Shoji Hirokazu, Kuroki Michio, Hiramoto Keiichiro, Matsumura Yoshifumi, Miura Atsushi, Kikuchi Yoshifumi, Hirakawa Hidetoshi
Dept. of Gastroenterology, Yamagata City Hospital Saiseikan.
Gan To Kagaku Ryoho. 2010 Aug;37(8):1583-6.
We report a rare case of metastatic colorectal cancer who suffered from hyperammonemic encephalopathy induced by 5- FU and was continuously treated with FOLFOX therapy. A 50-year-old man with ileus was diagnosed with ascending colon cancer Stage IV, and a right hemicolectomy was performed. Postoperative chemotherapy with modified FOLFOX6 was performed. Complications of nausea and vomiting were seen on day 2 , with confusion and cognitive disturbances on day 3 . None of the other radiographic examinations provided an explanation for his symptoms. Laboratory examination revealed hyperammonemia, so branched-chain amino acid solutions and high-volume drip infusion were started for its treatment. His symptoms entirely disappeared on day 4. We changed to chemotherapy for FOLFOX4 using branched-chain amino acid solutions and drip infusion. The tumor marker level normalized following two courses, and CT following ten courses showed that the size of the lung metastasis and abdominal lymph node had reduced significantly. The patient is currently receiving FOLFOX4.
我们报告了一例罕见的转移性结直肠癌患者，该患者因5-氟尿嘧啶引发高氨血症性脑病，并持续接受FOLFOX方案治疗。一名50岁患有肠梗阻的男性被诊断为升结肠癌IV期，遂行右半结肠切除术。术后采用改良FOLFOX6方案进行化疗。术后第2天出现恶心、呕吐并发症，第3天出现意识模糊和认知障碍。其他影像学检查均无法解释其症状。实验室检查显示高氨血症，因此开始使用支链氨基酸溶液并进行大量静脉滴注治疗。其症状在第4天完全消失。我们改用含支链氨基酸溶液并静脉滴注的FOLFOX4方案进行化疗。两个疗程后肿瘤标志物水平恢复正常，十个疗程后的CT显示肺转移灶和腹部淋巴结大小显著缩小。该患者目前正在接受FOLFOX4方案治疗。
