肝癌に対する腹腔鏡下超音波ガイドラジオ波焼灼術の1例

A Case of Hepatocellular Carcinoma Treated by Laparoscopic Ultrasound Guided Radio-freqency Thermal Ablation

　症例は77歳，女性．他院にて腹部超音波検査上肝に腫瘍を認め転院した．腹部超音波，CT検査上直径2.2cm大のS₅のHCCと診断した．臨床病期II，患者PSはGrade 4であり内科的局所療法を検討した．しかし，呼吸が止められずPEIT,PMCTなども困難でTAEは両股関節拘縮にて不可能と考え全身麻酔下腹腔鏡下ラジオ波焼灼術を施行した．15Gラジオ波針を経皮的に刺入，超音波をガイドとして腫瘍中央部へ針先端を展開した．焼灼前後にpower Dopplerを行い，腫瘍内血流のなくなることを確認した．穿刺部の止血を確認後，ポート刺入部を閉創した．ドレーンは使用しなかった．術後経過は良好で，2週間後の腹部CT検査で腫瘍部の完全壊死を確認し退院とした．

A 77-year old female was transferred to our hospital, because of a liver tumor detected by abdominal ultrasonography. Further abdominal ultrasonography and computed tomography (CT) revealed a nodular tumor measuring 2.2cm in diameter, located at the S5 of the liver. She was evaluated as clinical stage II and per-formance status grade 4, but we did not choose PEIT (percutaneous ethanol injectoion), PMCT (percutaneous microwave coagulation) nor TAE (trans arterial embolization), because she could not stop her breath nor stretch her contracted legs.