褐色細胞腫の転移性肝癌に対し腹腔鏡下肝部分切除を施行した1例

Laparoscopic segment 4 partial hepatectomy for metastatic liver cancer with pheochromocytoma

◆要旨：患者は58歳，女性．55歳の時に左副腎褐色細胞腫に対し腹腔鏡下左副腎切除術を施行した．以後，経過観察していたが，高血圧，高血糖およびカテコラミンの上昇を認めた．腹部CTおよび造影MRI検査で肝S4に35mmの腫瘤を認め，褐色細胞腫の肝転移の診断となった．術前の肝機能は正常範囲内であった．腫瘍はSegment4に認め，主要な脈管には接していなかったため，腹腔鏡下で肝S4部分切除術を施行した．術中，手術操作による血圧の急激な変動を認めたが，麻酔科医との連携によって問題なく手術を終えた．褐色細胞腫の肝転移に対する手術は腫瘍の圧排や肝門遮断によって循環動態の変動が大きいため，麻酔科との連携が非常に重要であった．

　The patient was 58-year-old female who underwent left adrenal resection for left adrenal pheochromocytoma 3 years ago. After left adrenal resection, she was followed up regularly. However, hypertension, hyperglycemia and elevated catecholamines were pointed out recently. Abdominal CT and contrast-enhanced MRI showed a 35mm tumor in Segment 4 of the liver, which was diagnosed as liver metastasis of pheochromocytoma. No metastasis of pheochromocytoma was found at other regions. Preoperative liver function was normal and the region of tumor was away from major vessels. We performed laparoscopic Segment 4 partial hepatectomy. During the operation, a rapid rise in blood pressure was observed by operative maneuver. In contrast, at the time of the Pringle maneuver, a rapid decrease in blood pressure was observed. Particularly, after cutting 4b branch, hypotension persisted and then the anesthesiologist started continuous administration of Noradrenalin to maintain proper blood pressure. As a result, the operation was completed without any problem in cooperation with an anesthesiologist. Her postoperative course was uneventful. Because the surgery of pheochromocytoma encountered some rapid changes in circulatory dynamics, cooperation with the anesthesiologist was important during operation. Since we did not find any previous reports focusing on circulatory dynamics during hepatectomy for liver metastasis of pheochromocytoma, we considered this report is a valuable report.