臨床婦人科産科78巻4号

2024年04月発行

増刊号 産婦人科医のための緊急対応サバイバルブック Ⅱ. 婦人科編 ❹オンコロジック・エマージェンシーへの対応法

腫瘍崩壊症候群

著者： 岡愛実子¹ 中川慧¹

所属機関： ¹大阪大学大学院医学系研究科産科学婦人科学教室

ページ範囲：P.170 - P.176

遭遇しやすい典型ケース

　76歳女性．既往歴なし．腹部膨満感を主訴に来院した．経腟超音波検査にて左付属器領域に充実成分を伴う10cm大の腫瘤性病変を認めた．骨盤部造影MRI検査，胸腹部造影CT検査にて骨盤内に10×7cm大で一部に充実成分を含む多房性腫瘤，広範囲に及ぶ腹膜播種，脾臓，肝臓への多発転移，腹水貯留を認めた．腹腔内観察および組織採取を目的とした審査腹腔鏡手術を施行したところ，広範な腹膜，横隔膜，腸管，大網，肝表面に播種病変を認め，Fagottiスコア12点であった．腹膜播種病変より組織を採取し，病理学的検査により高異型度漿液性癌，ステージⅣBと診断された．初回化学療法としてパクリタキセル＋カルボプラチンが投与された．4日後より，嘔気，下痢，動悸，尿量低下を認めた．血液検査でUA 9.9mg/dL，K 5.3mmol/dL，P 9.5mg/dL，Cre 2.2mg/dLを，12誘導心電図で心室性期外収縮を認め，clinical TLSと診断した．速やかにICUへ入室し，生理食塩水を用いた大量補液，フェブキソスタット投与にて加療を開始した．また，持続的にバイタルサイン，心電図，4〜6時間ごとの血液検査，水分in/out量をモニタリングし，腎臓内科医やICU担当医とも連携をとりながら管理を行った．治療開始後，症状は速やかに改善し，血液検査値も正常化し，6日後には一般病棟へ移動した．患者は予定通り化学療法を継続できた．

参考文献

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