内容紹介
Summary
We report a case of multiple lung metastasis of intrahepatic cholangiocarcinoma treated with chemotherapy, in which laparoscopic splenectomy was effective for thrombocytopenia. A 74-year-old woman was diagnosed with multiple lung metastasis of intrahepatic cholangiocarcinoma 6 years after partial liver resection(S3). She was undergoing treatment for post-transfusion hepatitis C infection since the age of 46 years and developed thrombocytopenia due to splenomegaly. The previous hospital determined that there was no indication for chemotherapy due to thrombocytopenia. Elective laparoscopic splenectomy resulted in an increase in the platelet count and facilitated the initiation of gemcitabine(GEM)and cisplatin(CDDP)combination chemotherapy. The patient has maintained a good treatment course without interruption due to thrombocytopenia during chemotherapy. In advanced cancer patients with thrombocytopenia complication due to splenomegaly, laparoscopic splenectomy may offer an effective auxiliary means for the safe implementation of chemotherapy.
要旨
症例は74歳,女性。輸血後C型肝炎の経過観察中に肝内胆管癌を発症し,前医で肝S3部分切除術を施行した。術後6年目の胸腹部造影CTで多発肺腫瘍を認め,肝内胆管癌の多発肺転移と診断した。C型肝硬変による脾機能亢進のため血小板減少があり治療困難と判断されたが,積極的な治療を希望され当科を受診した。血小板減少が改善すれば化学療法の忍容性はあると判断し,腹腔鏡下脾摘術を施行した。術後6日で血小板数は正常化し,術後2週間でgemcitabine+cisplatin(GC)療法を導入できた。化学療法中に血小板減少による治療の中断はなく,治療を継続し良好な経過を得ている。
目次
We report a case of multiple lung metastasis of intrahepatic cholangiocarcinoma treated with chemotherapy, in which laparoscopic splenectomy was effective for thrombocytopenia. A 74-year-old woman was diagnosed with multiple lung metastasis of intrahepatic cholangiocarcinoma 6 years after partial liver resection(S3). She was undergoing treatment for post-transfusion hepatitis C infection since the age of 46 years and developed thrombocytopenia due to splenomegaly. The previous hospital determined that there was no indication for chemotherapy due to thrombocytopenia. Elective laparoscopic splenectomy resulted in an increase in the platelet count and facilitated the initiation of gemcitabine(GEM)and cisplatin(CDDP)combination chemotherapy. The patient has maintained a good treatment course without interruption due to thrombocytopenia during chemotherapy. In advanced cancer patients with thrombocytopenia complication due to splenomegaly, laparoscopic splenectomy may offer an effective auxiliary means for the safe implementation of chemotherapy.
要旨
症例は74歳,女性。輸血後C型肝炎の経過観察中に肝内胆管癌を発症し,前医で肝S3部分切除術を施行した。術後6年目の胸腹部造影CTで多発肺腫瘍を認め,肝内胆管癌の多発肺転移と診断した。C型肝硬変による脾機能亢進のため血小板減少があり治療困難と判断されたが,積極的な治療を希望され当科を受診した。血小板減少が改善すれば化学療法の忍容性はあると判断し,腹腔鏡下脾摘術を施行した。術後6日で血小板数は正常化し,術後2週間でgemcitabine+cisplatin(GC)療法を導入できた。化学療法中に血小板減少による治療の中断はなく,治療を継続し良好な経過を得ている。