导丝圈套技术
圈套器经贵要静脉入路,进入锁骨下静脉的静脉角 圈套器抓住经胸导管出静脉角的0.018导丝,形成through-through通路



根据栓塞或覆膜支架释放需求不同,经导丝可以引入4-6Fr血管鞘 经血管鞘可以引入不同直径的导管进行胸导管栓塞,支架或外引流


胸导管外引流

   

先天性淋巴管发育不良胸导管外引流前后
引流前 引流后


下面是胸导管外引流治疗的另外一种病

肠-肺综合征 Gut-Lung syndrome

(包括百度、yahoo 和 google 未搜索到这个词,姑且暂用它吧)



Dugernier T, G, et al. Prospective evaluation of thoracic-duct  drainage in the treatment of respiratory failure complicating  severe acute pancreatitis. Intens Care Med. 1989

  • 10 patients
  • TD lymph drainage led to a clinical improvement of abdominal pain, peritonitis,  and shock
  • Larger volumes of TD lymph drained correlated with the greater clinical improvement

Brzek V, et al. Therapeutic effect of the prolonged thoracic duct  lymph fistula in patients with acute pancreatitis. Digestion. 1969

 
  • 12 patients
  • TD lymph drainage improved gas exchange in patients with respiratory impairment  or acute respiratory distress syndrome (ARDS) secondary to acute pancreatitis
  • Arterial oxygenation began to improve as soon as TD lymph drainage was started



慢性心衰的胸导管外引流(淋巴减压)
Lymphatic Decompression in Congestive Heart  Failure

WITTE, M. H., DUMONT, A. E., Clauss, R. H., RADER, B., LEVINE, N., & BREED, E. S. (1969). Lymph
Circulation in Congestive Heart Failure, 39(6), 723–733. http://doi.org/10.1161/01.CIR.39.6.723
 

T细胞消耗(减少)治疗

T Cell Depletion Therapy

 

长期引流的TD淋巴结导致严重的细胞免疫抑制

Prolong drainage of the TD lymph results in  profound cellular immunosuppression
  • 应用于器官移植 Organ transplantation
                         - 显著改善急性器官排异反应 Significantly improved the or acute organ rejection
                         - 不影响长期生存 No effect on long term survival
  • 显著临床改善下列患者 Marked clinical improvement in patients with:
                         - 严重顽固的风湿性关节炎 severe refractory rheumatoid arthritis
                         - 系统性红斑狼疮 systemic lupus erythematosus
                         - 硬皮病 scleroderma
  • 下列患者临床某些改善 Some improvement in patients with:
                         - 血管球性肾炎 glomerulonephritis
                         - 多肌炎 polymyositis
                         - 假麻痹性重症肌无力 myasthenia gravis
                         - 多发硬化 multiple sclerosis
 
Wang, H.-W., Escott, A. B. J., Phang, K. L., Petrov, M. S., Phillips, A. R. J., & Windsor, J. A. (2016). Indications, techniques, and clinical  outcomes of thoracic duct interventions in patients: a forgotten literature? The Journal of Surgical Research, 204(1), 213–227.


癌免疫治疗 CAR-T Cell Cancer Immune Therapy

Lim WA, June CH. The Principles of Engineering Immune Cells to Treat Cancer.Cell. 2017 Feb 9;168(4):724-740

未来
MRL and  Lymphatic  Embolization
慢性支气管炎 Chronic Bronchitis
间质性肺疾病 Interstitial Lung Disease
支气管肺发育异常 Bronchopulmonary Dysplasia
Liver Lymphatic  Embolization
心源性腹水 Cardiac Ascities
肝硬化腹水 Liver Cirrhosis Ascities
Thoracic Duct  Externalization
心衰 Heart Failure
肠-肺综合征 Gut-Lung syndrome
免疫治疗 (car T cell) Immunotherapy (car T cell)
消耗T细胞治疗  T cell depletion therapy
Development of  the new  lymphatic  imaging agents Liver lymphatic Imaging
Intestinal Lymphatic Imaging

顶一下
(0)
0%
踩一下
(0)
0%
------分隔线----------------------------
  • 上一篇:没有了
  • 下一篇:没有了
推荐内容
热点内容