颈深淋巴结静脉吻合术治疗阿尔茨海默病的短期效果研究  

Short-term outcome study on cervical deep lymph node-venous anastomosis technique in the treatment of Alzheimer’s disease

作　　者：甘承 孔征东 冉小叶 乔淑冬 章一新[3] 岳璐 王英杰 毕会 杨冬 马红彤 陈媛 柴红丽 贾莹 马辰浩 陈子翔 李科[3] 汪淼 薛立果 赵思文 文科 尹琳 丁波 朱珊 刘元波 臧梦青 Gan Cheng;Kong Zhengdong;Ran Xiaoye;Qiao Shudong;Zhang Yixin;Yue Lu;Wang Yingjie;Bi Hui;Yang Dong;Ma Hongtong;Chen Yuan;Chai Hongli;Jia Ying;Ma Chenhao;Chen Zixiang;Li Ke;Wang Miao;Xue Liguo;Zhao Siwen;Wen Ke;Yin Lin;Ding Bo;Zhu Shan;Liu Yuanbo;Zang Mengqing(Scar and Wound Treatment Department,Plastic Surgery Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100144,China;Neurology Department,Plastic Surgery Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100144,China;Plastic Surgery Department,Ninth People’s Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200011,China;Research Ward,Plastic Surgery Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100144,China;Internal Medicine Department,Plastic Surgery Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100144,China;Anesthesiology Department,Plastic Surgery Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100144,China;Operating Room,Plastic Surgery Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100144,China;Post-Anesthesia Care Unit,Plastic Surgery Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100144,China;Ultrasonography Department,Plastic Surgery Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100144,China;Neurosurgery Department,Longkou Nanshan Wellness Valley Cancer Hospital,Longkou 265700,China;Medical Affairs Office,Plastic Surgery Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100144,China;Patient-Physician Relations Office,Plastic Surgery Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100144,China)

机构地区：[1]中国医学科学院北京协和医学院整形外科医院瘢痕与创面治疗科,北京100144 [2]中国医学科学院北京协和医学院整形外科医院神经内科,北京100144 [3]上海交通大学医学院附属第九人民医院整复外科,上海200011 [4]中国医学科学院北京协和医学院整形外科医院研究型病房,北京100144 [5]中国医学科学院北京协和医学院整形外科医院内科,北京100144 [6]中国医学科学院北京协和医学院整形外科医院麻醉科,北京100144 [7]中国医学科学院北京协和医学院整形外科医院手术室,北京100144 [8]中国医学科学院北京协和医学院整形外科医院麻醉恢复室,北京100144 [9]中国医学科学院北京协和医学院整形外科医院超声科,北京100144 [10]龙口南山养生谷肿瘤医院神经外科,龙口265700 [11]中国医学科学院北京协和医学院整形外科医院医务处,北京100144 [12]中国医学科学院北京协和医学院整形外科医院医患办,北京100144

出　　处：《中华整形外科杂志》2025年第2期130-143,共14页Chinese Journal of Plastic Surgery

基　　金：北京市卫健委北京市研究型病房示范建设单位项目(BCRW202202)。

摘　　要：目的探讨颈深淋巴结静脉吻合术治疗阿尔茨海默病(AD)患者的短期临床效果。方法选择2024年9至10月于中国医学科学院整形外科医院瘢痕与创面治疗科应用颈深淋巴结静脉吻合技术治疗的AD患者进行前瞻性探索性研究。术前使用高频超声定位颈深淋巴结及颈外静脉。患者在全身麻醉下接受双侧颈深淋巴结静脉吻合术:通过耳后皮下注射吲哚菁绿进行淋巴造影,确定Ⅱ区及Ⅲ区淋巴结的显影情况;沿胸锁乳突肌后缘切开皮肤后,暴露颈外静脉、颈内静脉及Ⅱ、Ⅲ区淋巴结,并选择邻近静脉采用显微外科技术完成端侧或端端吻合。术前评估包括:简明智能精神状况检查量表(MMSE),得分越高表示认知功能越好;AD评估量表-认知分量表(ADAS-Cog),得分越高表示认知功能损害越大;AD协作研究组日常活动量表(ADCS-ADL),得分越高表示日常生活能力越好;神经精神问卷(NPI),得分越高表示行为和情绪症状越严重。术后进行相同量表检测,观察认知功能、生活自理能力和神经精神症状的变化。结果共纳入4例AD患者,男1例,女3例,年龄58~79岁,病程均超过2年,通过脑脊液特异性生物标志物确诊。所有患者均成功完成双侧颈深淋巴结静脉吻合术,平均每例患者完成4.3个淋巴结静脉吻合(2~7个/例)。手术时长平均6.5 h(5.5~8.5 h),术中出血量少(均少于50 ml)。术后6 h患者恢复正常饮食并下床活动,平均住院时间为4.1 d(3.5~5.0 d)。术后并发症包括坠积性肺炎1例,下肢肌间静脉血栓1例,一过性谵妄1例,均经治疗或观察后痊愈,无不良影响。患者术后记忆力减退、情绪波动及焦虑等症状均有不同程度改善。患者及家属报告生活质量提高,情绪稳定性和社交能力增强,证实该手术具有安全性及潜在认知改善效果。随访1个月时,神经心理学评估结果显示,4例患者MMSE评分较术前平均增加0.8分,2例完成了ADAS-Cog评价的�ObjectiveTo explore the short-term clinical effects of deep cervical lymph node-venous anastomosis in the treatment of Alzheimer’s disease(AD).MethodsA prospective exploratory study was conducted on the treatment of AD patients using the cervical deep lymph node-venous anastomosis technique in Scar and Wound Treatment Department,Plastic Surgery Hospital,Chinese Academy of Medical Sciences,from September to October 2024.The patients underwent high-frequency ultrasound to locate deep cervical lymph nodes and the external jugular vein.Under general anesthesia,bilateral deep cervical lymph node-venous anastomoses were performed.Indocyanine green(ICG)lymphography was conducted via subcutaneous injection behind the ear to visualize lymph nodes in levelsⅡandⅢ.After making a skin incision along the posterior margin of the sternocleidomastoid muscle,the external jugular vein,internal jugular veins,and associated lymph nodes were exposed.Adjacent veins were selected for anastomosis of lymph node.Using microsurgical techniques,end-to-side or end-to-end anastomosis was completed for lymph nodes in levelsⅡandⅢ.Preoperative assessments included the mini-mental state examination(MMSE,a higher score indicates better cognitive function),Alzheimer’s disease assessment scale-cognitive subscale(ADAS-Cog,a higher score indicates greater impairment of cognitive function),Alzheimer’s disease cooperative study scale for activities of daily living(ADCS-ADL,a higher score indicates better ability to perform daily activity),and neuropsychiatric inventory(NPI,a higher score indicates more severe behavioral and emotional symptom).Postoperative follow-up included the same scales to observe changes in cognitive function,activities of daily living,and emotional communication.ResultsFour patients(1 male,3 females,aged 58-79 years)with AD were included.All were diagnosed based on cerebrospinal fluid biomarkers.All patients successfully underwent bilateral deep cervical lymph node-venous anastomoses.On average,4.3(2-7 per person)anas

关 键 词：阿尔茨海默病 颈深淋巴结 淋巴结静脉吻合术 认知障碍 外科治疗 

分 类 号：R73[医药卫生—肿瘤]