Hamazoe Ryuichi, Sakimura Chika, Iwamoto Akemi, Yamane Nariyuki, Kimura Osamu
Dept. of Surgery, National Hospital Organization, Yonago Medical Center.
Gan To Kagaku Ryoho. 2007 Nov;34(12):2084-6.
A 61-year-old man was referred for evaluation of positive HBs-Ag and an unusually high level (28,396 ng/mL) of serum alpha-fetoprotein in serum. Computed tomography of the abdomen revealed a huge extrahepatically growing tumor which was originating from the caudate lobe and extended to the posterior segment of the right lobe of the liver and encircled the anterior half of inferior vena cava. Biochemical examination showed a good liver function with 8% of ICG R15 and 103% of prothrombin time. Total resection of the caudate lobe with posterior segmentectomy was performed. Relapsing tumors, which metastasized to the liver in 9 months, the right lung in 15 months and the left lung in 20 months after initial surgery, were totally resected, respectively. Radiation therapy was effective to mediastinal lymph nodes metastasized in 25 months after the initial surgery. He survived with good quality of life for 46 months until he died from brain metastasis. Therefore, the multidisplinary therapy combined with radiation and surgery for hepatocellular carcinoma of the caudate lobe may have improved a long-term survival.
一名61岁男性因血清乙肝表面抗原阳性及血清甲胎蛋白水平异常高（28,396 ng/mL）而前来接受评估。腹部计算机断层扫描显示，有一个巨大的肝外生长肿瘤，起源于尾状叶，延伸至肝右叶后段，并环绕下腔静脉前半段。生化检查显示肝功能良好，吲哚菁绿滞留率为8%，凝血酶原时间为103%。实施了尾状叶全切除并切除后段。复发性肿瘤分别在初次手术后9个月转移至肝脏、15个月转移至右肺、20个月转移至左肺，均被完全切除。放射治疗对初次手术后25个月出现的纵隔淋巴结转移有效。他生存质量良好，存活了46个月，直至死于脑转移。因此，对尾状叶肝细胞癌采用放疗和手术相结合的多学科治疗可能改善了长期生存率。
