Wakabayashi Kazuhiko, Hayashi Shigeoki, Masuda Hideki, Karube Hideaki, Ookame Hirohisa, Aoki Hisayuki, Sakamoto Naotaka, Tanaka Tomohiro, Fujii Masashi, Takayama Tadatoshi
Division of Surgery, Nerima Hikarigaoka Hospital, Third Dept. of Surgery, Nihon University School of Medicine.
Gan To Kagaku Ryoho. 2004 Mar;31(3):393-8.
A 41-year-old man was found to have advanced gastric cancer with simultaneous multiple bone metastases when pyloric stenosis was being diagnosed in our hospital. We performed gastrojejunostomy from the lower third of the stomach to the upper third of the duodenum to relieve the obstruction. However, at 8 days after surgery, disseminated intra-vascular coagulation (DIC) occurred. Therefore, the patient was administered combined chemotherapy with TS-1 plus low-dose cisplatin in addition to anti-DIC therapy. TS-1 (150 mg/day) and cisplatin (10 mg/body intravenously over the course of 30 minutes) were administered on days 1 to 5, 8 to 12, and 15 to 19 (weekday-on/weekend-off schedule). There was remarkable response to this chemotherapy, and the patient was shifted from inpatient to outpatient treatment. The treatment course was repeated for 4 cycles until remission was observed. Because of hematologic relapse due to DIC at 6 months after the first treatment, he was readmitted for administration of combined chemotherapy. Fortunately, DIC once again responded to the same chemotherapy regimen. In this pathologic condition, combined chemotherapy is unavoidable when DIC occurs with cancer. Accordingly, it is necessary that an effective combined chemotherapy with mild bone marrow suppression be chosen. A companion drug should be chosen in consideration of delayed homo-toxicity and of the possibility of relapse into DIC in the drug withdrawal period. In addition, it is indispensable that careful consideration be given to the most favorable dose and regimen.
一名41岁男性在我院被诊断为幽门狭窄时，发现患有晚期胃癌并伴有多发骨转移。我们从胃下三分之一至十二指肠上三分之一进行了胃空肠吻合术以缓解梗阻。然而，术后第8天发生了弥散性血管内凝血（DIC）。因此，除了抗DIC治疗外，还给予患者TS-1联合低剂量顺铂的联合化疗。TS-1（150mg/天）和顺铂（10mg/体，30分钟内静脉滴注）于第1至5天、第8至12天和第15至19天给药（工作日给药/周末停药方案）。该化疗取得了显著疗效，患者从住院治疗转为门诊治疗。治疗疗程重复4个周期直至观察到缓解。由于首次治疗后6个月因DIC出现血液学复发，他再次入院接受联合化疗。幸运的是，DIC再次对相同的化疗方案产生反应。在这种病理情况下，癌症发生DIC时联合化疗是不可避免的。因此，有必要选择一种骨髓抑制较轻的有效联合化疗方案。应考虑延迟同种毒性和停药期复发为DIC的可能性来选择辅助药物。此外，必须仔细考虑最适宜的剂量和方案。
