{"created":"2023-05-25T05:25:45.879101+00:00","id":4247,"links":{},"metadata":{"_buckets":{"deposit":"5db1a09d-8acf-430e-8c86-141d10bd6d72"},"_deposit":{"created_by":17,"id":"4247","owners":[17],"pid":{"revision_id":0,"type":"depid","value":"4247"},"status":"published"},"_oai":{"id":"oai:yamagata.repo.nii.ac.jp:00004247","sets":["29:31:124:125"]},"author_link":["13398","13415","13412","13399","13414","13397","13404","13396","13410","13402","13408","13409","13417","13416","13419","13406","13407","13413","13401","13418","13405","13411","13400","13403"],"item_3_alternative_title_18":{"attribute_name":"その他の言語のタイトル","attribute_value_mlt":[{"subitem_alternative_title":"A case of liver metastases from rectal carcinoid 10-years after initial surgery, treated with multidisciplinary treatment"}]},"item_3_alternative_title_19":{"attribute_name":"タイトル（ヨミ）","attribute_value_mlt":[{"subitem_alternative_title":"チョクチョウ カルチノイド キョクショ セツジョゴ 10ネン ノ カンテンイ ニ タイシ シュウガクテキ チリョウ オ オコナッタ 1レイ"}]},"item_3_biblio_info_6":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2018-02-15","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"1","bibliographicPageEnd":"69","bibliographicPageStart":"63","bibliographicVolumeNumber":"36","bibliographic_titles":[{"bibliographic_title":"山形大学紀要. 医学 : 山形医学"},{"bibliographic_title":"Bulletin of the Yamagata University. Medical science : Yamagata medical journal","bibliographic_titleLang":"en"}]}]},"item_3_description_42":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"subitem_description":"論文(Article)","subitem_description_type":"Other"}]},"item_3_description_5":{"attribute_name":"内容記述","attribute_value_mlt":[{"subitem_description":"【背景】直腸カルチノイドの発育速度はゆっくりであるが、１cm以上の大きさになるとリンパ節転移、肝転移のリスクが高まり、決して予後良好な疾患とは言えない。今回、直腸カルチノイドの初回手術後10年経過して肝転移を来たした症例に対し、肝切除を行った。その後さらに17年間にわたり手術、動注化学療法、分子標的薬、オクトレオチド、ペプチド受容体放射性核種療法などさまざまな治療を施行したまれな症例を経験したので報告する。\n【症例】37歳の女性。10年前に他院で直腸カルチノイドに対し経肛門的切除を受けている。肝右葉の巨大な嚢胞性腫瘍に対し、右葉切除を行ったところ直腸カルチノイドの肝転移であった。その４年後に再度肝転移が出現し再肝切除、異時性直腸カルチノイドに対し低位前方切除術を施行した。\n　残肝の肝転移が再び発生したため、肝動脈塞栓術、インターフェロンα、オクトレオチド投与、ストレプトゾシン肝動注、テガフール・ウラシル、S-1化学療法、エベロリムス、スニチニブ分子標的薬、カペシタビン＋テモゾロミド化学療法を行った。骨転移に対しては緩和照射を行った。\n　残肝転移巣が増大し、門脈臍部を圧排して全身状態不良となり、車いす移動しかできなくなったため、スイス　バーゼル大学で90Y, 177Luのペプチド受容体放射性核種療法（Peptide receptor radionuclide therapy; PRRT）を行った。PRRTで肝転移は縮小し、全身状態の改善が得られた。しかし多発性肺転移、胸膜播種出現し、直腸局所切除から27年の経過で永眠された。\n【結論】直腸カルチノイドで手術歴がある症例では、長期間経てからの肝転移や局所再発もあり得ることを念頭に置く必要がある。\n　直腸カルチノイドの肝転移に対して、手術、オクトレオチド、分子標的薬、化学療法、ペプチド受容体放射線核種療法などさまざまな治療を行って進行を抑えることが予後延長のために重要である。","subitem_description_type":"Other"}]},"item_3_full_name_2":{"attribute_name":"著者(ヨミ)","attribute_value_mlt":[{"nameIdentifiers":[{"nameIdentifier":"13412","nameIdentifierScheme":"WEKO"}],"names":[{"name":"ヒライ, イチロウ"}]},{"nameIdentifiers":[{"nameIdentifier":"13413","nameIdentifierScheme":"WEKO"}],"names":[{"name":"テズカ, コウジ"}]},{"nameIdentifiers":[{"nameIdentifier":"13414","nameIdentifierScheme":"WEKO"}],"names":[{"name":"ワタナベ, トシヒロ"}]},{"nameIdentifiers":[{"nameIdentifier":"13415","nameIdentifierScheme":"WEKO"}],"names":[{"name":"スガワラ, シュウイチロウ"}]},{"nameIdentifiers":[{"nameIdentifier":"13416","nameIdentifierScheme":"WEKO"}],"names":[{"name":"オカザキ, シンジ"}]},{"nameIdentifiers":[{"nameIdentifier":"13417","nameIdentifierScheme":"WEKO"}],"names":[{"name":"タカハシ, 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