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上大静脈症候群への血管内ステント留置を行った悪性胸膜中皮腫の1例


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Title: 上大静脈症候群への血管内ステント留置を行った悪性胸膜中皮腫の1例
Other Titles: Endovascular Stenting for Superior Vena Cava Syndrome Caused by a Malignant Pleural Mesothelioma
Authors: 長島, 聖二 / 福田, 実 / 北﨑, 健 / 御手洗, 和範 / 森, 雅一 / 河野, 茂
Authors (alternative): Nagashima, Seiji / Fukuda, Minoru / Kitazaki, Takeshi / Mitarai, Kazunori / Mori, Masakazu / Kohno, Shigeru / 北崎, 健
Issue Date: 30-Sep-2013
Publisher: 日本肺癌学会 / Japan Lung Cancer Society
Citation: 肺癌, 53(3), pp.250-254; 2013
Abstract: 背景.上大静脈症候群は緊急的な合併症である.しかしながら本邦における静脈内ステント留置術は保険適応対象外診療であるので,あまり行われていない.症例.67歳の男性.悪性胸膜中皮腫に対して化学療法を行っていたが,診断より2年2ヶ月後呼吸困難が強くなり入院した.胸部CT検査では右胸膜病変が増大し,上大静脈,右主肺動脈,右主気管支を狭窄していた.顔面を含む上半身の浮腫,頚静脈怒張を認め,上大静脈症候群と診断した.SpO2は保たれているのに強い呼吸困難を訴え,放射線治療を開始して効果が出るまで待てない切迫した状況になった.患者家族の説明同意を得て,上大静脈狭窄部にステント留置術を行った.治療直後より症状は改善し,合併症はなかった.3ヶ月後に在宅診療へ移行するまで上大静脈症候群の再発は認めなかった.結論.静脈内ステント留置術は,悪性胸膜中皮腫による上大静脈症候群に対して有用で安全な治療であった.上大静脈症候群に対する血管内治療の保険適応拡大が期待される. / Background. Superior vena cava syndrome (SVCS) is a serious complication of cancer; however, intravenous stenting is infrequently performed as treatment for SVCS in Japan because the procedure has not been approved for coverage by the Japanese national health insurance program. Case Report. A 67-year-old male undergoing chemotherapy for malignant pleural mesothelioma developed dyspnea and was admitted to our hospital two years and two months after receiving the cancer diagnosis. On CT, the patient's right pleural lesion exhibited enlargement, causing stenosis of the SVC, right main pulmonary artery and right main bronchus. He presented with edema of the upper body, including the face, and cervical vein swelling, and SVCS was diagnosed. The dyspnea increased in severity in spite of a well-maintained SpO2 value, and the patient developed an urgent status; therefore, it became difficult to wait for the effects of radiotherapy. After obtaining informed consent from the patient and his family, SVC stenting was performed. The patient's symptoms immediately improved following treatment, and no complications were observed. The SVCS did not recur for three months, after which the patient moved into home medical care. Conclusion. Our results in this case show that SVC stenting is a useful therapeutic option for treating SVCS caused by malignant mesotheliomas. Furthermore, we expect that endovascular treatment for SVCS will be approved for coverage under the Japanese national health insurance program.
Keywords: 悪性胸膜中皮腫 / 上大静脈症候群 / ステント / Malignant pleural mesothelioma / Superior vena cava syndrome / Stenting
URI: http://hdl.handle.net/10069/34009
ISSN: 03869628
DOI: 10.2482/haigan.53.250
Rights: © 2013 日本肺癌学会
Type: Journal Article
Text Version: publisher
Appears in Collections:Articles in academic journal

Citable URI : http://hdl.handle.net/10069/34009

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