内容紹介
Summary
The patient was a 63-year-old man. Computed tomography(CT)showed a 99 mm in diameter low-density mass in hepatic segments 4 and 8 as the main locus. This tumor was diagnosed as intrahepatic cholangiocarcinoma and was suspected to invade to left and right Gleason's sheath, and radical cure was judged impossible. After hepatic arterial chemotherapy and radiotherapy were performed, tumor shrinkage was confirmed, and tumor markers also became negative. So he was referred to our hospital for surgical indication. CT revealed that the tumor did not invade to the left Gleason's sheath. After percutaneous transhepatic portal embolization, hepatic right trisectionectomy was performed. He was administered gemcitabine as an adjuvant chemotherapy for 1 year. One year 5 months after surgery, the patient is alive without relapse. Preoperative hepatic arterial chemotherapy and radiotherapy could be an effective treatment for unresectable locally advanced intrahepatic cholangiocarcinoma.
要旨
症例は63歳,男性。肝機能異常を認め,腹部造影CTで肝S4,S8を主座とする99 mm大の乏血性腫瘍を認め,肝内胆管癌の診断となった。左右のグリソン鞘に浸潤を認め,根治切除不能と判断された。放射線療法併用肝動注化学療法を施行したところ,PR相当の腫瘍縮小を認め腫瘍マーカー陰性化も認めたため,手術適応に関して当科に紹介された。左グリソン鞘との距離を認め,門脈塞栓術後に肝右三区域切除術を施行した。病理結果は肝内胆管癌,pT3N0M0,pStage Ⅲであった。腫瘍断端が露出していたため,術後7週目より術後補助化学療法としてgemcitabineを静注で1年間投与した。術後1年5か月経過し,無再発生存中である。局所過伸展による切除不能肝内胆管癌に対して,術前放射線療法併用肝動注化学療法が有効な手段となり得ると考えられた。
目次
The patient was a 63-year-old man. Computed tomography(CT)showed a 99 mm in diameter low-density mass in hepatic segments 4 and 8 as the main locus. This tumor was diagnosed as intrahepatic cholangiocarcinoma and was suspected to invade to left and right Gleason's sheath, and radical cure was judged impossible. After hepatic arterial chemotherapy and radiotherapy were performed, tumor shrinkage was confirmed, and tumor markers also became negative. So he was referred to our hospital for surgical indication. CT revealed that the tumor did not invade to the left Gleason's sheath. After percutaneous transhepatic portal embolization, hepatic right trisectionectomy was performed. He was administered gemcitabine as an adjuvant chemotherapy for 1 year. One year 5 months after surgery, the patient is alive without relapse. Preoperative hepatic arterial chemotherapy and radiotherapy could be an effective treatment for unresectable locally advanced intrahepatic cholangiocarcinoma.
要旨
症例は63歳,男性。肝機能異常を認め,腹部造影CTで肝S4,S8を主座とする99 mm大の乏血性腫瘍を認め,肝内胆管癌の診断となった。左右のグリソン鞘に浸潤を認め,根治切除不能と判断された。放射線療法併用肝動注化学療法を施行したところ,PR相当の腫瘍縮小を認め腫瘍マーカー陰性化も認めたため,手術適応に関して当科に紹介された。左グリソン鞘との距離を認め,門脈塞栓術後に肝右三区域切除術を施行した。病理結果は肝内胆管癌,pT3N0M0,pStage Ⅲであった。腫瘍断端が露出していたため,術後7週目より術後補助化学療法としてgemcitabineを静注で1年間投与した。術後1年5か月経過し,無再発生存中である。局所過伸展による切除不能肝内胆管癌に対して,術前放射線療法併用肝動注化学療法が有効な手段となり得ると考えられた。