Sato M, Watanabe Y, Tokui K, Lee T, Kohtani T, Nakata Y, Chen Y, Kawachi K
Department of Surgery II, Ehime University School of Medicine, Shitsukawa, Shigenobu, Onsen-gun, Ehime, 791-0295, Japan.
Surg Endosc. 2000 Mar;14(3):296. doi: 10.1007/s004649901206. Epub 2000 Feb 12.
Due to recent improvements in radiographic technique, computed tomography (CT) occasionally delineates small hepatocellular carcinomas (HCCs) that are invisible with sonography. However, surgery has not been a viable option for these lesions because of the absence of tumor localization. We describe a new technique of preoperative tumor localization using a hookwire to guide laparoscopic surgery for such HCCs. A 68-year-old man with HCC had tumor recurrence after chemoembolization. Two recurrent lesions, 10 mm or less in diameter, located in segment III were demonstrated; not by sonography but by Lipiodol CT. We successfully placed a hookwire into the tumor through a 21-gauge needle under the guidance of CT. The hookwire instrument provided the only clue of tumor location at laparoscopy. The liver around the hookwire was thoroughly coagulated. The postoperative course was uneventful, and the tumor was completely ablated. Preoperative CT-guided hookwire placement is useful to localize and to laparoscopically treat small hepatic lesions.
由于近期放射成像技术的改进，计算机断层扫描（CT）偶尔能检测出超声检查无法发现的小肝细胞癌（HCC）。然而，由于无法进行肿瘤定位，手术并非这些病灶的可行治疗选择。我们描述了一种术前肿瘤定位新技术，即使用钩丝引导腹腔镜手术治疗此类肝癌。一名68岁的肝癌男性患者在化疗栓塞后出现肿瘤复发。通过碘油CT发现了位于Ⅲ段的两个直径10毫米或更小的复发病灶，而超声检查未发现。我们在CT引导下通过21号针成功将钩丝置入肿瘤。钩丝器械是腹腔镜检查时肿瘤定位的唯一线索。围绕钩丝的肝脏组织被彻底凝固。术后过程顺利，肿瘤被完全消融。术前CT引导下放置钩丝有助于定位并通过腹腔镜治疗小肝脏病灶。
