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Excepting operation-related deaths, including deaths within 30 days after operation and hospital deaths, and absolute non-curative resection cases, 171 resected cases of Hepatocellular carcinoma (HCC) were classified into 3 groups in terms of Kobayashi's risk score, namely, group A (score 7.5 or above; 29 cases), group B (7.4-6.0; 94) and group C (5.9 or below; 48). Results were: 1) The number of cases with a score of 6.0 or above was 123 out of 171 cases (71.9%). 2) In comparison with the other 2 groups, both postoperative survival rate and non-recurrent rate were significantly poor in group A (p

肝後下区域(S6)の腹側表面に,癌腫の一部が露出し存在した22×21mmの小肝細胞癌に対して,新たに開発した手術機器を用いて,本邦で初めて,腹腔鏡下マイクロ波凝固壊死療法を行ったところ,本法は,小肝細胞癌に対する新しい治療法として,有用と考えられたので報告した.症例は63歳,男性.肝機能,および凝固系検査の術後推移をみると,術後1日目に,GOTは423K.U, GPTは241K.U, T. Bil.は2.1mg/100mlと上昇した.また,術後,凍結血漿をまったく使用しなかったため,HPTは42%, PTは48.3%に低下した.しかし,すべての検査値は,術後7日目には術前値に復した.胃管は,術翌日には抜去し,2日目より食事を開始した.術後3週目に撮影したCTでは,治療部は癌腫を含め,著しくlow density areaに陥り,まったくenhanceされず,治療効果も充分であると判断された.また,術後合併症はまったく認められなかった.

肝細胞癌に対し, 従来の肝流入血遮断法に併用して, パルーンカテーテルによる選択的肝静脈遮断を行って肝中央2区域切除を施行した. カテーテルは術中経肝的に超音波ガイド下に経皮経肝的門脈造影の際のカテーテル挿入手技に準じて, 右および中肝静脈それぞれに挿入した. 切除線右側の右肝静脈に沿った切除の際は, 肝門部でのグリソン氏輪右枝遮断に併用してバルーンによる右肝静脈根部の遮断を, 切除線左側の中および左肝静脈近傍に沿った切除の際は, Pringle法による流入血全遮断に併用して中肝静脈根部の遮断を行うことにより, 良好な無血術野が得られた. 肝授動も肝鎌状間膜の切離のみで切除しえた. 術中出血量は1,100mlで, 術後の肝機能推移も良好であり, 本法は系統的切除あるいは腫瘍が主幹肝静脈に接して存在する場合などで, 肝切除の際, 肝静脈からの出血が予想される例には有用な方法と思われた.

To minimize intraoperative bleeding and allow more accurate resection, we have devised a new technique for hepatectomy. In addition to occlusion of the afferent vessels, we occlude the hepatic vein at the hepatocaval junction using a balloon catheter inserted transhepatically under intraoperative ultrasonic guidance. We have performed eight hepatectomies using this method. A sequence of 15 minutes of vascular occlusion followed by 5 minutes reperfusion was repeated throughout the operation, and the total ischemic time ranged from 45 to 90 minutes. This method greatly decreased intraoperative bleeding without causing significant elevation of the postoperative transaminase or lactic dehydrogenase levels when compared with occlusion of only the afferent vessels or nonischemic resection using a microwave tissue coagulator in patients undergoing equivalent resections. Also, the postoperative prothrombin time recovered to a significantly higher level, and there were no fatal postoperative complications using this method. Our method is useful for systematic hepatic resection along the hepatic vein or for resection of tumor sited at the confluence of the hepatic vein.

Cholangiocellular carcinoma (CCC), the malignant tumor arising from epithelial cells of the intrahepatic bile duct, has been classified as a primary liver cancer, although CCC has occurred less frequently than hepatocellular carcinoma (HCC) in Japan [1]. Most CCCs are advanced because a system for early diagnosis has not been established [2], and even though CCC is resectable, the prognosis is generally unfavorable [3–5]. We therefore studied clinically the 36 patients with CCC encountered at our hospital, and reported the current status of surgical treatment in Japan.

This is very interesting case of giant hepatocellular carcinoma that has multiple metastases with grape-like shape of 1 to 2cm in the inferior segment of right hepatic lobe, but no metastasis in left hepatic lobe. A 53-year-old female complained of abdominal tumor and abdominal distention. She had a status of central obesity like Baffalo hump, and an apparent elevation of serum cortisol concentration was seen (30.2μg/dl). And when we performed the extended right hepatic lobectomy including giant tumor, serum cortisol concentration returned to normality immediately. After the operation, a gradual weight-loss seen and she returned to standard shape for a year. This operation was a new method of liver resection. Having ligated the right hepatic artery, right hepatic lobectomy was performed without maneuver of the liver. The resected liver including metastatic tumor weighed 2700gr, and the volume of perioperative bleeding was 2750ml. The specimen showed that the main tumor consisting of an elastic soft and yellowish-white tissue, measured 15×13×12cm, and circumscribed multiple metastases in right inferior segment of the liver. Microscopically the tumor was characterized by slight dysplastic cells, producing bile juice. Histological diagnosis was Hepatocellular carcinoma, Edmondson II type. The patient has been well and no replase has been observed yet for 13 months since the operation.