[症例報告]肝細胞癌を合併したBudd-Chiari症候群の一期的手術の1治験例

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概要

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• A 38-year- old Japanese man with Budd-Chiari syndrome combined with hepatocellular carcinoma was successfully treated by direct reconstruction with open endvenectomy of the occluded vena cava and partial hepatectomy. In preoperative CT scanning, a round low density lesion, approximately 6 cm in diameter,was found in the superior-posterior segment of the liver. Inferior cavography and right atriography performed simultaneously demonstrated a complete obstruction of the hepatic vena cava, 8 cm in length , and left and middle hepatic veins. The venous pressure of the infrahepatic vena cava was moderately high with 220 mm H_2O. Laboratory examinations revealed a slight hepatic dysfunction including serum GOT of 70 IU/L and R-max in ICG disappearance test of 1.7mg/kg. Al fa-fetoprotein level in serum was considerably elevated with a reading of 500ng/ml. No esophageal varices were demonstrated preoperatively. The right thoracic and peritoneal cavity was entered through a right thoracoabdominal approach. The hepatic tumor was removed by partial resection of the superior-posterior segment of the liver. The occluded vena cava and hepatic veins were reconstructed by open endvenectomy technique with the aid of partial extracorporeal perfusion using femoro-femoral bypass technique. The caval venotomy was repaired by pericardial patch graft. Before making caval venotomy, the half round of the pericardial graft was longitudinally sutured on the wall of the posterior aspect of the occluded vena cava to cut down the clamping time in surgery. The resected hepatic mass was characterized by hepatocellular carcinoma in pathological examination. The liver around the mass was drrhotic including the findings of considerable fibrosis with vascular proliferation in the Glisson sheath and formation of pseudoazinus. The function of the reconstructed vena cava was acceptable in preperative venography via the femoral vein. The caval venous pressure was decreased from 220 mm H_2O preoperatively to 110 mm H_2O postoperatively. and alfa-fetoprotein level was also normalized from 500 ng/ml preoperatively to 2.9ng/ml postoperatively. The patient has been well with no recurrence of hepatic mass and no rethrombosis of the reconstructed vena cava 2 years after the surgery.

• 琉球大学医学部,Faculty of Medicine, University of the Ryukyusの論文

著者

• 金城 治

  琉球大学第2外科

• 金城 治

  大浜第一病院 外科

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• [症例報告]肝細胞癌を合併したBudd-Chiari症候群の一期的手術の1治験例

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