腹壁浸潤を伴う肝癌に対する腹腔鏡補助下肝外側区域切除術の1例

Laparoscopy-assisted left lateral segmentectomy for a patient with hepatocellular carcinoma with abdominal wall invasion

Ｃ型慢性肝炎を伴う69歳，女性．肝外側区域に急速に増大し腹壁へ直接浸潤する4cmの肝癌を認めた．腹腔鏡所見では，肝外側区域に肝外に発育する腫瘍を認め，大網や腹膜への直接浸潤を伴っていた．大網を超音波凝固切開装置で切離後，腹腔鏡下に腫瘍浸潤部を回り込んで肝周囲の観察と脱転を行えた．腫瘍浸潤部腹膜を切開し，直接浸潤部の範囲を同定した．腹腔内より確認しながら浸潤部の皮膚・腹壁切開を行った．9cmの腹壁欠損部を通して腹腔鏡補助下に腹壁浸潤部と肝外側区域切除を行った．周囲臓器へ浸潤する肝癌でも腹腔鏡を用いることで，肝の脱転操作が可能であり，また腹腔から浸潤部周囲の切開範囲を決定するうえで腹腔鏡は有用と思われた．

　A 69-year-old woman with chronic hepatitis C presented our hospital with a 4 cm hepatoma in the left lateral segment with abdominal wall invasion. Dissection of the surrounding hepatic ligaments and omental invasion using the ultrasonic coagulating shears were possible by the laparoscopic procedure. After confirming the range of direct invasion to the abdominal wall by laparoscopy, the abdominal wall was resected. Left lateral segmentectomy accompanied with abdominal wall invasion was performed through a 9 cm defect in the abdominal wall. Mobilization of the liver with tumor invading adjacent organs is possible with the laparoscopic procedure ; furthermore, laparoscopy may be useful to decide the extent of resection around the invasion.