巨大肝血管腫に対しhand-assisted laparoscopic partial hepatectomyを施行した1例

Hand-assisted Laparoscopic Partial Hepatectomy for a Huge Hemangioma of Liver:A Case Report

　症例は，48歳の女性．腹部超音波検査で肝腫瘤を指摘され来院した．腹部CT検査，MRI，血管造影検査で，肝外側区域（S₂）に胃を圧排している大きさ14cm大の巨大血管腫と肝前下区域S₅（4cm）および肝前上区域S₈（5cm）に各1個の計3個の血管腫を認めた．肝外側区域の巨大血管腫に対し，hand-assisted laparoscopic partial hepatectomyを施行した．Hand-assisted laparoscopicsurgeryは術野の展開および維持が容易であり，肝切離時の出血に対しても速やかに圧迫止血などの対応が可能で，安全に肝切除術が行えた．HALSは巨大な腫瘤の肝切除において有用な手段であると考えられた．また，開腹創の位置，大きさを考慮すれば，美容上についても満足できるものと考えられた．

A 48-year old female was referred to our hospital because of a liver tumor which had been identified by an abdominal ultrasonography. Abdominal computed tomography (CT), magnetic resonance imaging (MRI), and celiac angiography revealed a huge hepatic hemangioma, measuring 14 cm in size and compress-ing the stomach, in the left lateral segment (S₂) and two other hemangiomas, measuring 4 cm and 5 cm in size, respectively, in the right anterior inferior segment (S₅), and in the right anterior superior segment (S₈). The huge hemangioma in the left lateral segment was removed under a hand-assisted laparoscopic surgery.