内容紹介
Summary
In a 65-year-old woman, anemia was observed during outpatient follow-up after right lung cancer surgery, and upper gastrointestinal endoscopy was performed for examination. Gastrointestinal endoscopy revealed a Type 2 tumor on the small curvature in the middle part of the stomach, and she was diagnosed with gastric cancer. Distal gastrectomy with D2 lymph node dissection and BillrothⅠ reconstruction was performed for the gastric cancer. There were no postoperative complications, and she was discharged on the ninth day after surgery. The pathological diagnosis was gastric cancer, ML, Less, Type 2, 67×55×15 mm, muc>sig>por, pT4a(SE)N2M0, fStage ⅢB. S-1 adjuvant chemotherapy was administered, but then discontinued in the second course due to the development of adverse events. Reflux symptoms appeared after the surgery, and her dietary intake was poor. Her body weight and serum albumin level at 3 and 5 months after surgery were 51 kg and 52.5 kg, respectively, and 3.2 g/dL and 2.7 g/dL, respectively. Because there was no improvement in the reflux symptom, oral administration of acotiamide hydrochloride was initiated 7 months after the surgery. After initiating oral intake of acotiamide hydrochloride, her dietary intake improved, and her body weight and serum albumin level at 11 and 15 months after surgery were 54 kg and 57 kg, respectively, and 3.0 g/dL and 2.7 g/dL, respectively. Peritoneal recurrence was observed 23 months after surgery, and her oral intake decreased, but the recurrence of reflux symptoms was not observed. Acotiamide hydrochloride could be an option for the treatment of reflux symptoms after gastrectomy.
要旨
症例は65歳,女性。身長159 cm,体重59 kg。肺癌術後で外来経過観察中に貧血を認め,精査目的に上部消化管内視鏡検査を施行し,胃癌の診断となった。幽門側胃切除,D2郭清,BillrothⅠ(B-Ⅰ)再建術を施行した。術後診断は胃癌,ML,Less,Type 2,67×55×15 mm,muc>sig>por,pT4a(SE)N2M0,fStage ⅢBであった。術後S-1補助化学療法施行中の外来通院時に逆流症状を認め,食事摂取不良であった。術後3か月,5か月での体重はそれぞれ51 kg,52.5 kgおよび血清Alb値が3.2 g/dL,2.7 g/dLであり,低栄養となっていた。術後7か月で逆流症状の改善を認めなかったため,アコチアミド塩酸塩の内服を開始した。 内服開始後,逆流症状と食事摂取量が改善し,術後11か月,15か月での体重はそれぞれ54kg,57 kgおよび血清Alb値が3.0 g/dL,2.7 g/dLとなった。術後23か月目で腹膜播種再発を来し食事摂取不良となったが,逆流症状の再燃は認めなかった。胃切除術B-Ⅰ再建後の逆流症状に対して,アコチアミド塩酸塩が治療選択肢となる可能性が示唆された。
目次
In a 65-year-old woman, anemia was observed during outpatient follow-up after right lung cancer surgery, and upper gastrointestinal endoscopy was performed for examination. Gastrointestinal endoscopy revealed a Type 2 tumor on the small curvature in the middle part of the stomach, and she was diagnosed with gastric cancer. Distal gastrectomy with D2 lymph node dissection and BillrothⅠ reconstruction was performed for the gastric cancer. There were no postoperative complications, and she was discharged on the ninth day after surgery. The pathological diagnosis was gastric cancer, ML, Less, Type 2, 67×55×15 mm, muc>sig>por, pT4a(SE)N2M0, fStage ⅢB. S-1 adjuvant chemotherapy was administered, but then discontinued in the second course due to the development of adverse events. Reflux symptoms appeared after the surgery, and her dietary intake was poor. Her body weight and serum albumin level at 3 and 5 months after surgery were 51 kg and 52.5 kg, respectively, and 3.2 g/dL and 2.7 g/dL, respectively. Because there was no improvement in the reflux symptom, oral administration of acotiamide hydrochloride was initiated 7 months after the surgery. After initiating oral intake of acotiamide hydrochloride, her dietary intake improved, and her body weight and serum albumin level at 11 and 15 months after surgery were 54 kg and 57 kg, respectively, and 3.0 g/dL and 2.7 g/dL, respectively. Peritoneal recurrence was observed 23 months after surgery, and her oral intake decreased, but the recurrence of reflux symptoms was not observed. Acotiamide hydrochloride could be an option for the treatment of reflux symptoms after gastrectomy.
要旨
症例は65歳,女性。身長159 cm,体重59 kg。肺癌術後で外来経過観察中に貧血を認め,精査目的に上部消化管内視鏡検査を施行し,胃癌の診断となった。幽門側胃切除,D2郭清,BillrothⅠ(B-Ⅰ)再建術を施行した。術後診断は胃癌,ML,Less,Type 2,67×55×15 mm,muc>sig>por,pT4a(SE)N2M0,fStage ⅢBであった。術後S-1補助化学療法施行中の外来通院時に逆流症状を認め,食事摂取不良であった。術後3か月,5か月での体重はそれぞれ51 kg,52.5 kgおよび血清Alb値が3.2 g/dL,2.7 g/dLであり,低栄養となっていた。術後7か月で逆流症状の改善を認めなかったため,アコチアミド塩酸塩の内服を開始した。 内服開始後,逆流症状と食事摂取量が改善し,術後11か月,15か月での体重はそれぞれ54kg,57 kgおよび血清Alb値が3.0 g/dL,2.7 g/dLとなった。術後23か月目で腹膜播種再発を来し食事摂取不良となったが,逆流症状の再燃は認めなかった。胃切除術B-Ⅰ再建後の逆流症状に対して,アコチアミド塩酸塩が治療選択肢となる可能性が示唆された。