臨牀透析 Vol.24 No.8(5)


特集名 透析患者の呼吸器合併症
題名 肺腫瘍
発刊年月 2008年 07月
著者 辻田 章博 自治医科大学呼吸器内科
著者 大野 彰二 自治医科大学呼吸器内科
著者 杉山 幸比古 自治医科大学呼吸器内科
【 要旨 】 本邦において透析患者数の増加・高齢化がみられている.さらに健常人における肺癌罹患率も増加しており,今後の腎不全合併肺癌症例の増加が考えられる.透析導入症例では,ドライウエイト設定を目的とした胸部写真が撮影されるが,腫瘤影と肺うっ血,胸水貯留などとの鑑別が難しく,病期が進行して発見される症例もみられる.透析患者の抗癌剤治療については,抗癌剤の体内動態が不明瞭な薬剤が多く,明確な指針は得られていない.ただ,化学療法施行例では腎不全非合併症例に準じる効果を示す報告が多数みられている.早期肺癌患者では,手術により腎不全の合併の有無での予後の差はみられず,現時点では早期発見がもっとも予後を改善すると考えられる.
Theme Complications of Respiratory Organs in Dialysis Patients
Title Lung tumor treatment for dialysis patients
Author Akihiro Tsujita Division of Pulmonary Medicine, Department of Medicine,Jichi Medical University
Author Syoji Oono Division of Pulmonary Medicine, Department of Medicine,Jichi Medical University
Author Yukihiko Sugiyama Division of Pulmonary Medicine, Department of Medicine,Jichi Medical University
[ Summary ] In Japan, the number of patients undergoing dialysis has increased. The incidence of lung cancer in healthy adults has also increased. Therefore, the number of lung cancer patients with renal failure will likely increase in the future. Chest X-rays are frequently used in examinations to establish the dry weight of dialysis patients with renal failure. Since tumor shadows in chest X-rays are sometimes hard to differentiate from pulmonary congestion, retention of pleunal fluid, or calcification, much time is required to provide definitive diagnoses. This may lead to lung cancer not being diagnosed until it is at an advanced stage. There is little evidence concerning treatment with antineoplastic drugs for dialysis patients. Many case reports have indicated that the prognoses for lung cancer patients with chronic renal failure is comparable to those for patients without renal failure. At present, it is thought that early diagnosis of lung cancer is the best way to improve these prognoses.
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