特発性血小板減少性紫斑病を伴った舌癌患者の治療経験 : CDDP投与を契機に出血傾向が出現した1例について

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Before radical operation of tongue cancer of the patient with idiopathic thrombocytopenic purpura (ITP), γ-globulin was given in high dose and satisfactory results were obtained. The patient was a 38-year-old man referred to us by his dentist with a complaint of the presence of induration in his tongue. Histopathological examination revealed the lesion as squamous cell carcinoma. Preoperative radiation of 30 Gy was given, but the tumor showed radiation resistance. Therefore, additionally 80mg/body of CDDP was administrated. As the result of the chemotherapy, the number of platelets decreased to 0.2×104/mm3 and spontaneous bleeding from gingiva and purpura appeared. Platelettransfusion was undertaken and the number of platelets increased to 24.9×104/mm3 at a peak period. The platelet count finally reached 5.0×104/mm3. As a diagnostic therapy, high dose γ-globulin was administrated intravenously to confirm the diagnosis of ITP and the number of platelets reached to 7.1×104/mm3. Radical operation including tracheostomy, hemiglossectomy and radical neck disection was performed. Reconstruction was subsequentry undertaken with PM-MC flap. Although total bleeding was 2, 767ml, control of the hemorrhage was not difficult. Postoperative bleeding from suction catheter was 1, 118ml. Postoperative course was uneventful and recurrence of the tumor was not observed.