食道癌陽子線治療後の難治性食道潰瘍の特徴とその対応 Clinical Features of Refractory Radiation Esophageal Ulcer after Proton Beam Therapy and Its Management in a Patient with Esophageal Cancer

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筑波大学では食道癌に対し陽子線治療を施行し良好な治療成績を報告している.一方で,照射後食道潰瘍が56.4%の頻度で発生し,そのうち治癒不能な潰瘍を22.7%に認めている.陽子線照射後の難治性照射後潰瘍を当科では7例経験し,5例に穿孔または穿通を認めた.保存的治療を行った3例は合併症の制御が困難となり死亡したが,その後の2例は外科治療を施行し救命しえた.臨床的特徴として,初発症状が狭窄であること,初発症状から潰瘍形成,穿孔・穿通までの期間が1~2か月と極めて短期であり,すみやかな外科療法を検討する必要があることが挙げられる.手術所見の特徴として,潰瘍部位は周囲と強固に癒着しており剥離層の同定が困難であったが,血管障害を受けているため出血をほとんど認めず,鋭的操作により一度正しい剥離層を同定した後は比較的容易に剥離可能であった.

It has been reported that proton beam therapy is an effective treatment method for patients with locally confined esophageal cancer. However, there seems to be serious problems related to post-radiotherapy (RT) esophageal ulcers. We treated 7 patients who developed post-RT esophageal ulcers with the earliest symptom of esophageal stenosis, which was observed 7–17 months (median, 10.0) after completion of RT. Five of the patients had unhealed ulcers leading to lethal events such as perforation or penetration. The mean time between the appearance of the earliest symptom and lethal episode was no more than 2 months (mean, 2.1). The first 3 patients who underwent conservative therapies died from severe complications caused by perforation or penetration of post-RT esophageal ulcers. In the case of 2 consecutive patients, we performed surgical treatment as soon as possible since there were indications of penetration in post-RT developed esophageal ulcers. Therefore, they could be cured by a salvage operation which was subtotal esophagectomy using the stomach for esophageal replacement. Through the above-mentioned experience, we discussed surgical management for esophageal ulcers after proton beam therapy.

収録刊行物

  • 日本消化器外科学会雑誌

    日本消化器外科学会雑誌 45(12), 1145-1152, 2012

    一般社団法人 日本消化器外科学会

各種コード

  • NII論文ID(NAID)
    130004560775
  • 本文言語コード
    JPN
  • ISSN
    0386-9768
  • データ提供元
    J-STAGE 
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