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Physiologie de la circulation lymphatique

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Résumé

La circulation lymphatique, le sang et le milieu interstitiel divisent le pool liquidien extracellulaire en trois compartiments. Ceux-ci échangent en permanence eau, électrolytes et protéines, renouvelant constamment le milieu intérieur. Le volume et la rapidité de ces échanges varient en fonction de l'activité métabolique des tissus. Ils sont conditionnés mécaniquement par les différences de pression hydrostatique et oncotique entre les trois secteurs et par la taille des orifices ménagés entre les cellules endothéliales des capillaires. Ils sont en outre modulés par l'activité des cellules qui assurent dans les parois des capillaires le transport actif des grosses molécules et dans le milieu interstitiel la fragmentation ou la synthèse de ces mêmes macromolécules.

Le retour des liquides et des protéines vers le plasma sanguin ne peut être totalement assuré par le capillaire veineux dont la pression hydrostatique est trop élevée et dont la perméabilité aux macromolécules est limitée. Le système lymphatique, très perméable et très distensible se comporte comme un compartiment de stockage et de redistribution, préservant le milieu interstitiel de l'oedème lié à un apport plasmatique excessif. Les échanges qui se poursuivent à travers les parois des collecteurs et dans les lymphonoeuds atténuent les conséquences des variations circulatoires régionales. Les collecteurs terminaux ne ramènent aux creux sus-claviculaires que le trop plein du lac de régulation constitué par la circulation lymphatique; sa capacité demeure inconnue, la mesure du volume liquidien extracellulaire ne permettant pas de différencier compartiment interstitiel et lymphatique. Longtemps ignorée dans son existence, la circulation lymphatique défie encore toute mesure exacte.

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Hidden, G. Physiologie de la circulation lymphatique. Anat. Clin 1, 331–345 (1979). https://doi.org/10.1007/BF01654710

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