肺癌の経過中に生じた気道、食道狭窄に対する複数回のステント留置術がQOL改善に寄与した1例

A 81-year-old man came to our hospital with abnormal shadow on chest X-ray and was diagnosed as non-small cell lung cancer. The cancer became small,so we observed for a while, but the cancer enlarged and dysphagia was observed. Chest CT revealed an enlargement of subcarinal lymph node metastasis and stenosis of esophagus and left main bronchus. Therefore, we placed stents on esophagus and left main bronchus and he left hospital. After that, he underwent outpatient chemotherapy, but he had severe dyspnea and immediately hospitalized. Chest CT revealed stenoses of bilateral main bronchus due to enlargement of subcarinal lymph node. The stenosis of left main bronchus was severe, so we placed a stent on left main bronchus again and at the same time, he underwent radiation therapy against the enlargement of lymph node. After he finished radiation therapy, the size of subcarinal lymph node became small, so we placed a stent on right main bronchus. After that, his symptom of dyspnea was improved markedly. For stenoses of esophagus and tracheobronchus, double and multiple stentings considering patient’s disease state and complications of stentings are effective treatment to improve quality of life.

【症例】81歳，男性。胸部異常影を指摘され，精査で非小細胞癌と診断。その後腫瘍が自然縮小し経過観察していたが再度増大，同時に嚥下障害を認め入院。CT 検査で気管分岐部リンパ節腫大とそれによる食道，左気管支の圧排を認めたため，食道，左主気管支にステント留置術を行い，退院。以後外来で化学療法を行っていたが，呼吸苦が出現し緊急入院。気管分岐部リンパ節腫大による両側気管支の狭窄を認めた。左主気管支狭窄が高度であり，再度左主気管支にステント留置術を行い，同時にリンパ節腫大に対する放射線治療を開始。放射線治療終了後，気管分岐部リンパ節縮小を認め，右気管支狭窄に対しステント留置術を施行。以後は呼吸症状の著明な改善を認めた。
【結語】肺癌による食道や気管支狭窄に対しては，病態やステント留置後に生じる合併症を考慮した複数回のステント治療を行うことにより，QOL が改善する場合がある。