Takaoka Yoshinari, Morimoto Naoki, Miura Kouichi, Nomoto Hiroaki, Murayama Kozue, Hirosawa Takuya, Watanabe Shunji, Fujieda Takeshi, Ttsukui Mamiko, Kawata Hirotoshi, Niki Toshiro, Isoda Norio, Iijima Makoto, Yamamoto Hironori
Division of Gastroenterology, Department of Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Department of Diagnostic Pathology, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Clin J Gastroenterol. 2018 Dec;11(6):501-506. doi: 10.1007/s12328-018-0877-x. Epub 2018 Jun 16.
Hepatocellular carcinoma (HCC) can be difficult to diagnose and treat in patients with Osler-Rendu-Weber disease due to vascular malformation and regenerative nodular hyperplasia. In addition, percutaneous liver puncture should be avoided for the diagnosis and treatment as the procedure carries a high risk of bleeding. We herein report the successful treatment of HCC in a patient with Osler-Rendu-Weber disease using radiofrequency ablation (RFA) under laparoscopy. A 71-year-old man with Osler-Rendu-Weber disease was admitted to our hospital for the treatment of HCC. He also had chronic hepatitis C virus infection. The arterioportal shunts in the liver were detected by computed tomography (CT) and angiography. A tumor 20 mm in size was detected as a defected-lesion in the hepatic segment IV during the portal phase by CT. RFA under laparoscopy was performed for the curative treatment for HCC, with sufficient ablation obtained. Although the blood gushed out from the needle tract at the end of the procedure, complete hemostasis was achieved promptly using coagulation forceps. The post-operative course was favorable. Thus, laparoscopic RFA is a useful treatment modality for HCC in patients with Osler-Rendu-Weber disease, as a hemostasis device can be used with direct visualization.
由于血管畸形和再生结节性增生，奥-伦-韦氏病患者的肝细胞癌（HCC）可能难以诊断和治疗。此外，由于经皮肝穿刺操作有较高的出血风险，因此应避免将其用于诊断和治疗。我们在此报告了1例奥-伦-韦氏病患者在腹腔镜下使用射频消融（RFA）成功治疗HCC的病例。1名患有奥-伦-韦氏病的71岁男性因HCC入院治疗。他还患有慢性丙型肝炎病毒感染。通过计算机断层扫描（CT）和血管造影检测到肝脏存在动静脉分流。在CT门静脉期，肝IV段发现一个20毫米大小的肿瘤，表现为缺损性病变。对HCC进行了腹腔镜下RFA根治性治疗，消融充分。尽管在手术结束时针道有出血，但使用凝血钳迅速实现了完全止血。术后过程顺利。因此，腹腔镜RFA是治疗奥-伦-韦氏病患者HCC的一种有用的治疗方式，因为可以在直视下使用止血装置。
