胃癌に対するBillroth Ⅰ再建術による遠位胃切除術後の逆流性食道炎に塩酸アコチアミドが有効であった1例

[A Case in Which Acotiamide Hydrochloride Was Effective for Reflux Esophagitis after Distal Gastrectomy with Billroth Ⅰ Reconstruction for Gastric Cancer].

• Yukio Maezawa
• Toru Aoyama
• Junya Morita
• Kazuki Kano
• Shinya Amano
• Sho Sawazaki
• Masakatsu Numata
• Tsutomu Hayashi
• Takanobu Yamada
• Tsutomu Sato
• Takashi Ohshima
• Norio Yukawa
• Takaki Yoshikawa
• Munetaka Masuda
• Yasushi Rino

抄録

65歳女性は右肺癌手術後の外来経過観察中に貧血を認め、上部消化管内視鏡検査を実施した。消化管内視鏡検査の結果、胃中央部の小湾曲部に2型腫瘍を認め、胃癌と診断された。病理診断は胃癌、ML、Less、2型、67×55×15mm、muc>sig>por、pT4a(SE)N2M0、fStageⅢB.S-1補助化学療法を施行したが、有害事象の発生により2クール目で中止した。術後3ヶ月後の体重は51kg、5ヶ月後の血清アルブミン値は52.5kg、3.2g/dL、2.7g/dLであったが、逆流症状の改善が見られなかったため、術後7ヶ月後に塩酸アコチアミドの経口投与を開始した。塩酸アコチアミド経口投与開始後，食事摂取量は改善し，術後11ヶ月後の体重は54kg，15ヶ月後の体重は57kg，血清アルブミン値はそれぞれ3.0g/dL，2.7g/dLであった。術後23ヶ月後に腹膜再発が認められ，経口摂取量は減少したが，逆流症状の再発は認められなかった。

In a 65-year-old woman, anemia was observed during outpatient follow-up after right lung cancer surgery, and upper gastrointestinal endoscopy was performed for examination.Gastrointestinal endoscopy revealed a Type 2 tumor on the small curvature in the middle part of the stomach, and she was diagnosed with gastric cancer.Distal gastrectomy with D2 lymph node dissection and BillrothⅠ reconstruction was performed for the gastric cancer.There were no postoperative complications, and she was discharged on the ninth day after surgery.The pathological diagnosis was gastric cancer, ML, Less, Type 2, 67×55×15 mm, muc>sig>por, pT4a(SE)N2M0, fStage ⅢB.S -1 adjuvant chemotherapy was administered, but then discontinued in the second course due to the development of adverse events.Reflux symptoms appeared after the surgery, and her dietary intake was poor.Her body weight and serum albumin level at 3 and 5 months after surgery were 51 kg and 52.5 kg, respectively, and 3.2 g/dL and 2.7 g/dL, respectively.Because there was no improvement in the reflux symptom, oral administration of acotiamide hydrochloride was initiated 7 months after the surgery.After initiating oral intake of acotiamide hydrochloride, her dietary intake improved, and her body weight and serum albumin level at 11 and 15 months after surgery were 54 kg and 57 kg, respectively, and 3.0 g/dL and 2.7 g/dL, respectively.Peritoneal recurrence was observed 23 months after surgery, and her oral intake decreased, but the recurrence of reflux symptoms was not observed.Acotiamide hydrochloride could be an option for the treatment of reflux symptoms after gastrectomy.