背景：胸导管是全身淋巴液回流至静脉系统的主要通道。胸导管阻塞、狭窄等病变，可能影响全身淋巴液回流。下肢继发淋巴水肿多见于妇科肿瘤或膀胱癌患者，常继发于盆腔淋巴结清扫及放疗后。胸导管异常与下肢继发淋巴水肿的病变进展是否存在相关性，目前尚无研究。本文将就此进行探讨。

方法：应用超声评估下肢继发淋巴水肿患者胸导管走行、直径、通畅度，与淋巴水肿进展情况进行相关性分析。Inbody体成分分析仪评估病变肢体及健测淋巴液沉积情况。

结果：北京协和医院2015年09月至2017年01月共14名下肢淋巴水肿的患者纳入本研究。14名淋巴水肿患者中胸导管超声正常6名，胸导管异常的患者为8名。胸导管异常组患者起病至水肿加重平均年限为2.18±1.19年，对比胸导管正常组为8.33±2.10年，具有明显的统计学差异（P<0.05）；胸导管异常组患者中有3位患者在随访期内再次入院治疗，而随访期内无胸导管正常组患者再次入院治疗。

结论：胸导管阻塞或者狭窄可加快下肢淋巴水肿患者的病程进展，并影响淋巴-静脉吻合术后恢复，增加再次入院的风险。

Objective: The thoracic duct (TD) is the main channel for the return of whole body lymph fluid to the venous system. The obstruction or narrow of the TD may affect the lymph fluid reflux. The lymphedema of the lower extremity is more common in the patients with gynecological tumors or bladder cancer, often secondary to pelvic lymph node dissection and radiotherapy. There is no study to confirm the relationship between the thoracic duct abnormalities and the progression of the secondary lymphedema of the lower extremities. The article will discuss this point.

Methods: Ultrasound was used to evaluate the thoracic duct walking, diameter, and patency of patients with secondary lymphedema of the lower extremities, which to analyze the correlation with the progression of the lymphedema.  The Inbody composition analyzer was used to evaluate the lesioned limbs and to assess the lymphatic deposition.

Results: The study included 14 patients diagnosed lower extremity lymphedema from September 2015 and September 2017 at Peking Union Medical College Hospital, of whom 6 were belonged to the TD normal group and eight patients in TD abnormality group. The average duration of disease in the TD abnormality group was 2.18±1.19 years but the another group was 8.33±2.10 years with the significant statistical difference (P=0.02). Three of eight patients in the TD abnormality group received second operation during the follow-up period, and no one return to ward in the TD normal group.

Conclusion: Obstruction or narrow of the thoracic duct for the patients with the lower extremity lymphedema will accelerate the progression of the disease and effect the clinical effectiveness after operation.