婦人科癌術後の下肢リンパ浮腫の危険因子と後腹膜大腿鼠径部でのリンパ管静脈吻合術の有効性

抄録

Lymphedema of the lower extremities may develop following surgical resection of malignant tumors and intrapelvic lymph node dissection. We performed primary intrapelvic lymphaticovenular anastomosis (PILA) to prevent postoperative lymphedema in the lower extremities. The procedures were conducted in patients with cancer of the uterine body, who underwent total hystero-oophoretomy, together with intrapelvic and para-aortic lymph node dissection. The afferent lymphatics entering suprainguinal lymph nodes were end-to-end anastomosed with branches of the deep inferior epigastric veins. The procedure was performed in 8 patients aged between 35 and 61 years. We performed complete PILA procedures in 7 patients. However, there was one case of right PILA only and one case of left PILA only. The time required to construct PILA ranged from 100 to 200 minutes. There has not been any patient developing postoperative lymphangitis in this series. The follow-up period ranged from 66 to 52 months after surgery. Three patients showed mild lymphedema, two patients just after surgery, and one patient 50 months after surgery. None of the other patients has shown any signs of lymphedema on follow-up to date. PILA following lymph node dissection may be useful for the prevention of lymphedema in the lower extremities.