Neduka Hideaki, Munemoto Masayoshi, Ojima Toshihiko, Earashi Mitsuharu, Fujii Hisatake, Nonomura Akitaka
Dept. of Surgery, Yatsuo General Hospital.
Gan To Kagaku Ryoho. 2016 Nov;43(12):1939-1941.
A 68-year-old woman was diagnosed with advanced gastric cancer with a type 3 deep ulcer of the middle stomach by endoscopy. An abdominal computed tomography scan revealed multiple lymph node metastases and peritoneal disseminations. The clinical stage was determined to be T4a(SE), N2P1M1(PER), H0 and stage IV . A gastrectomy was scheduled after 2 courses of S-1 plus oxaliplatin(SOX)with curative intent. On day 3 after initiatingSOX therapy, the patient complained of severe abdominal pain. Because the abdominal CT scan showed intra-abdominal free air and a defect in the gastric wall, we performed an emergency total gastrectomy. The defect in the gastric wall was about 1 cm in diameter and was located in the anterior wall of the lower body, consistent with the center of the tumor. The operative findings suggested that the perforation was caused by chemotherapy-induced necrosis of gastric cancer cells. The patient was discharged 16 days after surgery and received post-operative chemotherapy. Our findings suggest that the risk of gastric perforation should be considered when administeringchemotherapy to patients with advanced gastric cancer and a deep ulcer.
一名68岁女性经内镜检查诊断为晚期胃癌，胃中部有3型深溃疡。腹部计算机断层扫描显示多发淋巴结转移和腹膜播散。临床分期确定为T4a(SE)、N2P1M1(PER)、H0，为IV期。计划在进行2个疗程的S-1联合奥沙利铂（SOX）治疗后进行根治性胃切除术。在开始SOX治疗后的第3天，患者主诉严重腹痛。由于腹部CT扫描显示腹腔内有游离气体和胃壁缺损，我们进行了急诊全胃切除术。胃壁缺损直径约1 cm，位于胃体下部前壁，与肿瘤中心一致。手术结果提示穿孔是由化疗诱导的胃癌细胞坏死所致。患者术后16天出院，并接受了术后化疗。我们的研究结果表明，对晚期胃癌伴深溃疡患者进行化疗时应考虑胃穿孔的风险。
