Goto Ayana, Tanaka Yoshihiro, Suetsugu Tomonari, Fukada Masahiro, Imai Takeharu, Tanahashi Toshiyuki, Matsuhashi Nobuhisa, Takahashi Takao, Yamaguchi Kazuya, Yoshida Kazuhiro
Dept. of Surgical Oncology, Gifu University School of Medicine.
Gan To Kagaku Ryoho. 2020 May;47(5):823-825.
Case 1, a man in his 70s, was admitted because of a bleeding gastric ulcer during DCF therapy for esophageal cancer(EC). Three days after endoscopic hemostasis, abdominal pain and vomiting occurred.CT revealed hepatic portal venous gas (HPVG).No intestinal necrosis was observed on contrast-enhanced CT.Therefore, we selected a conservative treatment and found improvement.Case 2, a man in his 70s, developed frequent diarrhea during DCF therapy for EC.Case 3, a man in his 80s, developed hematochezie during DCF therapy for EC.Both cases 2 and 3 were diagnosed as HPVG using abdominal ultrasonography.The symptoms were mild, so we selected a conservative treatment and found improvement.Case 4, a man in his 60s, noticed sudden severe abdominal pain during DGS therapy for EC.Plain CT detected HPVG and gas in the small intestinal wall.We suspected intestinal necrosis due to HPVG with peritoneal irritation and performed emergency small intestine resection.We encountered 4 patients who developed HPVG during chemotherapy.The presence of HPVG is a poor prognostic sign, suggestive of intestinal necrosis, but some patients show improvement with conservative treatments.We also discuss previous reviews and reports.
病例1，一名70多岁男性，因食管癌（EC）接受DCF治疗期间出现胃溃疡出血入院。内镜止血三天后，出现腹痛和呕吐。CT显示肝门静脉积气（HPVG）。增强CT未观察到肠坏死。因此，我们选择保守治疗并取得改善。病例2，一名70多岁男性，在EC的DCF治疗期间出现频繁腹泻。病例3，一名80多岁男性，在EC的DCF治疗期间出现便血。病例2和病例3均通过腹部超声诊断为HPVG。症状较轻，因此我们选择保守治疗并取得改善。病例4，一名60多岁男性，在EC的DGS治疗期间突然出现严重腹痛。平扫CT检测到HPVG和小肠壁积气。我们怀疑因HPVG伴腹膜刺激导致肠坏死并进行了急诊小肠切除术。我们遇到4例化疗期间发生HPVG的患者。HPVG的存在是预后不良的征象，提示肠坏死，但部分患者经保守治疗后有所改善。我们还讨论了既往的综述和报告。
