先天性胆道拡張症術後の遺残膵内胆管腺扁平上皮癌の肝転移に対し肝動注化学療法が有効であった1例 A CASE OF HEPATIC ARTERIAL INFUSION THERAPY FOR LIVER METASTASIS OF ADENOSQUAMOUS CARCINOMA OF THE BILE DUCT AFTER EXCISION OF CONGENITAL BILIARY DILATION

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症例は69歳,男性.2006年6月に当科で先天性胆道拡張症術後の遺残膵内胆管腺扁平上皮癌にて膵頭十二指腸切除術(PD-I)を施行された.術後約6カ月後に発熱をきたして当院を受診し,血液検査で著明な炎症所見とCEAの高値を認めた.腹部超音波検査および腹部造影CTで肝S7に腫瘍を認め,肝転移あるいは肝膿瘍の鑑別診断が困難であった.保存的治療にても発熱,炎症所見は改善せず,腫瘍も増大傾向がみられたため,針穿刺を行った.病理組織学的に胆管腺扁平上皮癌の肝転移と診断された.5-FU+CDDPの肝動注化学療法を行ったところ肝転移は著明に縮小し,発熱,炎症所見も軽快してCEAは正常値となった.胆管腺扁平上皮癌の予後はきわめて不良で,治癒切除が行われても比較的早期に再発,転移をきたしやすい.有効な集学的治療法は確立されていないが,肝転移に対しては肝動注化学療法が治療法の選択肢の一つになりうると考えられた.

A 69-year-old man who had undergone pancreaticoduodenectomy for adenosquamous carcinoma of the intrapancreatic remnant bile duct in June 2006 was admitted to the hospital because of fever about six months after the surgery. Severe inflammatory findings were noted and serum CEA level was elevated. Abdominal US and CT scan revealed a liver tumor in the S7 of the liver. It was difficult to differentiate between metastasis and an abscess. No symptomatic remission was gained by conservative therapy and an increasing tendency of the tumor was observed. Then needle puncture was performed after all. The histopathological examination revealed liver metastasis of adenosquamous carcinoma of the bile duct. Hepatic arterial infusion therapy with 5-FU+CDDP was performed. The liver tumor subsequently shrank, uncontrollable inflammation improved, and the serum CEA level fell to normal range.<BR>Adenosquamous carcinoma of the bile duct carries extremely poor prognosis and is prone to recur or metastasize in an early phase. No effective multimodal therapy for the disease has been established as yet. We suggest that the hepatic arterial infusion therapy with 5-FU+CDDP is a useful therapy for liver metastasis of adenosquamous carcinoma of the bile duct.

収録刊行物

  • 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association  

    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 69(7), 1759-1763, 2008-07-25 

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10021944896
  • NII書誌ID(NCID)
    AA11189709
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13452843
  • データ提供元
    CJP書誌  J-STAGE 
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