Miura M, Terashima Y, Yamazaki S, Ikeyama S, Sasaki K, Taki S, Fukuda Y, Ishikawa M, Yogita S, Tashiro S
1st. Dept. of Surgery, Tokushima University School of Medicine.
Gan To Kagaku Ryoho. 1997 Jun;24(8):1031-4.
A 43-year-old woman was admitted to our hospital for sigmoid colon cancer with multiple liver metastasis (H3). As preoperative CTAP (CT during arterial portography) examination showed 23 metastatic nodules in the whole liver, hepatic resections were not indicated. Angiographic findings showed that right and left hepatic arteries branched separately from the celiac artery. Sigmoid colon resection with D3 lymph node dissection and catheterization to the right hepatic artery via gastroduodenal artery were undertaken as a first operation. Continuous hepatic artery infusion chemotherapy with MMC, 5-FU oriented by in vitro chemosensitivity test (SDI test: Succinic Dehydrogenase Inhibition test) of primary tumor was performed 7 days after the first operation. After administration of MMC (40 mg) and 5-FU (16,500 mg), metastatic nodules in the right lobe almost disappeared except for the one tumor of S7, but the size and number of the nodules in the left lobes increased. At 10 months after the first operation, the left hepatic lobectomy and extirpation of only one tumor in the right lobe (S7) underwent. This case showed the usefulness of continuous hepatic artery infusion chemotherapy oriented by in vitro chemosensitivity test for multiple liver metastasis from colon cancer.
一名43岁女性因乙状结肠癌伴多发肝转移（H3）入住我院。术前CT动脉门静脉造影（CTAP）检查显示全肝有23个转移结节，不适合行肝切除术。血管造影结果显示，肝右动脉和肝左动脉分别从腹腔动脉分支。首次手术行乙状结肠切除并D3淋巴结清扫，经胃十二指肠动脉向肝右动脉插管。首次手术后7天，根据原发肿瘤的体外化疗敏感性试验（SDI试验：琥珀酸脱氢酶抑制试验）进行以丝裂霉素（MMC）、5-氟尿嘧啶（5-FU）为主的持续肝动脉灌注化疗。给予MMC（40mg）和5-FU（16500mg）后，右叶转移结节除S7的一个肿瘤外几乎消失，但左叶结节的大小和数量增加。首次手术后10个月，行左肝叶切除及右叶仅一个肿瘤（S7）切除。该病例显示了体外化疗敏感性试验指导下的持续肝动脉灌注化疗对结肠癌多发肝转移的有效性。
