Harimoto Norifumi, Araki Kenichiro, Muranushi Ryo, Hoshino Kouki, Hagiwara Kei, Ishii Norihiro, Tsukagoshi Mariko, Igarashi Takamichi, Watanabe Akira, Kubo Norio, Shibuya Kei, Miyazaki Masaya, Kawanaka Hirofumi, Shirabe Ken
Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22, Showamachi, Maebashi, 371-8511, Japan.
Department of Innovative Cancer Immunotherapy, Graduate School of Medicine, Gunma University, Maebashi, Japan.
Surg Case Rep. 2020 Jul 31;6(1):190. doi: 10.1186/s40792-020-00952-4.
Liver cirrhosis occurs in approximately 80-90% of patients with hepatocellular carcinoma (HCC), and hepatic resection may be dangerous because of well-documented liver cirrhosis, which may be accompanied by portal hypertension (PH). Here we report a patient with advanced HCC with gastric varices and PH who experienced a good clinical course after undergoing balloon-occluded retrograde transvenous obliteration (BRTO), percutaneous transhepatic portal vein embolization (PTPE), hand-assisted laparoscopic (HALS) splenectomy, and right lobectomy of the liver.
A 72-year-old man had two HCCs with gastric varices. CT revealed one tumor (4.5 cm) located in segment 7, involving the right hepatic vein, adjacent to the middle hepatic vein. Another tumor (2.7 cm) was located in segment 6. He first underwent BRTO for gastric varices and PTPE for planned right lobectomy of the liver. To reduce PH, HALS splenectomy was performed, and uncomplicated right lobectomy of the liver was performed 10 weeks after the first visit. He has remained free of recurrence for at least 1 year.
Our patient underwent uncomplicated BRTO, PTPE, HALS splenectomy, and right lobectomy of the liver for advanced HCC with PH. Controlling portal pressure is important when hepatic resection is required to treat HCC with PH.
肝细胞癌（HCC）患者中约80 - 90%会发生肝硬化，由于已有充分文献记载的肝硬化可能伴有门静脉高压（PH），肝切除手术可能具有危险性。在此，我们报告一名患有晚期HCC且伴有胃静脉曲张和PH的患者，该患者在接受球囊闭塞逆行静脉栓塞术（BRTO）、经皮经肝门静脉栓塞术（PTPE）、手辅助腹腔镜（HALS）脾切除术及肝右叶切除术后，临床病程良好。
一名72岁男性患有两个HCC病灶及胃静脉曲张。CT显示一个肿瘤（4.5厘米）位于第7段，累及肝右静脉，与肝中静脉相邻。另一个肿瘤（2.7厘米）位于第6段。他首先接受了针对胃静脉曲张的BRTO和针对计划中的肝右叶切除术的PTPE。为降低PH，进行了HALS脾切除术，并在首次就诊10周后顺利进行了肝右叶切除术。他至少已无复发1年。
我们的患者接受了针对伴有PH的晚期HCC的BRTO、PTPE、HALS脾切除术及肝右叶切除术，手术过程顺利。在需要肝切除治疗伴有PH的HCC时，控制门静脉压力很重要。
