ICG蛍光リンパ管造影検査とリンパマッピングを受けたリンパ浮腫患者の経験

The Experiences of Patients with Lymphedema who Underwent ICG Fluorescence Lymphangiography and Lymphatic Mapping

要　旨

　本研究では，ICG検査・リンパマッピングを受けたリンパ浮腫患者の経験を明らかにすることを目的とした．研究対象は，リンパ浮腫専門治療施設で，ICG検査とリンパマッピングを受けた続発性リンパ浮腫患者18名とし，ICG検査とリンパマッピングを受けた経験について，半構造化面接調査を実施し，質的帰納的分析を行った．

　結果，ICG検査・リンパマッピングを受けたリンパ浮腫患者の経験として【自分のリンパ状態を目の当たりにした】【習ってきたリンパの流れと異なることに衝撃を受けた】【なんとか流れようとしているリンパが愛おしく感じた】【暗闇のなかで一筋の希望の光が見えた】【自分でどうにかしていこうという意欲が沸きあがるのを感じた】【リンパの状態に対して自分はどうしたらよいかわかった】の6つのカテゴリーが得られた．

　患者は自分のリンパの状態を目の当たりにし，既知の知識との違いに衝撃を受け，一方ではリンパの状態と自覚症状が一致することに納得し，リンパ液がどうにか流れようとするのを見て希望や労わりの気持ちが生じ，現状を維持したいという気持ちからセルフケアへの意欲が高まったと推察された．

　以上から，ICG検査・リンパマッピングによるリンパの可視化は，リンパ浮腫と対峙する状況をつくり出し，その経験は完治が難しいリンパ浮腫だからこそ希望につながった．リンパの状態を可視化することは長期にわたるリンパ浮腫のセルフケアを支える鍵となることが示唆された．

　This study assessed the experiences of patients with lymphedema who underwent ICG fluorescence lymphangiography (ICG test) and lymphatic mapping. A semi-structured interview survey was conducted involving 18 patients with secondary lymphedema who underwent the ICG test and lymphatic mapping at a lymphedema treatment facility to investigate their experiences. The content of the interview was analyzed by qualitative inductive analysis.

　As a result, the following 6 categories were extracted: “having faced my lymphatic condition”, “having been shocked to find that the lymphatic flow was different from what I had previously learned”, “having felt a sense of fondness for my lymph that is trying to flow”, “having seen a ray of hope in the darkness”, “having felt motivated to do things about it on my own” and “having understood what I should do to improve my lymphatic condition”.

　The patients were shocked to see their lymphatic condition and how it differed from their prior knowledge; however, they were convinced by the consistency between their lymphatic condition and subjective symptoms. Observing a lymph that is trying to flow was hypothesized to provide patients with a sense of hope and care, and their desire to maintain their current health status increased their motivation for self-care.

　The visualization of lymphatic flow using the ICG test and lymphatic mapping enabled patients to confront their disease, providing hope to patients with lymphedema for which there is no cure. This study suggested that visualization of the lymphatic condition is key to supporting long-term self-care of lymphedema.