北大形成外科におけるリンパ浮腫の治療：簡易に良結果を得るために

抄録

Simple methods producing good outcomes in the treatment of lymphedema include manual lymphatic drainage and decongestive lymphatic therapy using a compression bandage (DLT). DLT represents the first treatment for lymphedema regardless of the underlying etiology (primary, secondary or its clinical stage). The International Society of Lymphology has stated that "complex decongestive physiotherapy (CDP) for lymphedema is proved to be effective by the long experience and involves a two-phase treatment program that can be applied to both children and adults." CDP is a program consisting of two phase-dependent treatments and is the international standard therapy for lymphedema. Regarding surgical treatment, no randomized clinical trials or comparative studies of surgical treatment were available, but recently a microsurgical technique including lymphaticovenous anastomosis (LVA) has been reported with good outcomes. We reported several series of upper limb lymphedema cases treated by microsurgical lymphaticovenous implantation (MLVI) combined with compression therapy. We have recently introduced both ultrasonography for mapping the subcutaneous vein and indocyanine green fluorescence lymphography for information on the dermal backflow of lymph fluid. Compression therapy with a bandage was applied 6 months preoperatively and 6 months postoperatively in our series. This combined technique provides increased lymphatic flow through newly created lymphaticovenous bypasses by MLVI surgery, with assistance for pumping function in the lymphatics by compression therapy. In this article, we present how we combined the MLVI and conservative treatment as a simple method for a good outcome.