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Background Portal branching patterns that differ from those previously described are occasionally encountered during liver surgery. Methods A total of 60 patients with normal intrahepatic venous anatomy underwent helical computed tomography during arterial portography (CTAP). Next, 3 dimensional portograms were reconstructed to verify the locations of the portal veins. Portal branching patterns in the right hemiliver were assessed. Results In all 60 patients examined, the right anterior portal vein bifurcated into the ventral and dorsal branches. In 42 (70%) of 60 patients, some branches arose from the right posterior portal trunk. Between 1 and 3 branches (mean 2.3 branches per patient) coursed cranially, between 2 and 5 branches (mean 3.2 branches per patient) coursed caudally, and between 1 and 2 branches (mean 1.3 branches per patient) coursed laterally. Conclusions We propose that the right liver should be divided into 3 segments, which are designated as the right anterior, middle, and posterior segments.

症例は59歳の男性で, 右下腹部痛で近医入院. 保存的治療に反応せず, 当院に転院となった. 下部消化器内視鏡で回盲部に粘膜下腫瘍様の隆起を認め生検ではgroup Iであったが, CEAが高値であることと, 腫瘍が大きく易出血性を認めたことから, 結腸右半切除を施行した. 切除標本の肉眼所見では回盲部に9×8cmの隆起性病変を認めた. 病変は正常粘膜で覆われ, 一部潰瘍を形成しており3型の腫瘍であった. 病理組織学的所見では中分化腺癌の像を示す粘膜下を主座とした巨大なcolon cancer であり, 粘膜表面の病変はごくわずかでssから腸間膜にかけて膿瘍を伴う巨大な腫瘤を形成していた. Si, INFγ, ly1, v1ew (-), aw (-), ow (-), P0H0n0M (-) stage IIIaであった. 粘膜下腫瘍様形態を呈する大腸癌は比較的まれであり, 本邦で42例である. その発育進展様式, 診断などにつき若干の文献的考察を加え報告する.

消化管の一部が右横隔膜下と肝の間に嵌入した病態はChilaiditi症候群と呼ばれている.今回われわれは,本邦報告31例と比較的稀な小腸型Chilaiditi症候群を経験したので若干の文献的考察を含め報告する.症例は82歳男性.腹痛嘔吐を主訴に来院し,腹部レントゲン単純撮影, CT, threedimensional computed tomography (3 DCT)などから,小腸型Chilaiditi症候群および絞扼性イレウスと診断し手術を施行した.本症例はTreitz靱帯近傍において小腸の内ヘルニアにより発生したイレウスを伴う,小腸型Chilaiditi症候群であり比較的稀である.小腸型Chilaiditi症候群は絞扼性イレウスを起こしやすく注意が必要である.嵌入臓器の同定が診断上重要であるが,この際3 DCTが極めて有用であった.

We report a case of a 76-year-old female with unresectable advanced pancreatic tail cancer in whom systemic chemotherapy using gemcitabine hydrochloride was effective. The patient came to our hospital with a complaint of upper abdominal discomfort and was diagnosed as an advanced pancreatic tail cancer with severe vessel invasion. A curative operation was thought to be impossible, so gemcitabine hydrochloride was administered (800 mg/m2/week x 3/4 weeks). After 2 courses, the CEA, CA19-9 and SPan-1 value were decreased, and reduced tumor size was identified. Sixteen months after the first diagnosis, she died dissemination.

Liver vein patterns which differ from those previously described are occasionally encountered during surgery. Therefore, we reclassified the anterosuperior segment (S8) into S8v (ventral area) and S8d (dorsal area), and the right paramedian sector into the ventral segment (S8v+S5) and the dorsal segment (S8d) based on portal and hepatic vein patterns. Using this new classification, we performed three types of limited resection of S8 in six patients with neither major nor minor procedural complications including biliary leaks, and no blood transfusion. This new classification allows development of surgical procedures where resection is limited to the portal unit and tumor.

Although a right liver graft without a middle hepatic vein resulted in potential venous congestion in the right paramedian sector, the details of the hepatic venous distribution in the right paramedian sector have not been established. In this study, the ramification patterns of the hepatic veins draining the right anterosuperior segment (S8) and the relation between the hepatic and portal veins were assessed using multislice computed tomography in 44 patients without lesions in the liver. All 52 drainage veins of the ventral area of S8 joined the middle hepatic vein, and all 48 drainage veins of the dorsal area joined the right hepatic vein. The hepatic vein crossing between the ventral and dorsal areas was observed in each patient examined. Therefore, we propose a reclassification wherein the right paramedian sector is divided into ventral and dorsal segments. This new classification may contribute to the development of new and safer surgical procedures, including more limited resection and right lobe adult living donor liver transplantation to avoid graft congestion.

We describe a rare case of esophageal metastasis from hepatocellular carcinoma. Esophagoscopy showed an oozing semipedunculated polypoid mass. Endoscopic ultrasound showed a mosaic pattern, and angiography and computed tomography showed tumor staining similar to that of the primary tumor in the liver. The present patient underwent superselective transcatheter arterial infusion of anticancer agents and permanent hemostasis was achieved.

The aim of this study was to evaluate the effect of the local therapy for colorectal liver metastases on overall survival. Seventy-two patients who had resected liver metastases from colorectal cancer during the period from 1982 to 2001 were evaluated for survival. There was no significant difference in overall survival by either surgical method for colorectal liver metastases or postoperative arterial infusion chemotherapy. However, the 5-year survival rate of resected metachronous liver metastases with postoperative arterial infusion chemotherapy was 44.9%, and that for patients with no extra hepatic metastases was 57.4%. Patients who have metachronous liver metastases from colorectal cancer should therefore be considered for postoperative arterial infusion chemotherapy. It is necessary to improve the outcome for cases that have extra hepatic metastases.