末期前立腺癌に続発した下肢リンパ浮腫に対するリンパ管静脈吻合術

Microscopic lymphatic vessel-vein anastomosis for secondary lymphedema of a lower limb in prostate cancer：A case report

　症例は，73歳男性。前立腺癌および癌リンパ節転移に伴う左下肢リンパ浮腫に対し保存的治療を行ったが効果を認めず，徐々に増悪して歩行困難となった。本人の希望を最優先し，リンパ管静脈吻合術を施行した。術後1週間頃より著明に改善して歩行可能となり，術後8日目に退院となった。末期医療の一環として施行でき，身体的・精神的苦痛症状を緩和することができたと考えられた。

　A 73-year-old male presented our hospital with a rapid enlarging left lower limb. He gave a history of progressive prostate cancer and he had been treated with nonoperative hormonotherapy for five years. On clinical evaluation with his history,physical examination and CT scan,he was made a diagnosis of left lower limb lymphedema concomitanted with increase of prostate cancer and lymph nodes metastasis. Any physiotherapy didn't take effect,therefore he was treated with microscopic lymphatic vessel-vein anastomosis. The postoperative course was uneventful. Gradually and surely his lower limb was reduce and he could ambulate by degrees. He was discharged on the eighth postoperative day. We thought that this treatment for secondary lymphedema of the lower limb refractory to nonoperative management was one of the best supports for patients with a short lease on life.