@article{oai:u-fukui.repo.nii.ac.jp:00028858,
 author = {椿, 貴佳 and 児玉, 麻衣子 and 武藤, 悠平 and 佐藤, 譲之 and 安齋, 正樹 and 小林, 美貴 and 上谷, 幸男 and 浦井, 真友美 and 廣野, 靖夫 and 五井, 孝憲 and TSUBAKI, Takayoshi and KODAMA, Maiko and TAKETOU, Yuuhei and SATOU, Masayuki and ANZAI, Masaki and KOBAYASHI, Miki and KAMITANI, Yukio and URAI, Mayumi and HIRONO, Yasuo and GOI, Takanori},
 journal = {福井大学医学部研究雑誌, Journal of Interdisciplinary Research of the School of Medical Sciences, University of Fukui},
 month = {Mar},
 note = {上腹部の激痛を主訴として福井大学病院を来院した45歳男性において，画像検査により右上葉肺がんを原発とする肝転移および多発リンパ節転移を認められたので，シスプラチン，ペメトレキセドナトリウム水和物，およびベバシズマブを用いた化学療法が開始された。7次治療まで施行したが，依然として進行性の病態にあり，肝転移巣の増大による腹水の増悪が認められた。がん性腹膜炎による腹水貯留は，嘔気，食欲不振，腹部膨満感といった症状の原因となり，患者のQOLを低下させ，治療継続を困難とするので，腹水濾過濃縮再静注法 (Cell-free concentrated ascites re-infusion therapy, CART) を施行した。14回のCART施行により，全身状態は維持され，化学療法を10次治療まで継続することが可能であった。それにより，日常生活動作は改善し，仕事や私生活を充実させることが可能となった。CARTは難治性腹水を認めるがん終末期患者の全身状態，QOL維持，および緩和ケアとして有効であり，当該患者へのCART施行導入が積極的に検討されるべきと考える。


Background: Ascites fluid accumulation due to carcinomatous peritonitis causes symptoms such as nausea, anorexia, and abdominal distention. It significantly reduces the patient's Quality of Life (QOL) and makes it difficult to continue treatment.
Cell-free and concentrated ascites reinfusion therapy (CART) is a treatment for a patient with cancerous refractory ascites, which ascitic fluid is withdrawn from the patient into the bag, then ascitic fluid is filtrated to remove bacteria and cancer cells, and furthermore ascitic fluid including helpful materials such as albumin is administered to the patient by the parenteral rout after concentrating. It is possible to relieve symptoms caused by refractory ascites. We report a case of a patient with terminal lung cancer who was able to continue chemotherapy and improve QOL by frequent CART.
Case presentation: A 45-year-old man came to University of Fukui Hospital with a chief complaint of severe pain in the upper abdomen. A computed tomography (CT) scan revealed a right upper lobe lung cancer, liver metastases and multiple lymph nodes metastases. Therefore, chemotherapy was initiated. Chemotherapy with cisplatin, pemetrexed sodium hydrate, and bevacizumab was administered up to the seventh-line treatment, but the results were all progressive disease. At that time, liver metastasis and para-aortic lymph node metastasis increased, resulting in worsening of ascites and abdominal distension, and CART was introduced.
By continuing 14 cycles of CART, the patient's general condition could be maintained, and chemotherapy could be continued up to the tenth line. His activities of daily living were improved and he was able to continue his own work and enjoy his personal time.
Conclusion: We experienced a case in which frequent CART was performed to continue chemotherapy and to improve QOL in terminal lung cancer patients. CART is effective in maintaining the general condition and QOL of patients with refractory ascites, as well as opioid use and psychosocial care. The introduction of CART into patients with refractory ascites should be proactively considered.},
 pages = {43--49},
 title = {肺がん終末期での腹水濾過濃縮再静注法の頻回施行によりQOLの改善が認められた1例},
 volume = {22},
 year = {2022},
 yomi = {ツバキ, タカヨシ and コダマ, マイコ and タケトウ, ユウヘイ and サトウ, マサユキ and アンザイ, マサキ and コバヤシ, ミキ and カミタニ, ユキオ and ウライ, マユミ and ヒロノ, ヤスオ and ゴイ, タカノリ}
}