Takayama T, Kato H, Tachimori Y, Watanabe H, Furukawa H, Takayasu K, Sakamoto M, Makuuchi M
Department of Surgery, National Cancer Center Hospital, National Cancer Center Research Institute, Tokyo, Japan.
Jpn J Clin Oncol. 1996 Aug;26(4):248-51. doi: 10.1093/oxfordjournals.jjco.a023223.
We describe a case of rupture of a liver metastasis from esophageal leiomyosarcoma which was treated successfully by hepatic arterial embolization, thus facilitating hepatectomy. A 59-year-old woman who had previously undergone esophagectomy for leiomyosarcoma was admitted in a state of hypovolemic shock. Ultrasonography revealed multiple tumors in the left lobe of the liver and massive intraperitoneal hemorrhage, confirmed by paracentesis, possibly due to spontaneous rupture. Subsequent hepatic angiography showed extravasation from the tumor, and embolization of the feeding left hepatic artery was performed. After achieving hemostasis, a left hepatic lobectomy was carried out just beneath the reconstructed stomach tube. The patient made an uneventful recovery and remains well after one year. Emergency arterial embolization followed by hepatectomy is an appropriate treatment for patients with spontaneous rupture of liver metastases.
我们描述了一例食管平滑肌肉瘤肝转移瘤破裂的病例，该病例通过肝动脉栓塞术成功治疗，从而为肝切除术创造了条件。一名59岁女性，此前因平滑肌肉瘤接受了食管切除术，现因低血容量性休克入院。超声检查显示肝脏左叶有多个肿瘤，腹腔穿刺证实有大量腹腔内出血，可能是自发破裂所致。随后的肝血管造影显示肿瘤有造影剂外渗，遂对供血的左肝动脉进行了栓塞。止血后，在重建胃管下方进行了左肝叶切除术。患者恢复顺利，一年后情况良好。对于肝转移瘤自发破裂的患者，紧急动脉栓塞后行肝切除术是一种合适的治疗方法。
