肝細胞癌に対する胸腔鏡下マイクロ波凝固壊死療法の経験

概要

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Thoracoscopic microwave coagulonecrotic therapy (TMCT) have been reported one of the benefit approach for hepatocellular carcinoma (HCC) which located on the subphrenic area of the liver. In this report, TMCT was performed on 3 patients with HCC. They were selected because percutaneous ethanol injection therapy (PEIT), transcatheter arterial embolization (TAE) were not effective and surgical resection could not be done because of hepatic dysfunction. A thoracoscope was introduced into the thoracic cavity through the fifth intercostal space in the midaxillary line, and two other trocars were placed at the 4th intercostal space in the anterior axillary line and 5th intercostal space in the posterior axillary line. TMCT was performed with the guidance of endoscopic ultrasonography (EUS), 1 case was done across the diaphragm and 2 cases were done open the diaphragm. Microwave coagulators with 10 mm diameters, 40 mm in length were used under the condition of output of coagulator at 80 - 100 watts and the duration at 40 - 60 sec. MCT was repeated until the surrounding tissue was unclear by EUS. The effectiveness of the coagulation were ascertain by postoperative enhanced computed tomography.