癌終末期における下肢浮腫は難治性であり,浮腫増悪により歩行困難となる場合が少なくない.今回,入院中に下肢リンパ浮腫を発症した症例に対し複合的理学療法を施行しその効果を検討した.対象は,当院緩和ケアチームで担当した急性下肢リンパ浮腫症例のうち,浮腫発症前Performance Status(以下PS)2以上の症例10例を対象とした.下肢リンパ浮腫の診断は,理学所見とともに超音波検査を行い静脈血栓が併存していないことを確認した.複合的理学療法としてスキンケア,リンパドレナージ,圧迫療法,運動療法を組み合わせて治療.浮腫軽減の目的での利尿剤の投与は併用しなかった.治療効果の検討のため,下肢計測(足背,足関節,下腿,大腿周径),PS変化で有効性を検討した.治療による副作用・事故はなく安全に治療を行えた.下肢計測では4回の治療で有意に大腿,下腿周径の改善を認めた.PSは治療前平均3.8で歩行困難であったが,治療開始7日で平均PS1.9と有意に改善し,さらに21日後では,治療により歩行可能となり平均PS0.9に改善された.以上より,下肢リンパ浮腫の治療は困難であるが,PS2以上で合併症のない急性期では複合的理学療法によりPSが改善され有効な治療法と考えられる.Malignant lymphedema of the leg is intractable : although not fatal, the patients\u27 quality of life and daily life activity can be decreased. This study reports the usefulness of complex decongestive physiotherapy (CDP) as a treatment for acute malignant lymphedema. Ten cases of acute malignant lymphedema with pre-critical Performance Status greater than 2 were treated with CDP by the palliative care team in Nakadori General Hospital. Diagnosis of acute malignant lymphedema was determined from clinical history and physical examination. Furthermore, ultra-sonography examination was performed to rule out the possibility of deep venous thrombosis. CDP was structured by Dr Michael Foeldi as multiple treatments of skin care, manual lymph drainage (MLD), compression bandage and ergotherapy. The effectiveness of CDP was evaluated through changes in body weight, leg diameter, serum albumin value and performance status (PS). No side effects were observed during CDP. There were no changes in body weight and serum albumin value. Significant improvement of leg diameter was observed at the fourth treatment. PS was significantly improved seven days after CDP from 3.8 to 1.9, and with continuous treatment, by the 21st day PS improved to 0.9 and the patients could walk around the bedside. Although treatment of acute malignant leg lymphedema is problematic, CDP is an effective treatment when applied as soon as possible
