Hashimoto Kazuhiko, Sasaki Yo, Yokoyama Shigekazu, Hiraki Masayuki, Matsumoto Shinji, Tokuoka Masayoshi, Matsuyama Jin, Morita Shunji, Morimoto Takashi, Fukushima Yukio, Nomura Takashi, Yoshida Shigeyuki, Takeda Masashi
Dept. of Surgery, Yao Municipal Hospital.
Gan To Kagaku Ryoho. 2011 Nov;38(12):2466-8.
A 70-year-old man with type B hepatitis had ruptured HCC in segment 5, and he underwent with TAE at other hospital in June 2007. Then, he was introduced to our hospital in July 2007. Partial hepatectomy( S5) was performed in August 2007 (pT2N0M0, Stage II). Afterward, he underwent TACE therapy twice because of multiple intrahepatic recurrences. Abdominal CT revealed a viable recurrence lesion (S5), and peritoneal dissemination (surface of S3) in June 2009. We carried out partial hepatectomy (S5), and removal of peritoneal dissemination because of good liver function and without any other extra hepatic recurrence in July 2009. Histologically, the intrahepatic lesion( S5) and the S3 surface lesion were diagnosed as moderately differentiated HCC. In July 2010, abdominal CT revealed three lesions of peritoneal dissemination (right subphrenic lesion, hepatic flexure of the colon, neighborhood of left ureter, then the second removal of peritoneal dissemination was performed. In January 2011, he had multiple lung metastatic lesions, and multiple bone metastatic lesions were occurred in March 2011, then his general condition was getting worse. In April 2011, he was dead 46 months after the first TAE therapy for ruptured HCC, or 21 months after the first resection of peritoneal dissemination. Surgical resection of peritoneal dissemination of HCC may improve a survival for patients whose intrahepatic lesion is contorollable.
一名70岁的B型肝炎男性患者，其肝5段的肝细胞癌（HCC）破裂，于2007年6月在其他医院接受了经动脉栓塞术（TAE）。随后，他于2007年7月转诊至我院。2007年8月进行了肝部分切除术（肝5段）（pT2N0M0，II期）。之后，由于肝内多次复发，他接受了两次经动脉化疗栓塞（TACE）治疗。2009年6月腹部CT显示有一个存活的复发灶（肝5段）以及腹膜播散（肝3段表面）。由于肝功能良好且无其他肝外复发，我们于2009年7月进行了肝部分切除术（肝5段）并切除了腹膜播散灶。组织学检查显示，肝内病灶（肝5段）和肝3段表面病灶均被诊断为中分化肝细胞癌。2010年7月，腹部CT显示有三处腹膜播散灶（右膈下病灶、结肠肝曲、左输尿管附近），随后进行了第二次腹膜播散灶切除术。2011年1月，他出现了多发肺转移灶，2011年3月出现多发骨转移灶，随后其全身状况逐渐恶化。2011年4月，在首次因HCC破裂接受TAE治疗46个月后，或首次切除腹膜播散灶21个月后，他去世。对于肝内病灶可控的肝细胞癌患者，手术切除腹膜播散灶可能会提高生存率。
