Iwata Miku, Sakamoto Katsunori, Ito Chihiro, Sakamoto Akimasa, Uraoka Mio, Nagaoka Tomoyuki, Tamura Kei, Funamizu Naotake, Takai Akihiro, Ogawa Kohei, Takada Yasutsugu
Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
Surg Case Rep. 2021 May 10;7(1):115. doi: 10.1186/s40792-021-01198-4.
The Fontan procedure (FP) is a palliative surgery for functional single ventricle. The Fontan circulation maintains pulmonary circulation by a high central venous pressure, leading to chronic congestive liver. The number of patients diagnosed with hepatocellular carcinoma (HCC) arising from liver fibrosis and cirrhosis after FP is increasing. Several reports have described surgical treatment for HCC after FP, but few have described laparoscopic surgery.
The patient was a 31-year-old man who had undergone the FP for single right ventricle at 3 years. Several liver masses were detected at 30 years. A liver mass in segment 3 showed increasing size concomitant with increasing alpha-fetoprotein concentration, and a solitary HCC 15 mm in diameter was diagnosed. The tumor was located on the liver surface, abutting the origin of the left hepatic vein. Laparoscopic partial liver resection was performed. The postoperative course was uneventful and the patient was discharged on postoperative day 3. The patient remained disease-free on follow-up after 7 months.
Although we had some concerns, such as difficulty managing general anesthesia and easy venous bleeding due to high central venous pressure, laparoscopic partial liver resection was performed with safe exposure of the left hepatic vein.
Fontan手术（FP）是一种用于功能性单心室的姑息性手术。Fontan循环通过高中心静脉压维持肺循环，导致慢性充血性肝损伤。Fontan手术后因肝纤维化和肝硬化而诊断为肝细胞癌（HCC）的患者数量正在增加。有几份报告描述了Fontan手术后HCC的手术治疗，但很少有描述腹腔镜手术的。
患者为一名31岁男性，3岁时因右单心室接受了Fontan手术。30岁时发现多个肝脏肿块。3段的一个肝脏肿块大小增加，同时甲胎蛋白浓度升高，诊断为直径15mm的孤立性HCC。肿瘤位于肝表面，毗邻左肝静脉起源处。进行了腹腔镜肝部分切除术。术后过程顺利，患者于术后第3天出院。7个月后的随访中患者无疾病复发。
尽管我们有一些担忧，如全身麻醉管理困难以及由于高中心静脉压导致静脉容易出血，但腹腔镜肝部分切除术在安全暴露左肝静脉的情况下得以进行。
