Key result
Right hepatectomy with tumor thrombus removal using total hepatic vascular exclusion and venovenous bypass resulted in 3-year survival with good quality of life despite later pulmonary metastases.
Case Report (n=1)
No
This case demonstrates that even small hepatocellular carcinomas can form intra-atrial tumor thrombi leading to pulmonary thromboembolism, which can be successfully managed with thrombolysis and surgical resection.
Supports feasibility of complex resection for HCC with atrial thrombus; leaves open optimal selection and survival benefit versus systemic therapy.
症例は64歳の女性で，HBs抗原陽性のため経過観察中，2006年9月，肝S7に径15 mmの腫瘤が指摘されたが，患者が精査治療を拒否したため経過観察となっていた．2007年4月突然の呼吸困難で発症し，当院救急外来に搬送された．心USで右心系の拡大と右心房に腫瘤が指摘され，縦隔造影CTで右肺動脈に肺塞栓が認められた．血栓溶解療法後腹部精査を行い，肝S7の肝細胞癌が右肝静脈から右心房へ腫瘍栓を形成し，それによる血流障害で血栓が形成され，肺血栓塞栓症を発症したと考えた．肝右葉切除，腫瘍栓抜去術を施行．肝離断後，右葉を尾側に牽引することにより腫瘍栓も尾側へ移動し，心嚢内下大静脈でクランプが可能であったが，クランプにより血圧低下したためveno-venous bypassを併用した．術後経過は良好．12か月後に多発性肺転移を来した．術後24か月が経過したが，良好なquality of lifeのもと生存中である．肺血栓塞栓症で発症した下大静脈，右心房内腫瘍栓を有する肝細胞癌は，今までに報告例がない．
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Kyokane et al. (2010) conducted a case report in Hepatocellular carcinoma with intra-atrial tumor thrombus and pulmonary thromboembolism (n=1). Right hepatectomy with tumor thrombus removal by total hepatic vascular exclusion and active venovenous bypass was evaluated on Patient survival and postoperative course. Right hepatectomy with tumor thrombus removal using total hepatic vascular exclusion and venovenous bypass resulted in 3-year survival with good quality of life despite later pulmonary metastases.
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