下肢静脈瘤治療後に発生する下腿浮腫に対する歩行訓練 : 静脈瘤に対する硬化療法後の下腿浮腫および手術後に発生した下腿浮腫 Gait Training for Lower Leg Edema in Patients Experiencing Sclerotherapy or Operative Procedures for Leg Varicose Veins

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一次性下肢静脈瘤の治療法として硬化療法と伏在静脈高位結紮術を併用した場合,しばしば頑固な下肢浮腫を認める.そこで,我々は下腿浮腫の予防的アプローチとして弾力包帯による圧迫療法,歩行訓練の有効性を検討した.当院で行った一次性下肢静脈瘤,956人1417肢の内,特に頑固な下肢浮腫を来す可能性のある症例,すなわち手術療法として大および小伏在静脈結紮術,不全交通枝結紮術さらに広範囲な静脈瘤切除術を施行した症例24例を対象とし,下肢静脈瘤治療後に発生する下肢浮腫について歩行訓練の有効性を検討した.歩行訓練としては,手術翌日より,1)足底静脈のフットポンプ機能を活性化させる目的で床歩行を20分間,1日3回,2)下腿膝部から足関節部までの静脈-筋肉ポンプを活性化する目的で階段昇降(100step)を1日3回行わせた.さらに併用療法として,3)足背から大腿中央部まで弾力包帯および弾力ストッキングで圧迫した.術後早期の圧迫療法と歩行訓練の併用は足底部の静脈によるフットポンプおよび静脈(静脈弁)-筋ポンプ作用を有効に働かせるのに有効で下腿浮腫の軽減に効果的であると考えられた.

It is well known that lower leg edema occurs in patients who have undergone sclerotherapy and operative procedure or such operative procedures as high ligataion of the long and short saphenous veins of ligation of the perforator branch for varicose veins of the legs. To date, there have been no reports regarding rehavilitation approaches for patients who have undergone the above mentioned procedures. We evaluated the efficacy of gait training to improve such lower leg edema. Group I : sclerotherapy only, group II : operative procedure, group III : both sclerotheraphy and operative procedure, group IV : as controls inpatients with no led varicose vein who had undergone a tonsillectomy. As rehabilitation therapy, the subjects were required to do 1) 20 minutes walking on the floor to activate the venous foot pump function, 2) to go up and down steps to activate the venous muscle pump function, and 3) to undergo added compression therapy using an elastic bandage and elastic stocking. In group I , the leg edema improved within several days due to the use of an elastic bandage or elastic stocking and no recurrence was encountered. Regarding operation therapy, in group I, strong leg edema occurred on the first postoperative day. In group II, it occurred again on the seventh postoperative day after compression therapy. In group III, no leg edema occurred again. Our results have led us to conclude that walking and goig up and down steps as gait training soon after surgical procedures are very effective for decerasing lower leg edema.

収録刊行物

  • 川崎医学会誌

    川崎医学会誌 28(2), 101-107, 2002

    川崎医科大学

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