内容紹介
Summary
We report a case of esophageal cancer with aortic thrombosis that occurred during chemotherapy and was successfully treated by aortic thrombectomy and video-assisted thoracoscopic esophagectomy. A 70-year-old man with esophageal cancer(Mt, Type 1c, cT2cN0cM0, cStageⅡ)was administered 5-FU plus cisplatin chemotherapy. On day 7 in the first course of the chemotherapy, he experienced abdominal pain. Abdominal CT revealed endo-aortic thrombotic deposits in the aortic arch about 3 cm in diameter. He immediately received heparin at a dose of 20,000 U/day administered intravenously, but the thrombus had not resolved by the next day. He underwent aortic thrombectomy, and warfarin was administered orally after the thrombectomy. He did not experience any difficulties or discomfort related to the thrombus after the thrombectomy. He then underwent video-assisted thoracoscopic esophagectomy and was discharged uneventfully on the 18th postoperative day. Currently, he is under follow-up with no recurrence.
要旨
今回われわれは,術前化学療法中に生じた大動脈血栓に対し血栓摘出術により治療関連死を回避し,胸腔鏡下食道切除術を行うことができた症例を経験した。症例は70歳,男性。吐血を主訴に当院を受診し,精査にて食道癌(Mt,Type 1c,cT2cN0cM0,cStageⅡ)と診断された。5-FU,シスプラチン併用化学療法(FP療法)を開始した。1コース目のday 7に腹痛を認めたためCTを撮影したところ,大腸の浮腫上変化とともに約3 cm大の大動脈血栓を認めた。絶食補液で腹痛は改善し,翌日のCTで大腸の浮腫も改善した。血栓に関してはヘパリン投与を開始したが,翌日のCTで縮小を認めなかったため心臓外科医にて血栓摘出術を施行した。血栓摘出後,梗塞の症状もなく,画像上も血栓を認めなかった。2コース目の化学療法は施行せず,胸腔鏡下食道亜全摘,後縦隔経路胃管再建を施行し,合併症なく,術後18日目に退院した。現在,血栓の再燃なく,食道癌の再発もなく外来にて経過観察中である。
目次
We report a case of esophageal cancer with aortic thrombosis that occurred during chemotherapy and was successfully treated by aortic thrombectomy and video-assisted thoracoscopic esophagectomy. A 70-year-old man with esophageal cancer(Mt, Type 1c, cT2cN0cM0, cStageⅡ)was administered 5-FU plus cisplatin chemotherapy. On day 7 in the first course of the chemotherapy, he experienced abdominal pain. Abdominal CT revealed endo-aortic thrombotic deposits in the aortic arch about 3 cm in diameter. He immediately received heparin at a dose of 20,000 U/day administered intravenously, but the thrombus had not resolved by the next day. He underwent aortic thrombectomy, and warfarin was administered orally after the thrombectomy. He did not experience any difficulties or discomfort related to the thrombus after the thrombectomy. He then underwent video-assisted thoracoscopic esophagectomy and was discharged uneventfully on the 18th postoperative day. Currently, he is under follow-up with no recurrence.
要旨
今回われわれは,術前化学療法中に生じた大動脈血栓に対し血栓摘出術により治療関連死を回避し,胸腔鏡下食道切除術を行うことができた症例を経験した。症例は70歳,男性。吐血を主訴に当院を受診し,精査にて食道癌(Mt,Type 1c,cT2cN0cM0,cStageⅡ)と診断された。5-FU,シスプラチン併用化学療法(FP療法)を開始した。1コース目のday 7に腹痛を認めたためCTを撮影したところ,大腸の浮腫上変化とともに約3 cm大の大動脈血栓を認めた。絶食補液で腹痛は改善し,翌日のCTで大腸の浮腫も改善した。血栓に関してはヘパリン投与を開始したが,翌日のCTで縮小を認めなかったため心臓外科医にて血栓摘出術を施行した。血栓摘出後,梗塞の症状もなく,画像上も血栓を認めなかった。2コース目の化学療法は施行せず,胸腔鏡下食道亜全摘,後縦隔経路胃管再建を施行し,合併症なく,術後18日目に退院した。現在,血栓の再燃なく,食道癌の再発もなく外来にて経過観察中である。