Yamagiwa Tetsuya, Maejima Ryuhei, Shimada Norihiro, Dairaku Naohiro, Narisawa Ayumi, Iwahashi Shigetoshi
Dept. of Gastroenterology, Iwaki Kyoritsu General Hospital.
Gan To Kagaku Ryoho. 2011 Jun;38(6):999-1001.
A 44-year-old man visited a nearby hospital because of severe headache. Brain MRI revealed a subdural hematoma, and he was transferred to the Department of Neurosurgery of our hospital. Burr hole surgery was performed on the second day of hospitalization because of an enlargement of the hematoma. Laboratory data on admission showed the presence of a disseminated intravascular coagulation(DIC). Bone marrow aspiration revealed metastases of signet ring cell carcinoma, and abdominalCT showed gastric cancer. He was diagnosed as having DIC with bone marrow metastases of advanced gastric cancer. Despite anti-DIC therapy and blood transfusion, his systemic bleeding tendency was not improved. The neurosurgeon therefore consulted with a palliative care team. Since the patient was still young, we considered that he should be treated with anti-cancer drugs. At first, his family did not accept chemotherapy because they were pessimistic about his prognosis. However, after he regained his consciousness, we were able to perform sequential MTX and 5-FU therapy with the consent of the patient and his family. The therapy was successful, and he recovered from DIC and was discharged on the 57th hospital day.
一名44岁男性因剧烈头痛前往附近医院就诊。脑部磁共振成像（MRI）显示硬膜下血肿，随后他被转至我院神经外科。由于血肿增大，在住院第二天进行了钻孔手术。入院时的实验室检查数据显示存在弥散性血管内凝血（DIC）。骨髓穿刺显示印戒细胞癌转移，腹部CT显示胃癌。他被诊断为晚期胃癌伴骨髓转移的DIC。尽管进行了抗DIC治疗和输血，但其全身出血倾向并未改善。因此，神经外科医生咨询了姑息治疗团队。由于患者仍较年轻，我们认为应给予抗癌药物治疗。起初，他的家人因对其预后悲观而不接受化疗。然而，在他恢复意识后，经患者及其家人同意，我们成功进行了序贯甲氨蝶呤（MTX）和氟尿嘧啶（5-FU）治疗。治疗取得成功，他从DIC中康复，并于住院第57天出院。
