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Phlebologie 2021; 50(02): 135-140
DOI: 10.1055/a-1389-0540
Schwerpunktthema

Lymphstase und Fettgewebshypertrophie – Pathophysiologische Zusammenhänge und therapeutische Optionen

Lymphatic stasis and adipose tissue hypertrophy – Pathophysiological relationships and therapeutical options
Gabriele Faerber
  Zentrum für Gefäßmedizin, Hamburg
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Zusammenfassung

Angeborene oder erworbene, iatrogene, traumatische oder postinfektiöse Störungen des Lymphabflusses führen aufgrund der Lymphstase im Laufe der Zeit zu Gewebeveränderungen wie Fibrosierung und vermehrter lokaler Fettgewebebildung. Häufig kommt es hierdurch zu einer extremen Volumenzunahme der betroffenen Extremität, die nicht durch das Lymphödem allein, sondern vor allem durch die massive Fettgewebshypertrophie bedingt ist. Lymphgefäße und Lymphknoten sind immer in Fettgewebe eingebettet. Dieses perilymphatische Fettgewebe ist essenziell für die lymphatische wie auch immunologische Funktion des Lymphsystems, da das Lymphsystem Fettsäuren als primäre Energiequelle nützt. Kommt es nach Lymphadenektomie und/oder Unterbrechung von Lymphgefäßen zur Lymphstase in der betroffenen Extremität, signalisiert diese einen gesteigerten Energiebedarf für die notwendige Immunantwort und die chronische Inflammation verursacht eine Überstimulation der Fettgewebsproliferation, um ausreichend Energie zur Verfügung stellen zu können. In der Folge kommt es zu weiteren pathophysiologischen Veränderungen, die die Drainagefunktion und damit die Lymphstase weiter verschlechtern. Es hat sich ein Circulus vitiosus aus Lymphstase, Fettgewebsproliferation und Fibrosierung entwickelt.

Da die komplexe Entstauungstherapie diesen Zustand allein nicht wesentlich verbessern kann, kommen therapeutisch zusätzliche gewebereduzierende operative Verfahren, in erster Linie die Liposuktion, ggf. in Kombination mit mikrochirurgischen Operationstechniken, zum Einsatz.

Abstract

Congenital or acquired disruptions of the lymphatic circulation due to trauma, surgery or infection, cause lymphatic stasis which leads in time to tissue changes like fibrosis and enhanced local adipogenesis. Thus, the extreme increase in volume of the affected extremity is not caused by lymphoedema alone, but by the massive lipohypertrophy induced by it. Lymphatic vasculature and lymph nodes are always embedded in adipose tissue. The perilymphatic adipose tissue is essential for the lymphatic drainage as well as for the immune function of the lymphatic vasculature, because it uses fatty acids as its primary source of energy. Lymphatic stasis after lymphadenectomy or disruption of the lymphatics signals an enhanced energy demand for the necessary immune response. The resulting chronic inflammation causes overstimulation of adipocyte proliferation to provide enough energy. Consecutively more pathophysiological changes occur which in turn further impair lymph drainage and so lymphatic stasis. A vicious circle of lymph stasis, proliferation of adipose tissue and fibrosis results.

Schlüsselwörter

Lymphödem - Fettgewebshypertrophie - Inflammation - Fibrose - Liposuktion

Key words

lymphoedema - adipose tissue hypertrophy - inflammation - fibrosis - liposuction


Publication History

Article published online:
04 March 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
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