リンパ管エコー入門
静脈エコーからのステップアップ

目次
序文······························································································ i
監修にあたって············································································· iv
Recommendation ········································································· vi
目次······························································································· viii
動画の閲覧方法············································································· xii

第 1 章 リンパ浮腫の基礎知識
1 リンパ系の機能・解剖 ············································································2
2 リンパ管の変性············································································2
3 リンパ浮腫とは············································································6
4 リンパ浮腫の症状···········································································8
5 原発性リンパ浮腫············································································14
6 診断の重要性···········································································14
7 リンパ浮腫の治療············································································16

第 2 章 基礎編
Ⅰ エコー検査の基礎
1 リンパ管エコーの位置づけ·········································································· 22
2 リンパ管エコーの特徴 ··········································································22
1. リンパ管エコーのメリット ― 22　2. リンパ管機能検査 ― 26
3 リンパ管エコーに使う超音波診断装置 ··········································································28
1. プローブの選択 ― 28　2. 超音波の種類 ― 28
3. リンパ管の表示方法（短軸像・長軸像） ― 36
4. 操作盤のボタン説明 ― 36　5. プローブの持ち方，ゼリーのつけ方 ― 38
まとめ：リンパ管エコーを行う際の具体的な手順 ― 38
4 エコー検査の安全上の注意点 ··········································································40
1. プローブでの過度な圧力を避ける ― 40　2. 安定した体位の確保 ― 40
3. 清潔で快適な環境の維持 ― 40　4. 患者の不安軽減とコミュニケーション ― 40

Ⅱ リンパ管エコー検査の基礎
1 D-CUPS の概要 ··········································································42
2 D-CUPS の 5 項目 ··········································································42
1. D（Doppler：ドプラモードで色がつかない） ― 42
2. C（Crossing：近くの静脈に合流せず素通りする） ― 42
3. U（Uncollapsible：静脈よりつぶれにくい） ― 44
4. P（Parallel：複数本のリンパ管が並走する） ― 44
5. S（Superficial fascia：浅筋膜直下に存在する） ― 44
3 動脈・神経とリンパ管の見分け方·········································································· 48
1. 動脈 ― 48　2. 神経 ― 48
4 脂肪組織の評価 ··········································································50
1. 浮腫の評価 ― 50　2. 脂肪組織の増生 ― 50　3. 脂肪組織の線維化 ― 50
5 検査所見の総合評価と治療選択 ··········································································52

Ⅲ 最新のエコー検査装置
1 超高周波プローブ ··········································································54
1. 特徴 ― 54　2. リンパ管エコー検査ではこう使う ― 54
2 高感度微小血流イメージング（MVFI） ··········································································56
1. 特徴 ― 56　2. リンパ管エコー検査ではこう使う ― 56
3 ポータブルエコー ··········································································58
1. 特徴 ― 58　2. リンパ管エコー検査ではこう使う ― 58

第 3 章 実践編
Ⅰリンパ管エコー検査の手順
① スクリーニングリンパ管エコー：SLUS
1 検査前の確認 ··········································································62
2 エコー機器と患者のセッティング ··········································································62
3 手順 ··········································································64
1. 浮腫の評価 ― 64　2. リンパ管を観察する時のプローブの位置と角度 ― 64
3. スキャンの手順 ― 68
4 リンパ管の解析と評価 ··········································································72
1. サイズ ― 72　2. 形状 ― 72　3. その他の異常所見 ― 74
5 報告書の作成 ··········································································76
6 いろいろな周波数のリンパ管エコー画像 ····················································78
1. 18MHz と12MHz ― 78　2. 10MHz（ポータブルエコー） ― 78
3. 33MHz ― 78
7 トラブルシューティング ··········································································82
〇リンパ管が見つからない ― 82
〇浮腫が強く，貯留した組織液とリンパ管との区別がつかない ― 84
〇画面全体が暗い，または白い ― 86
〇深いところが黒っぽくて見えにくい ― 86
〇浅筋膜がわからない ― 86　〇見たい深さの画像がぼやけている ― 88
〇ドプラモードで画面全体的に色がついてしまう，またはまったく色がつかない ― 86
8 上肢のリンパ管エコー検査 ··········································································88

Ⅱリンパ管エコー検査の手順
② 術前検査
1 術前検査としてのリンパ管エコー検査の意義 ························································90
2 エコー機器と患者のセッティング ··········································································92
3 手順 ··········································································92
1. 浮腫の評価 ― 92　2. リンパ管の探索 ― 94　3. 静脈の探索 ― 94
4 特殊な場合 ··········································································98
1. 下腿のリンパ管径が1mm を超える場合 ― 98
2. 外側・後面に拡張したリンパ管がある場合 ― 98
3. 皮下組織の線維化が強い場合 ― 100
5 注意が必要な所見 ··········································································100
1. 浅筋膜上にリンパ管があることもある ― 100
2. まん丸な脈管は動脈のことがある ― 100
3.ドプラモードで色がつかないからといってリンパ管とは断定できない ― 100
4. プローブの圧迫でつぶれないリンパ管 ― 100
6 トラブルシューティング ··········································································102
1. 拡張したリンパ管が見つからない ― 102　2. 静脈が見つからない ― 104
3. リンパ管と静脈の位置が遠い ― 104

Ⅲ ケーススタディ
【症例①】 60 歳代， 女性，二次性リンパ浮腫（右下肢：軽症，左下肢：重症）·············································································106
【症例②】50 歳代， 女性，二次性リンパ浮腫（右：超早期，左：早期）·············································································109
【症例③】70 歳代， 女性，二次性右上肢リンパ浮腫··············································································110

Ⅳ クイズ
【クイズ①】40 歳代， 女性，二次性リンパ浮腫（左下肢：中等度）·····································
·········································114
【クイズ②】 60 歳代， 女性，二次性リンパ浮腫（右下肢：早期，左下肢：早期）··············································································116
【クイズ③】 70 歳代， 女性，肥満性浮腫，廃用性浮腫，うっ滞性皮膚炎，右下腿リンパ漏··············································································116

Ⅴ リンパ管エコーでここまでわかった！
―リンパ管エコーのこれまでの研究―
1 立つとリンパ管はふくれる？！···············································································118
2 リンパ管エコー検査にはどのプローブがよい？！·················································120
3 LVA の術前検査で，どう使うの？！······································································121
4 LVA に適した「拡張したリンパ管」はどこにあるの？！·····································122
5リンパ浮腫の診断ができるの？！············································································124
6 D-CUPS の感度は？································································································125
7むくみの重症度とリンパ管所見は相関する？·························································125
8リンパ浮腫の評価に，エラストグラフィはどう使うの？·······································126

Ⅵ リンパ管エコー検査Q&A
1 技師らかの質問······························································································ 128
2形成外科医からの質問······························································································133
3その他······························································································136

あとがき······························································································ 139
事項索引······························································································ 140
著者紹介······························································································ 142