A controversial Alzheimer’s surgery is said to reverse symptoms

一项备受争议的阿尔茨海默病手术据称能逆转症状

The video opens with a man in his 80s slumped in a hospital bed, his face hollow as he scrunches his eyes. A jump cut advances the scene three days: the man is alert now, words gathering as he identifies his son. Six months later, he is pictured sitting upright, engaged in conversation. His gaze is animated. At eight months, the man walks briskly down a hospital corridor. He recites a near-century-old Maoist military anthem from memory. He is practically unrecognizable from the withered figure in the opening frame.

视频开头是一位 80 多岁的老人瘫坐在病床上，面容憔悴，双眼紧闭。镜头一转，时间推进了三天：老人此刻精神焕发，随着他认出儿子，话语逐渐清晰。六个月后，照片中的他坐得笔直，正在与人交谈。他的目光炯炯有神。八个月时，老人步履轻快地走在医院走廊上。他能凭记忆背诵一首近百年前的毛泽东主义军歌。他与开场画面中那个枯萎的身影几乎判若两人。

China is waging war on Alzheimer’s. What can its approach teach the rest of the world?

中国正在与阿尔茨海默病作战。它的方法能给世界其他地区带来什么启示？

The footage records the recovery of a man who, in September 2020, became the first person in the world to undergo a surgery known as deep cervical lymphatic-venous anastomosis (dcLVA) to treat Alzheimer’s disease. The procedure involves connecting tiny lymphatic vessels in the neck — part of the drainage system that carries waste away from the brain — to nearby veins, creating a route that, in theory, allows fluid and waste proteins to flow more easily into the bloodstream.

这段录像记录了一名男子的康复过程，他在 2020 年 9 月成为全球首位接受一种名为深颈淋巴静脉吻合术（dcLVA）手术以治疗阿尔茨海默病的人。该手术涉及将颈部微小的淋巴管——这是将废物从大脑排出的引流系统的一部分——与附近的静脉连接起来，理论上创造了一条通道，使液体和废物蛋白更容易流入血液。

The treatment was first reported in 2022 in a Chinese-language journal by microsurgeon Qingping Xie, president of the Qiushi Hospital in Hangzhou, China. At the time, it drew little notice. But that changed the following year, when Wei Chen, a lymphatic microsurgeon at the Cleveland Clinic in Ohio, began showing the footage (with consent from Xie and the man’s family) at surgical meetings around the world.

该疗法最早于 2022 年在一本中文期刊上由微外科医生谢庆平报道，他是位于中国杭州的求是医院的院长。当时，它并未引起太多注意。但情况在次年发生了变化，当时俄亥俄州克利夫兰诊所的淋巴微外科医生陈伟开始在全球各地的外科会议上展示这段录像（经谢庆平和该男子家属同意）。

“A lot of jaws dropped,” recalls Chen. “It basically started a frenzy of this surgery being performed left and right.”

“很多人下巴都惊掉了，”陈伟回忆道。“这基本上引发了一股热潮，这种手术到处都在做。”

Almost all of the surgeries took place in China, where hundreds of hospitals were soon offering the experimental procedure. Propelled by viral testimonial videos and aggressive marketing campaigns on social-media platforms such as Douyin and WeChat, it was sought out by thousands — with many people paying more than 200,000 yuan (US30,000) for a chance of recovery.

几乎所有的手术都在中国进行，那里很快有数百家医院提供这种实验性手术。在抖音和微信等社交媒体平台上病毒式传播的见证视频和激进的营销活动推动下，成千上万的人寻求这种治疗——许多人支付了超过 20 万元人民币（约 3 万美元）以换取康复的机会。

The rapid adoption, in the absence of hard evidence, prompted Chinese regulators to intervene. Last year, they restricted the procedure to more-formalized clinical research settings, rather than the ad hoc use that had proliferated previously. And Xie, the pioneer of the technique, has been in detention since September for undisclosed reasons.

在缺乏确凿证据的情况下迅速推广，促使中国监管机构介入。去年，他们将该手术限制在更规范化的临床研究环境中，而不是之前泛滥的随意使用。而该技术先驱谢庆平自 9 月以来因未披露的原因被拘留。

The great brain clearance and dementia debate

大脑清除与痴呆症的大辩论

Now, as controlled studies get under way around the world, the scientific community remains divided over whether or not the procedure actually alters the course of the disease. Mechanistic explanations for why the surgery might work remain hard to square with how quickly some individuals seem to improve, clinicians say. And many researchers remain concerned about the risks, including infection, bleeding and injury to nearby nerves.

如今，随着全球范围内的对照研究展开，科学界对于该手术是否真正改变了疾病进程仍存在分歧。临床医生表示，关于手术为何有效的机制解释，仍难以与某些个体似乎改善速度之快相吻合。许多研究人员仍然担心风险，包括感染、出血和对附近神经的损伤。

Nature spoke to more than two dozen researchers in the field, revealing a mix of qualified enthusiasm and deep scepticism.

《自然》杂志采访了该领域二十多位研究人员，揭示了谨慎的热情与深深的怀疑并存。

“The concept is scientifically valid and biologically plausible,” says Young-Kwon Hong, a lymphatics researcher at the Beth Israel Deaconess Medical Center in Boston, Massachusetts. But he worries that the excitement has outpaced the evidence. “The hope is high,” he says, “and whenever hope is high, the hype also follows.”

