Indocyanine green蛍光法が胆管内進展した大腸癌肝転移に対する腹腔鏡下肝切除時の切除範囲決定に有用であった1例

Intraoperative indocyanine green fluorescence imaging as an effective tool for identifying the extent of biliary infiltration in colorectal liver metastasis : A case report

◆要旨：症例は82歳，女性．労作時胸痛を主訴に前医を受診し，高度貧血を認め，精査でS状結腸癌同時性肝転移と診断された．原発巣の切除後に，肝転移の切除目的に当院へ紹介された．当院の画像検査で切除可能多発肝転移（3病変）と診断し，1病変は胆管内進展が疑われた．同3病変に対して，腹腔鏡下肝部分切除術を施行した．術中にICG蛍光法を用いることで胆管内進展によって術前に投与したICGの排泄障害が生じた領域を明瞭に視認でき，過不足ないR0切除が可能であった．ICG蛍光法は，腹腔鏡下肝切除の際に胆管内進展範囲の推定に有用である．

　An 82-year-old woman presented with chest pain on exertion and was referred to a previous hospital, where blood tests revealed severe anemia. Imaging studies diagnosed sigmoid colon cancer with three synchronous liver metastases. After resection of the primary lesion, the patient was referred to our hospital for surgical treatment of the liver metastases. Contrast-enhanced MRI suggested biliary infiltration by one of the liver metastases. A laparoscopic partial hepatectomy was performed with a diagnosis of resectable liver metastases. The use of indocyanine green（ICG）fluorescence during surgery allowed clear identification of the biliary stasis area associated with biliary infiltration, facilitating R0 resection. ICG fluorescence is useful in delineating the extent of the biliary stasis area during laparoscopic liver resection.