S1,S5を温存した拡大肝切後の高ビリルビン血症に対し集学的治療が奏効した1例

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  • Multidisciplinary Treatment for Hyperbilirubinemia after Extended Hepatectomy in a Patient with Multiple Metastatic Liver Cancer.

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We found that multidisciplinary treatment was effective in hyperbilirubinemia after extended hepatectomy. In a 58-year-old man undergoing sigmoidectomy for sigmoid colon cancer, a metastatic liver tumor was found in all segments but S1 and S5 of the liver. Staged hepatectomy was conducted to remove all segments but these two. The patient's fever rose and hyperbilirubinemia appeared postoperatively, and then he suffered liver failure. Methicillin-resistant Staphylococcus epidermidis and Enterococcus faecalis were detected from a blood culture. A liver biopsy disclosed sinusoidal fibrosis. The remnant liver volume increased to 96% of the preoperative volume 43 days after the second hepatectomy. Even after the infection was successfully controlled, the hyperbilirubinemia still continued. After the treatment with hyperbaric oxygenation (HBO) and the administration of ursodeoxycholic acid (UDCA), steroids, and phenobarbital, the total bilirubin level decreased. Hypoxia of hepatocytes may have been improved by the HBO, and the cholagogic function also improved by the steroids and UDCA.

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