Wada Hiroshi, Nagano Hiroaki, Noda Takehiro, Damdinsuren Bazarragchaa, Marubashi Shigeru, Miyamoto Atsushi, Takeda Yutaka, Umeshita Koji, Dono Keizo, Wakasa Kenichi, Monden Morito
Dept of Surgery, Graduate School of Medicine, Osaka University.
Gan To Kagaku Ryoho. 2006 Nov;33(12):1935-7.
We report a 73-year-old man who underwent surgery for peritoneal dissemination of hepatocellular carcinoma (HCC) after percutaneous ethanol injection therapy (PEIT). He received posterior segmentectomy for HCC in 1997. Four years after the first hepatic resection, a recurrence lesion in the right caudal lobe of the liver was detected by computed tomography (CT). He underwent percutaneous ethanol injection therapy (PEIT) and transcatheter arterial embolization (TAE). He was referred to our hospital for further treatment. Abdominal CT revealed an early-enhanced lesion (3.2 cm in size) in the right caudal lobe of the liver and an irregular mass lesion (1.5 cm in size) in the cranial. We diagnosed the disease as recurrent HCC and carried out partial hepatectomy, removal of peritoneal dissemination and a reconstruction of the inferior vena cava. A histological feature of the tumor was a moderately differentiated HCC, and there was no lymphatic structure in the tumor, and no connection to the residual liver. Therefore, we diagnosed the tumor as peritoneal dissemination of HCC. We think that this is a rare but a serious complication of PEIT and every effort should be attempted to prevent this complication, especially in the treatment of superficial and larger HCC.
我们报告了一名73岁男性，其在经皮乙醇注射治疗（PEIT）后因肝细胞癌（HCC）腹膜播散而接受手术。他于1997年接受了肝癌右后叶切除术。首次肝切除术后四年，通过计算机断层扫描（CT）检测到肝脏右尾状叶出现复发灶。他接受了经皮乙醇注射治疗（PEIT）和经导管动脉栓塞术（TAE）。他被转诊至我院接受进一步治疗。腹部CT显示肝脏右尾状叶有一个早期强化病灶（大小为3.2 cm），以及在头侧有一个不规则肿块病灶（大小为1.5 cm）。我们将该疾病诊断为复发性肝癌，并进行了肝部分切除术、腹膜播散灶切除及下腔静脉重建。肿瘤的组织学特征为中度分化的肝癌，肿瘤内无淋巴管结构，与残余肝脏无连接。因此，我们将该肿瘤诊断为肝癌腹膜播散。我们认为这是PEIT一种罕见但严重的并发症，应尽一切努力预防这种并发症，尤其是在治疗浅表性及较大的肝癌时。
