Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma, 370-0829, Japan.
Department of Surgery, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma, 370-0829, Japan.
Clin J Gastroenterol. 2022 Feb;15(1):177-184. doi: 10.1007/s12328-021-01558-5. Epub 2021 Nov 22.
We herein report a successfully treated case of huge ruptured hepatocellular carcinoma (HCC) by conversion hepatectomy after transarterial embolization (TAE) and lenvatinib therapy. A 33-year-old male patient with right hypochondralgia and liver tumor was referred to our hospital. He had a history of surgery for heart malformation. The tumor at the right lobe was 15 cm in diameter with bloody ascites. Right atrial thrombus 4.5 cm in diameter and marked cardiac dilatation were observed. TAE with ethanol suspended in lipiodol and gelatin sponge achieved hemostasis of the ruptured HCC. Although viable HCC remained after TAE, surgical treatment was abandoned because of abdominal wall invasion and his heart function. Lenvatinib and rivaroxaban were then initiated for HCC and atrial thrombus, respectively. Lenvatinib treatment resulted in a reduction in tumor marker levels and the tumor size. First, we planned conversion hepatectomy after 5 months of lenvatinib. However, recurrence of atrial thrombus prompted us to put off the surgery, and lenvatinib was re-administered. After improvement of atrial thrombus, we finally performed conversion hepatectomy 10 months after starting lenvatinib administration. The tumor was completely removed by combined resection of the diaphragm, and the patient has been doing well without any signs of recurrence.
我们在此报告一例成功治疗的巨大破裂肝细胞癌（HCC）病例，该患者在经动脉栓塞（TAE）和仑伐替尼治疗后接受了转换性肝切除术。一名 33 岁男性因右季肋部疼痛和肝肿瘤就诊于我院。他曾因心脏畸形接受过手术。右叶肿瘤直径 15cm，伴血性腹水。发现右心房 4.5cm 直径血栓，伴有明显的心脏扩张。TAE 联合乙醇混悬液碘油和明胶海绵栓塞成功止血破裂的 HCC。尽管 TAE 后仍有存活的 HCC，但由于腹壁侵犯和心脏功能，手术治疗被放弃。仑伐替尼和利伐沙班分别用于 HCC 和心房血栓的治疗。仑伐替尼治疗后肿瘤标志物水平和肿瘤大小均降低。我们最初计划在仑伐替尼治疗 5 个月后进行转换性肝切除术。然而，由于心房血栓复发，我们推迟了手术，并重新给予仑伐替尼治疗。在心房血栓改善后，我们最终在开始仑伐替尼治疗 10 个月后进行了转换性肝切除术。通过联合膈肌切除完全切除了肿瘤，患者情况良好，无复发迹象。
