高度門脈腫瘍栓を伴う切除不能な大型肝細胞癌に対し門脈結紮・ラジオ波凝固療法・3次元原体照射による併用療法が著効した1例  [in Japanese] A Case of Huge Hepatocellular Carcinoma with Extensive Portal Vein Tumor Thrombus, Successfully Treated with Multi-Model Therapy Including Ligation of Right Portal Vein, Radiofrequency-Ablation, and Postoperative Three-Dimensional Comformal Radiotherapy  [in Japanese]

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Author(s)

    • 別府 透 BEPPU Toru
    • 熊本大学大学院消化器外科学 Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
    • 石河 隆敏 ISHIKO Takatoshi
    • 熊本大学大学院消化器外科学 Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
    • 堀野 敬 HORINO Kei
    • 熊本大学大学院消化器外科学 Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
    • 小森 宏之 KOMORI Hiroyuki
    • 熊本大学大学院消化器外科学 Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
    • 増田 稔郎 MASUDA Toshiro
    • 熊本大学大学院消化器外科学 Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
    • 林 洋光 HAYASHI Hiromitsu
    • 熊本大学大学院消化器外科学 Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
    • 岡部 弘尚 OKABE Hirohisa
    • 熊本大学大学院消化器外科学 Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
    • 広田 昌彦 HIROTA Masahiko
    • 熊本大学大学院消化器外科学 Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
    • 馬場 秀夫 BABA Hideo
    • 熊本大学大学院消化器外科学 Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University

Abstract

症例は82歳の男性で,C型肝硬変,肝細胞癌の診断で,他院にて平成15年より計4回の肝動脈化学塞栓療法の治療歴がある.平成17年8月より急速なAFPの上昇(8月98.8ng/ml,9月1,627ng/ml,10月11,679ng/ml,11月199,880ng/ml)を認めた.同年12月のCTにて門脈右枝に充満した腫瘍栓を伴う径6cmの肝細胞癌を認め,当科入院となった.肝機能(ICG-R15:29.0%),非癌部肝切除率74%,年齢などから切除は不能と判断し,開腹による門脈結紮術とラジオ波凝固療法および,門脈腫瘍栓に対する術後3次元原体照射(総線量45Gy)を施行した.経過観察中にS6,S8に径1cm大の再発を認め,経皮的ラジオ波凝固療法を施行した.術後2年が経過した現在,AFPは正常,tumor freeで外来通院中である.切除不能な門脈腫瘍栓を有する大型肝細胞癌に対する,新しい治療選択肢に成りうると考え報告した.

We report a case of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) successfully treated with multimodel therapy. A 82-year-old man with HCC who had undergone transcatheter arterial chemoembolization (TACE) 4 times and admitted for rapidly elevated AFP was found in abdominal computed tomography (CT) to have HCC (S5) 6cm in diameter with PVTT (Vp3) and two satellites (S4). When the high resection rate and poor liver function ruled out right hepatectomy, we conducted intraoperative ligation of the right portal vein and radiofrequency ablation (RFA) and three-dimensional postoperative comformal radiotherapy (total: 45Gy). HCC recurred in the right liver alone at 6, 15, and 20 months after surgery. Percutaneous RFA was achieved for all of these lesions. Two years postoperatively, AFP remains within a normal range and the patient is doing very well without reccurrences. Operative portal ligation combined with RFA and three-dimensional postoperative comformal radiotherapy is thus quite useful in treating unresectable HCC with PVTT (Vp3).

Journal

  • The Japanese journal of gastroenterological surgery

    The Japanese journal of gastroenterological surgery 41(12), 2035-2040, 2008-12-01

    The Japanese Society of Gastroenterological Surgery

References:  15

Codes

  • NII Article ID (NAID)
    110007005899
  • NII NACSIS-CAT ID (NCID)
    AN00192066
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    03869768
  • Data Source
    CJP  NII-ELS 
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