脾機能亢進症を有する肝細胞癌に対し用手補助腹腔鏡下肝部分切除と脾摘を施行した1例

Hand-assisted laparoscopic partial hepatectomy and splenectomy for hepatocellular carcinoma and hypersplenism

　肝硬に伴う肝細胞癌と脾機亢進症に対しhand-assisted laparoscopic surgeryによる肝部分切除と脾摘術を行った．症例は63歳，女性．慢性C型肝硬変で経過観察中，肝S3に2.5cmの肝細胞癌を指摘された．汎血球減少および脾腫を認めた．臍下，左側腹部，傍正中にトロッカーを挿入し，上腹部正中に小開腹を加えた．脾摘，外側区域の授動は気腹下に行い，肝切離は吊り上げ法で行った．手術時間310分，出血量840g，脾重量530g，腫瘍径25×20mm，切離断端までの距離10mmであった．術後門脈内血栓を認めたが，保存的治療にて軽快した．一期的に腹腔鏡下肝切除と脾摘術を施行した報告は稀であり，文献的考察を加え報告する．

We describe a patient with hepatocellular carcinoma and thrombocytopenia, secondary to liver cirrhosis, who underwent a successful hand-assisted laparoscopic hepatectomy and splenectomy simultaneously. A 63-year-old woman with liver cirrhosis was admitted for the treatment of hepatocellular carcinoma. CT showed a hypervascular tumor measuring 2.5 cm in diameter in segment Ⅲ. The maximum diameter of the spleen was 16 cm. The platelet count was 3.7×10⁴/μl, secondary to hypersplenism. The serum albumin level was 2.7 g/dl, the prothrombin time was 68%, and the liver function was classified as Child B.