タキサン系抗癌剤による虚血性大腸炎の2例

Two Cases of Ischemic Colitis Associated with Paclitaxel-Based Chemotherapy in Patients with Ovarian Cancer

要旨　〔症例1〕患者は50歳代，女性．当院婦人科で右卵巣癌と診断され，卵巣癌根治術が施行された．術後化学療法パクリタキセル70mg/m²とシスプラチン60mg/m²の4クール目投与約1週間後に腹痛を伴う下痢と血便が出現し，下部消化管内視鏡検査で上行結腸～S状結腸にかけて広範囲に白苔を伴う潰瘍性病変が観察された．〔症例2〕患者は70歳代，女性．多量の腹水で発症し，試験開腹の結果，卵巣癌と診断された．術後化学療法パクリタキセル160mg/bodyとカルボプラチン400mg/bodyの初回投与約1週間後から，腹痛を伴う下痢と血便が出現した．下部消化管内視鏡検査でS状結腸に白苔と著明な発赤を伴った浮腫状粘膜の密な散在，腹部CT検査ではS状結腸～盲腸にかけてびまん性の高度な壁浮腫が認められた．いずれもタキサン系による虚血性大腸炎と診断され，保存的加療により軽快した．

　In case 1, a woman in her 50s underwent a radical operation for ovarian cancer after being diagnosed with right ovarian cancer at the Department of Gynecology of our hospital. She developed diarrhea and bloody stool with abdominal pain about one week after administration of the fourth course of postoperative chemotherapy with paclitaxel 70mg/m² and cisplatin 60mg/m². Colonoscopy showed an ulcerative lesion accompanied by an extensive white coating from the ascending colon to the sigmoid colon. In case 2, a woman in her 70s presented with massive ascites and was diagnosed with ovarian cancer based on exploratory laparotomy. She developed diarrhea and bloody stool with abdominal pain about one week after the first administration of postoperative chemotherapy with paclitaxel 160mg/body and carboplatin 400mg/body. Colonoscopy showed dispersed clusters of edematous mucosa accompanied by a white coating and marked redness in the sigmoid colon, while abdominal CT（computed tomography）revealed severe, diffuse wall edema up to the cecum. Both of these patients were diagnosed with ischemic colitis induced by taxanes, and they improved with conservative therapy.