転移性肝癌に対して抗癌剤動注療法により惹起された広範囲な胃・十二指腸潰瘍の3症例

Gastroduodenal Ulcers after Hepatic Arterial Infusion Chemotherapy for Metastatic Liver Cancer, Report of Three Cases

要旨　〔症例1〕は41歳，男性．S状結腸癌肝転移術後．肝再発に対して肝動注リザーバーよりmitomycin-Cおよびスフェレックス（微小デンプン）を間歇動注したところ十二指腸球部から下行脚にかけて広範なA₁ stageの縦走性潰瘍を認めた．プロトンポンプ阻害剤を8週間投与したがH₁ stageまでの回復にとどまった．〔症例2〕は56歳，女性．盲腸癌肝転移に対して右半結腸切除術，肝動注リザーバー留置術施行．肝動注リザーバーより5-FUおよびcisplatinを間歇動注したところ十二指腸下行脚に広範で浅いA₁stage潰瘍を認めた．〔症例3〕は58歳，男性．盲腸癌肝転移に対して右半結腸切除術，肝部分切除肝動注リザーバー留置術を施行．肝動注リザーバーより5-FUおよびmitomycin-Cを間歇動注したところ，胃前庭部後壁から十二指腸球部にかけて広範囲なびらん性変化を伴うA₁stageの潰瘍を認めた．プロトンポンプ阻害剤を6週間投与したが，H₂ stageまでの回復にとどまった．抗癌剤による潰瘍の特徴としては，①潰瘍範囲が広区域で，②急激な変化で潰瘍面を形成し，③治癒段階では潰瘍の中心部は肉芽性の変化が強く，また，④治癒段階では潰瘍周囲面での再生上皮性の変化に乏しかった．

　〔Case 1〕 A 41-year-old man underwent left half colectomy and hepatectomy for colonic cancer and liver metastasis. Six months after the operation, abdominal CT revealed metastatic lesions in the liver. At first, he had received systemic chemotherapy for eight months. However, the tumor increased in size. Fourteen months after the operation, a hepatic arterial infusion port was implanted.Three cycles of intrahepatic arterial chemoembolization using degradable starch microspheres and mitomycin C were performed. It caused a hemorrhagic duodenal ulcer. Eight weeks after the treatment with a proton pump inhibitor, follow-up endoscopy revealed the H1 stage ulcer in the descending duodenum.

　〔Case 2〕 A 56-year-old woman underwent right half colectomy, so a hepatic arterial infusion port was implanted for cecal cancer and liver metastasis. Four cycles of intrahepatic arterial chemoembolization using degradable starch microspheres and mitomycin C were performed. After this therapy, one cycle of intrahepatic arterial chemotherapy using 5-FU and cisplatin was administered. It caused A₂ stage ulcer in the descending duodenum.

　〔Case 3〕 A 58-year-old man underwent right half colectomy and hepatectomy. A hepatic arterial infusion port was implanted for cecal cancer and liver metastasis. Three cycles of intrahepatic arterial chemotherapy using 5-FU, cisplatin and mitomycin C were performed. It caused A₁ stage ulcer in the posterior wall of the antrum. Six weeks after the treatment with proton pump inhibitor, follow-up endoscopy revealed the H₂ stage ulcer in the posterior wall of the antrum.