“这一概念在科学上是有效的，在生物学上是合理的，”马萨诸塞州波士顿贝斯以色列女执事医疗中心的淋巴系统研究人员洪永权（Young-Kwon Hong）说。但他担心兴奋情绪已经超过了证据。“希望很高，”他说，“每当希望很高时，炒作也会随之而来。”

Medical maverick

医学特立独行者

Xie did not set out to reinvent Alzheimer’s treatment. He trained as a reconstructive microsurgeon, and is more at home with reconnecting severed vessels than with troubleshooting brain drainage. But according to interviews Xie gave before his detention, and corroborated by his daughter Angela, who spoke to Nature, a stray case of tinnitus set him on a different path.

谢庆平最初并没有打算重新发明阿尔茨海默病的治疗方法。他接受的是重建微外科训练，比起排查大脑引流问题，他更擅长重新连接断裂的血管。但根据谢庆平在被拘留前接受的采访，以及向《自然》杂志透露情况的女儿安吉拉（Angela）的证实，一个偶然的耳鸣病例让他走上了不同的道路。

In 2019, while performing surgery to relieve pressure on nerves that carry sound signals to the brain, Xie noticed abnormalities in lymphatic structures deep in the neck of a middle-aged woman with persistent ringing in her ears. To bypass the problem area, he connected lymph vessels to nearby veins, adapting a technique first developed in the 1960s to treat painful swelling in the arms and legs that can happen when lymph nodes are removed or damaged during cancer treatment.

2019 年，在为一名中年女性进行手术以缓解将声音信号传递到大脑的神经压力时，谢庆平注意到该女子颈部深处的淋巴结构存在异常，她伴有持续的耳鸣。为了绕过问题区域，他将淋巴管与附近的静脉连接起来，改编了一项最初于 20 世纪 60 年代开发的技术，用于治疗癌症治疗期间淋巴结被切除或受损时手臂和腿部可能出现的疼痛性肿胀。

After the surgery, the woman reported not only that her tinnitus improved, but so had her mental acuity. Intrigued, Xie dug into the literature and found research that seemed to explain the phenomenon. In 2015, a team led by neuroimmunologist Jonathan Kipnis identified a network of lymphatic vessels in the protective membranes that encase the brain, overturning the long-held idea that the brain lacked a conventional lymphatic system.

手术后，该女子报告说，不仅她的耳鸣改善了，她的精神敏锐度也有所提高。谢庆平对此感到好奇，深入查阅文献，发现了似乎能解释这一现象的研究。2015 年，由神经免疫学家乔纳森·基普尼斯（Jonathan Kipnis）领导的团队在大脑的保护膜中识别出一个淋巴管网络，推翻了大脑缺乏传统淋巴系统的长期观点。

Three years later, Kipnis and his colleagues showed that disrupting these vessels in mice impaired clearance of toxic amyloid-β proteins and accelerated cognitive decline.

三年后，基普尼斯及其同事表明，破坏小鼠的这些血管会损害有毒淀粉样蛋白-β的清除，并加速认知衰退。

Together, the findings pointed to a kind of hidden plumbing keeping the brain clean. This echoed earlier work by neuroscientists Jeff Iliff and Maiken Nedergaard at the University of Rochester Medical Center in New York. In 2012, they described an array of fluid-filled channels, distinct from true lymphatic vessels, that run alongside blood vessels and move fluid through brain tissue to flush out waste.

这些发现共同指向了一种保持大脑清洁的隐藏管道系统。这与纽约罗切斯特大学医学中心神经科学家杰夫·伊利夫（Jeff Iliff）和迈肯·内德加德（Maiken Nedergaard）早期的工作相呼应。2012 年，他们描述了一系列充满液体的通道，与真正的淋巴管不同，这些通道沿着血管运行，通过脑组织移动液体以冲洗废物。

For Xie, the pieces clicked: if the brain’s waste ultimately drains through these fluid-clearing pathways into lymphatic vessels in the neck, he reasoned, then improving the outflow there might enhance clearance upstream. And if clogs in that plumbing contribute to disease, then fixing the flow might even help to treat neurodegenerative conditions such as Alzheimer’s. The 84-year-old man in Xie’s video was his first test case.

对谢来说，这些线索串联起来了：如果大脑的废物最终通过这些液体清除途径排入颈部的淋巴管，他推理道，那么改善那里的流出量可能会增强上游的清除能力。如果该管道系统的堵塞导致了疾病，那么修复流动甚至可能有助于治疗阿尔茨海默病等神经退行性疾病。谢视频中的那位 84 岁老人是他的第一个测试案例。

Weifeng Zeng first stumbled on Xie’s work in February 2023, buried in a China Medical News bulletin listing the “Seven major advances in microsurgery in 2022”; Xie’s dcLVA technique ranked sixth. By then, Xie had performed it on more than 60

曾维峰（Weifeng Zeng）最早在 2023 年 2 月偶然发现了谢的工作，当时它被埋没在《中国医学新闻》的一份公告中，该公告列出了“2022 年微外科七大进展”；谢的 dcLVA 技术排名第六。到那时，谢已经在 60 多人身上进行了该手术