Mamada Yasuhiro, Yoshida Hiroshi, Taniai Nobuhiko, Bandou Kouichi, Mizuguchi Yoshiaki, Kakinuma Daisuke, Ishikawa Yoshinori, Akimaru Koho, Tajiri Takashi, Naito Zenya
Surgery for Organ Function and Biological Regulation, Graduate School of Medinine, Nippon Medical School, Tokyo, Japan.
J Nippon Med Sch. 2007 Aug;74(4):314-8. doi: 10.1272/jnms.74.314.
A case of hepatocellular carcinoma (HCC) causing a major arterioportal (A-P) shunt is reported. The patient exhibited massive ascites and tested positive for hepatitis B surface antigen. An abdominal computed tomography (CT) examination showed a low-density lesion in the left lobe of the liver and an A-P shunt, but no tumor stain was visible. Upper gastrointestinal endoscopy revealed severe esophageal varices. Because the tumor marker level was abnormally high, an HCC causing an A-P shunt in a cirrhotic liver background with severe esophageal varices as a result of portal hypertension was diagnosed. We performed endoscopic variceal ligation to treat the severe esophageal varices and interventional radiology treatment for the A-P shunt and HCC, but the patients condition was unchanged. Because the patients liver function gradually improved, surgical treatment was selected. The patient underwent left hepatectomy. Pathological examination revealed a poorly differentiated HCC in a cirrhotic liver background. The postoperative course was uneventful, and the patient was discharged 2 weeks after the operation. The patient subsequently underwent transcatheter arterial embolization therapy for recurrent HCC in the right lobe of the liver, but the esophageal varices disappeared.
报告了一例导致严重动门静脉（A-P）分流的肝细胞癌（HCC）病例。该患者出现大量腹水，乙肝表面抗原检测呈阳性。腹部计算机断层扫描（CT）检查显示肝脏左叶有低密度病变及A-P分流，但未见肿瘤染色。上消化道内镜检查发现严重食管静脉曲张。由于肿瘤标志物水平异常升高，诊断为在肝硬化肝背景下导致A-P分流且因门静脉高压出现严重食管静脉曲张的HCC。我们进行了内镜下静脉曲张结扎术以治疗严重食管静脉曲张，并对A-P分流和HCC进行了介入放射学治疗，但患者病情未改善。由于患者肝功能逐渐改善，遂选择手术治疗。患者接受了左肝切除术。病理检查显示为肝硬化肝背景下的低分化HCC。术后过程顺利，患者术后2周出院。患者随后因肝右叶复发性HCC接受了经导管动脉栓塞治疗，且食管静脉曲张消失。
