術中ICG蛍光法が有用であった肝細胞癌腹膜播種の1例

The usefulness of indocyanine green fluorography to detect recurrence of peritoneal dissemination of resected hepatocellular carcinoma : A case report

◆要旨：患者は49歳，男性．肝S8の肝細胞癌に対し肝動脈化学塞栓術とラジオ波焼灼術を施行された．初回治療から約2年後のCT検査で計4か所の肝細胞癌腹膜播種再発を疑う結節を指摘された．根治切除可能と判断し，腹腔鏡下腫瘍切除を施行した．術中にICG蛍光法を用いたナビゲーション手術を行い，術前に指摘できなかった新規の病変を3か所認め，合計7か所の播種結節を切除した．術後約2年経過し，腹膜播種再発はなく，経過良好である．ICG蛍光法によるナビゲーション手術は肝細胞癌腹膜播種病変の特定に有用であった．

　We describe a 49-year-old male who underwent transcatheter arterial chemoembolization and radiofrequency ablation to tr eat hepatocellular carcinoma of liver segment 8. About 2 years after treatment, computed tomography revealed four nodules that we suspected might reflect peritoneal dissemination of the hepatocellular carcinoma. We performed laparoscopic tumor resection guided by indocyanine green （ICG） fluorography and found three lesions that were not evident preoperatively. We dissected nodules at seven disseminated locations. At 2 years postoperatively, the patient is well; no recurrence of peritoneal dissemination is evident. Navigated surgery under ICG fluorography guidance is useful for the detection of disseminated peritoneal lesions associated with hepatocellular carcinoma.