マイクロ波凝固法が奏効した大腸癌の多発肝転移の1例 [in Japanese] A CASE OF MULTIPLE HEPATIC METASTASES FROM A COLONIC CANCER SUCCESSFULLY TREATED WITH MICROWAVE COAGULATION THERAPY [in Japanese]
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われわれは,手術中に発見した大腸癌の多発肝転移に対し,マイクロ波凝固法を施行し,完全壊死を得た症例を経験したので,報告する.症例は58歳の女性で腸閉塞症状にて受診し,大腸癌と診断された.術前CT検査や超音波検査では肝に異常を認めなかった.左半結腸切除術を施行したが,術中に1cm以下の5個の多発肝転移を認めたためマイクロ波凝固法を併施した.病理組織学的には,大腸はtubular adenocarcinoma,肝臓はmetastatic adenocarcinomaと診断された.術7カ月後のCTと血管造影で新たな転移巣を認め,術9カ月後に肝拡大右葉切除術を施行した.病理組織学的診断で初回手術時マイクロ波凝固法をした肝の転移巣はすべて壊死していた.肝切後18カ月後の現在無再発生存中である.本例のように,多発肝転移例に対してもマイクロ波凝固法をすることで,根治手術が期待できると考える.
We report a case of colonic cancer in which multiple hepatic metastases found intraoperatively were treated with microwave coagulation therapy and thereafter those metastases were histologically proved to be completely necrotized. A 58-year-old woman was admitted to the hospital because of colonic obstruction due to an advanced colonic cancer. Preoperative CT scan and ultrasonography revealed no hepatic metastases. When a left colectomy for the colonic cancer was performed, five metastatic lesions in the liver smaller than 1 cm in S4. S5, S6 and S7 segments were found out. A microwave needle electrode was inserted into the hepatic lesions to coagulate them in situ. Seven months after the operation a new metastatic lesion of the liver was detected, and nine months after the operation an extended right hepatectomy including all previously coagulated metastases was performed. Liver specimen histologically showed that coagulated hepatic metastases were completely necrotized. There has been no sign of recurrence, as of 18 months after the hepatectomy. We would stress that multiple hepatic metastses can be controlled with microwave coagulation therapy that offers a possibility of curative hepatic resection.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 58(7), 1578-1582, 1997-07-25
Japan Surgical Association