経皮的経肝門脈枝塞栓術後の肝動脈塞栓術によりギランバレー症候群を発症した１症例のサイトカインよりの検討 [in Japanese] A Case Report of Guillain-Barre Syndrome Induced by Transcatheter Chemoembolization after Percutaneous Transhepatic Portal Embolization Analyzed by Cytokines [in Japanese]
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経皮的経肝門脈枝塞栓術 (以下, PTPE) は, 主に, 肝細胞癌や肝門部胆管癌, 胆嚢癌などの肝胆道系悪性腫瘍に対する拡大肝切除術術前処置としてもはや疑いの無いところであるが, その反面合併症などが少なからず存在し, 今回PTPEおよび肝動脈化学塞栓療法 (TACE) 施行後にギランバレー症候群を発症した症例を経験したので報告する. 症例は68歳の男性, 慢性肝炎 (C型) で経過観察中, 拡大右葉切除予定でPTPE施行するも肝機能不良にて手術施行せずTACE施行. その後, 感冒様症状を呈した後, ギラン-バレー症候群を発症した. この症例を詳細に検討した結果, IL-6の過剰な反応が見られ, 何らかの免疫反応異常の可能性が示唆された.<BR>PTPEおよびTACE施行後に肝梗塞が生じた場合, の侵襲の大きさから予期せぬ合併症が生ずることがあり, PTPE後のTACEは適応を選び慎重に行う必要があると考えられる.
Percutaneous transhepatic portal embolization (PTPE) for preconditioning is often employed in hepatobiliary surgery for major hepatectomy. We report a case of Guillain-Barre syndrome after PTPE. A 68-yearold man was admitted to our hospital because of a liver tumor. The tumor was located in segment8, along the middle and right hepatic vein. Preoperative evaluation of this patient, suggested determined that an extended right hepatic lobectomy or more was necessary. PTPE was performed before hepatectomy. CT was done two weeks after PTPE, which indicated that the left lobe was enlarged by117%, however, based on the other laboratory data and patient's performance status, a major hepatectomy did not seem to be indicated. We therefore decided to do a trans-arterial chemoembolization (TACE) first. After five days, the patient had a slight fever and leukocytosis, both of which had resolved by the ninth day. On the twelfth day after TACE, the patient had quadriplegia, anarthria, dyspnea, and vertigo. A neurosurgeon diagnosed the patient as having Guillain-Barre syndrome. We checked the cytokines, HGF, IL-6, IL-1β and TGF-β1, in five patients including this patient. In this study, only IL-6 was increased about twelve fold after PTPE. Some immunological over-reaction probably occurred, resulting in Guillain-Barre syndrome. Because PTPE may have unknown side effects, it should be used only after careful deliberation.
- The Japanese Journal of Gastroenterological Surgery
The Japanese Journal of Gastroenterological Surgery 37(3), 301-306, 2004
The Japanese Society of Gastroenterological Surgery