nmpЖурнал им. Н.В. Склифосовского «Неотложная медицинская помощь»Russian Sklifosovsky Journal "Emergency Medical Care"2223-90222541-8017“N.V. Sklifosovsky Research Institute for Emergency Medicine”10.23934/2223-9022-2025-14-2-406-415nmp-2186Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEWSДиагностика и визуализация лимфатической системы в клинической практикеDiagnostics and Visualization of The Lymphatic System in Clinical Practicehttps://orcid.org/0000-0001-7802-4588РазумовскийВ. С.RazumovskyV. S.

Разумовский Вадим Сергеевич - ассистент кафедры госпитальной хирургии № 2 ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» МЗ РФ.

119435, Москва, ул. Большая Пироговская, д. 2, стр. 4

Vadim S. Razumovsky - Assistant of the Department of Hospital Surgery No. 2.

Bolshaya Pirogovskaya Str. 2, bldg. 4, Moscow, 119435

ernieball9@mail.ruhttps://orcid.org/0000-0002-1847-711XТарабринЕ. А.TarabrinE. A.

Тарабрин Евгений Александрович - доктор медицинских наук, заведующий кафедрой госпитальной хирургии № 2 ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» МЗ РФ.

119435, Москва, ул. Большая Пироговская, д. 2, стр. 4

Evgeny A. Tarabrin - Doctor of Medical Sciences, Head of the Department of Hospital Surgery No. 2.

Bolshaya Pirogovskaya Str. 2, bldg. 4, Moscow, 119435

tarabrin_e_a@staff.sechenov.ruhttps://orcid.org/0000-0002-1493-0351МуравьёвС. Ю.MuravyovS. Yu.

Муравьёв Сергей Юрьевич - доктор медицинских наук, профессор кафедры госпитальной хирургии № 2.

119435, Москва, ул. Большая Пироговская, д. 2, стр. 4

Sergey Yu. Muravyov - Doctor of Medical Sciences, Professor of the Department of Hospital Surgery No. 2.

Bolshaya Pirogovskaya Str. 2, bldg. 4, Moscow, 119435

muravev_s_yu@staff.sechenov.ruhttps://orcid.org/0000-0002-4335-3987БерикхановЗ. Г.BerikkhanovZ.G. M.

Берикханов Зелимхан Гези-Махмаевич - кандидат медицинских наук, доцент кафедры госпитальной хирургии № 2.

119435, Москва, ул. Большая Пироговская, д. 2, стр. 4

Zelimkhan G.M. Berikkhanov - Candidate of Medical Sciences, Associate Professor of the Department of Hospital Surgery No. 2., I.M. Sechenov First Moscow State Medical University (Sechenovskiy University).

Bolshaya Pirogovskaya Str. 2, bldg. 4, Moscow, 119435

berikkhanov_z_g@staff.sechenov.ruhttps://orcid.org/0009-0004-3964-6519КоносевичД. О.KonosevichD. O.

Коносевич Дарья Олеговна - студентка 6-го курса лечебного факультета, группа 701-12 ИКМ ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» МЗ РФ.

119435, Москва, ул. Большая Пироговская, д. 2, стр. 40

Darya O. Konosevich - 6th-grade Student, Faculty of Medicine, Group 701-12 ICM.

Bolshaya Pirogovskaya Str. 2, bldg. 4, Moscow, 119435

kono03.dar@yandex.ruФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» МЗ РФ (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenovskiy University), Department of Hospital Surgery No. 2Russian Federation202506092025142406415Copyright © Разумовский В.С., Тарабрин Е.А., Муравьёв С.Ю., Берикханов З.Г., Коносевич Д.О., 20252025Разумовский В.С., Тарабрин Е.А., Муравьёв С.Ю., Берикханов З.Г., Коносевич Д.О.Razumovsky V.S., Tarabrin E.A., Muravyov S.Y., Berikkhanov Z.M., Konosevich D.O.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jnmp.ru/jour/article/view/2186

Визуализация лимфатической системы в течение десятков лет ограничивалась лимфосцинтиграфией и чрессосудистой лимфангиографией под рентгеновским излучением. Данные методы не позволяют получить информацию о состоянии центральных крупных лимфатических коллекторах и сосудах.

Получение изображений центрального звена лимфатических путей при помощи рентгенологического исследования стало возможным благодаря введению контрастного вещества через лимфатический сосуд на стопе. Выраженная вариантная анатомия дистального лимфатического русла и технические сложности при выделении такого сосуда в хирургической ране затрудняют выполнение этих методов.

Применение техники интранодального введения контрастных веществ в лимфатическую систему вкупе с магнитно-резонансной томографией (МРТ) привело к разработке лимфангиографии с МРТ-динамическим контрастированием, которая обеспечивает исключительную возможность визуализации центральной лимфатической системы.

Ввиду физических свойств, в первую очередь вязкости контрастного вещества на масляной основе, визуализация центральной лимфатической системы может быть неадекватной без МРТ.

Также остаётся актуальным вопрос разработки надёжного способа доставки препарата в лимфатическое русло, что требует хирургического подхода к задаче. Роль лимфангиографии в качестве диагностического и лечебного метода до сих пор не определена. Большое число пациентов с хилотораксом и хилоперитонеумом (до 4% при торакальных вмешательствах) как ятрогенной, так и идиопатической этиологии (до 14%) делают лимфангиографию перспективным методом в лечении и диагностики с целью планирования доступа и объёма операции при неэффективности консервативного лечения.

For decades, imaging of the lymphatic system was limited to lymphoscintigraphy and transvascular lymphangiography with X-ray. These methods do not provide information on the state of the central large lymphatic collectors and vessels. Obtaining images of the central link of the lymphatic pathways using radiographic examination has become possible due to the introduction of a contrast agent through a lymphatic vessel in the foot. The pronounced variant anatomy of the distal lymphatic bed and the technical difficulties in isolating such a vessel in a surgical wound make it difficult to perform these methods.

Intranodal contrast injection combined with magnetic resonance imaging (MRI) has led to the development of dynamic contrast-enhanced MR lymphangiography, which provides exceptional imaging capabilities for the central lymphatic system.

Due to the physical properties, primarily the viscosity of the oil-based contrast agent, visualization of the central lymphatic system may be inadequate without MRI. The issue of developing a reliable method for delivering the drug to the lymphatic system also remains relevant, which requires a surgical approach to the task. The role of lymphangiography as a diagnostic and therapeutic method has not yet been determined. A large number of patients with chylothorax and chyloperitoneum (up to 4% in thoracic interventions) of both iatrogenic and idiopathic etiology (up to 14%) make lymphangiography a promising method in treatment and diagnosis for the purpose of planning access and volume of surgery when conservative treatment is ineffective.

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The authors declare that there are no conflicts of interest present.