食道胃静脈瘤治療後の肝癌発生例の検討 THE OCCURRENCE OF HEPATOMA FOLLOWING THE TREATMENT FOR ESOPHAGOGASTRIC VARICES
今回教室で経験した肝硬変症に起因する食道胃静脈瘤治療後の肝癌発生例,また同時に診断された症例を併せて検討し,治療方針に関して考察を加えたので報告する.<br> 肝硬変に起因する食道胃静脈瘤に肝癌を合併したのは25例であった.食道胃静脈瘤治療後に肝癌が発見された異時発生群は13例であった.うち静脈瘤の治療として手術が行われていたのが6例で, EISが6例に施行されていた.手術群は,肝癌発生時においても静脈瘤からの出血の心配なく肝癌治療に専念できた.予後を比較しても手術群に長期生存例がありまた死因としても出血死はなく止血の点で優れていた.同時診断例は12例であった.手術した2例に出血死はなく肝癌治療に専念できた.以上より肝硬変に起因する静脈瘤は,肝予備の許す限り積極的に手術を行うことを基本方針としている.
In this study our cases of hepatoma which developed after the treatment for esophagogastric varices caused by liver cirrhosis or those diagnosed as having a hepatoma and the varices simulatneously were studied, and some discussion on the therapeutic guidelines was added.<br> There were 25 cases of hepatoma following esophagogastric varices caused by liver cirrhosis. In 13 of the 25 cases, hepatoma was heterochronously found after the treatment of esophagogastric varices. Of the 13 cases, operation was performed in six cases as the treatment of the varices and EIS in another six cases. We were able to apply ourselves closely to treat the hepatoma in the six operated cases without worrying about bleeding from the varices. When compared for the prognosis, long-term survivors are noted in operated cases and there was no death due to hemorrhage. Operation is superior to the other in hemostasis. The remaining 12 cases were synchronuously diagnosed as having a hepatoma and varices. Of the 12 cases, two cases were operated on, in which we were able to concentrate on the treatment of hepatoma alone. It is concluded that aggresive attitude toward operation should be basically employed for the treatment of verices due to liver cirrhosis, if the hepatic functional reserve of the patient can permit it.
- 日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society
日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society 56(7), 1312-1316, 1995-07-25
Japan Surgical Association