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Please use this identifier to cite or link to this item: http://hdl.handle.net/20.500.12001/2295

 
Title :[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
Title alternative :Surgical Treatment for Budd-Chiari Syndrome Combined with Hepatocellular Carcinoma : a Case Report
Authors :伊波, 潔
古謝, 景春
金城, 治
国吉, 幸男
赤崎, 満
久貝, 忠男
安里, 義徳
玉城, 守
永吉, 盛司
平安, 恒男
松本, 直之
与那覇, 俊美
新屋, 瑛一
大田, 守雄
城間, 寛
喜名, 盛夫
草場, 昭
Authors alternative :Iha, Kiyoshi
Koja, Kageharu
Kinjyo, Osamu
Kuniyoshi, Yukio
Akasaki, Mitsuru
Kugai, Tadao
Asato, Yoshinori
Tamashiro, Mamoru
Nagayoshi, Seiji
Hirayasu, Tsuneo
Matumoto, Naoyuki
Yonaha, Toshimi
Shinya, Eiichi
Oota, Morio
Shiroma, Hiroshi
Kina, Morio
Kusaba, Akira
Authors affiliation :琉球大学医学部第二外科
Issue Date :1989
Publisher :琉球大学医学部
Type Local :雑誌掲載論文
Type (NII) :Journal Article
ISSN :0289-1530
Abstract :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.
Rights :琉球医学会
URI :http://hdl.handle.net/20.500.12001/2295
Citation :琉球大学医学会雑誌 : 医学部紀要 = Ryukyu medical journal Vol.11 no.2 p.113 -120
Appears in Collections:Ryukyu medical journal

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