内容紹介
Summary
A 60-year-old man underwent surgical distal gastrectomy 10 years prior to receiving treatment for stomach cancer. He visited our hospital with complaints of abdominal fullness and weight loss. Abdominal computed tomography(CT)revealed intestinal blockage starting at the duodenum near the Treitz ligament. During upper alimentary canal endoscopy, a type 2 tumor covering the entire circumference of the horizontal duodenum was found, and biopsy results indicated that the tumor was a well-differentiated adenocarcinoma. Although no distant metastasis was observed in the abdominal CT scan, multiple attached bulky lymph nodes were observed leading to a suspicion of metastasis. Finally, the patient was diagnosed as having progressive duodenal cancer accompanied with advanced lymph node metastasis. A gastrojejunal bypass surgery with laparoscopy was performed. When the patient's overall condition improved, mFOLFOX6 chemotherapy was started, and 6 courses were completed. As the sizes of the primary tumor and bulky lymph nodes decreased, surgery to completely remove the cancer was performed. UFT/UZEL supplemental postoperative chemotherapy was administered for 6 months. The patient remained alive, with no remissions 3 years post-surgery.
要旨
症例は60歳,男性。10年前に胃癌に対して開腹幽門側胃切除術の既往がある。腹部膨満感,体重減少を主訴に当院へ受診となった。腹部造影CT検査で,トライツ靱帯近傍の十二指腸を閉塞起点とする腸閉塞を呈していた。上部消化管内視鏡検査で十二指腸水平脚に全周性の2型腫瘍を認め,生検結果はwell differentiated adenocarcinomaであった。腹部造影CT検査では遠隔転移はないが,複数のbulkyリンパ節転移を疑い,高度リンパ節転移を伴う十二指腸癌と診断した。腹腔鏡下に胃空腸バイパス術を施行し,全身状態の改善を待ちmFOLFOX6による化学療法を開始した。合計6コース行い,原発巣の縮小,bulkyリンパ節の縮小を認め,根治的手術を施行した。UFT/UZELによる術後補助化学療法を6か月間行い,現在術後約3年,無再発生存中である。
目次
A 60-year-old man underwent surgical distal gastrectomy 10 years prior to receiving treatment for stomach cancer. He visited our hospital with complaints of abdominal fullness and weight loss. Abdominal computed tomography(CT)revealed intestinal blockage starting at the duodenum near the Treitz ligament. During upper alimentary canal endoscopy, a type 2 tumor covering the entire circumference of the horizontal duodenum was found, and biopsy results indicated that the tumor was a well-differentiated adenocarcinoma. Although no distant metastasis was observed in the abdominal CT scan, multiple attached bulky lymph nodes were observed leading to a suspicion of metastasis. Finally, the patient was diagnosed as having progressive duodenal cancer accompanied with advanced lymph node metastasis. A gastrojejunal bypass surgery with laparoscopy was performed. When the patient's overall condition improved, mFOLFOX6 chemotherapy was started, and 6 courses were completed. As the sizes of the primary tumor and bulky lymph nodes decreased, surgery to completely remove the cancer was performed. UFT/UZEL supplemental postoperative chemotherapy was administered for 6 months. The patient remained alive, with no remissions 3 years post-surgery.
要旨
症例は60歳,男性。10年前に胃癌に対して開腹幽門側胃切除術の既往がある。腹部膨満感,体重減少を主訴に当院へ受診となった。腹部造影CT検査で,トライツ靱帯近傍の十二指腸を閉塞起点とする腸閉塞を呈していた。上部消化管内視鏡検査で十二指腸水平脚に全周性の2型腫瘍を認め,生検結果はwell differentiated adenocarcinomaであった。腹部造影CT検査では遠隔転移はないが,複数のbulkyリンパ節転移を疑い,高度リンパ節転移を伴う十二指腸癌と診断した。腹腔鏡下に胃空腸バイパス術を施行し,全身状態の改善を待ちmFOLFOX6による化学療法を開始した。合計6コース行い,原発巣の縮小,bulkyリンパ節の縮小を認め,根治的手術を施行した。UFT/UZELによる術後補助化学療法を6か月間行い,現在術後約3年,無再発生存中である。