[症例報告]びまん性汎細気管支炎を合併した慢性腎不全患者に発症した肺癌の1手術例

概要

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A case of lung cancer associated with diffuse panbronchiolitis(DPB) operated during hemodialysis for chronic renal failure is reported. A 74-year-old woman was admitted to the hospital because of rapid aggravation of an uremic syndrome. Emergency hemodialysis was performed. A chest X-ray film revealed a coin lesion in the 4th bronchopulmonary segment of the left lung and difuse micronodular shadows in the bilateral lung field due to DPB. The mass showed spicula in a chest tomograph. Vascular indentation was demonstrated by a chest CT scan. Lung cancer was highly suspected because of a transbronchial lung biopsy and brushing cytology with clinical stage of T_1N_0M_0 The respiratory function was improved by administration of erythromycin. After correction of hyperkalemia and anemia by hemodialysis and blood transfusion, partial resection of the lower lobe of the left lung (limited operation) was safely performed with perioperative careful attention to fluid overload and hyperkalemia. Histological examinations revealed well-differentiated papillary adenocarcinoma. Hemodialysis using nafamostat mesilate was performed 5 days postoperatively. The post operative course was uneventful and the patient had been well without any signs of recurrence of cancer 9 months after the surgery, but she died of other causes.
琉球医学会,Ryukyu Medical Associationの論文