横隔膜腫瘍と鑑別困難であった肝癌破裂の1例 : 広背筋による横隔膜再建

概要

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Spontaneous rupture of hepatocellular carcinoma (HCC) is sometimes encountered clinically. We experienced a case of spontaneous rupture of a HCC, which was surgically resected along with the diaphragm.A 74-year old woman presented with anemia. Preoperative imaging suggested a tumor arising on the diaphragm. After thoracotomy and laparotomy, the intraoperative diagnosis was changed to spontaneous rupture of a HCC with invasion to the diaphragm and right lower lung. Wide resection of the diaphragm including an area measuring 13×10 cm, partial resection of the right lower lung and right hepatectomy were performed. The defect in the diaphragm was reconstructed by suturing with a reversed latissimus dorsi muscle flap.There was no recurrence of HCC 7 years after surgery. Furthermore, the patient had no muscle weakness in the right arm during daily living activities.In conclusion, a good outcome may be obtained by combined resection of a ruptured HCC along with the diaphragm, even if the tumor has infiltrated the diaphragm. A latissimus dorsi muscle flap is considered to have a better antibacterial effect than an artificial mesh prosthesis, and is suitable for patients requiring wide resection of the diaphragm.
山形大学の論文
2014-02-15