Watanabe Ko, Hikichi Takuto, Nakamura Jun, Hashimoto Minami, Takagi Tadayuki, Suzuki Rei, Sugimoto Mitsuru, Konno Naoki, Takasumi Mika, Sato Yuki, Irie Hiroki, Kimura Takashi, Kenjo Akira, Marubashi Shigeru, Obara Katsutoshi, Ohira Hiromasa
Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.
Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.
Case Rep Gastroenterol. 2018 Nov 28;12(3):679-685. doi: 10.1159/000494918. eCollection 2018 Sep-Dec.
We describe the first case of a nonhealing duodenal ulcer with perforation after proton beam therapy (PBT) of a liver tumor that was successfully treated endoscopically using polyglycolic acid (PGA) sheets with fibrin glue. A 69-year-old man received PBT for a liver tumor. Esophagogastroduodenoscopy (EGD) 3 months after PBT revealed a duodenal ulcer. A proton pump inhibitor was administered for 7 weeks, and the ulcer healed. Six months after the EGD, recurrence of the duodenal ulcer with perforation occurred. An emergency open surgery with placement of the omental patch was performed. However, 5 days after the surgery, because the EGD revealed a perforation site in the duodenal ulcer that was not closed, the conservative treatment was continued. Twenty-eight days after the surgery, EGD revealed that the perforation size had increased. Therefore, we conducted endoscopic closure therapy using PGA sheets with fibrin glue. Eleven days after the closure procedure, the EGD showed that the perforation site was filled with granulation tissue and was closed. Forty-nine days after the procedure, EGD revealed that the ulcer had healed. This endoscopic closure treatment was effective for a nonhealing duodenal ulcer with perforation after PBT of a liver tumor.
我们描述了首例肝脏肿瘤质子束治疗（PBT）后出现十二指肠溃疡穿孔且不愈合的病例，该病例通过使用聚乙醇酸（PGA）片和纤维蛋白胶进行内镜治疗而成功治愈。一名69岁男性因肝脏肿瘤接受了PBT。PBT后3个月进行的食管胃十二指肠镜检查（EGD）发现十二指肠溃疡。给予质子泵抑制剂治疗7周后，溃疡愈合。EGD检查6个月后，十二指肠溃疡复发并穿孔。进行了紧急开放手术并放置了网膜补片。然而，术后5天，由于EGD显示十二指肠溃疡的穿孔部位未闭合，因此继续采取保守治疗。术后28天，EGD显示穿孔尺寸增大。因此，我们使用PGA片和纤维蛋白胶进行了内镜闭合治疗。闭合手术后11天，EGD显示穿孔部位充满肉芽组织且已闭合。术后49天，EGD显示溃疡已愈合。这种内镜闭合治疗对于肝脏肿瘤PBT后出现的十二指肠溃疡穿孔且不愈合有效。
