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| Abstract |
We report a case of 90-year-old patient who underwent preoperative 3-dimensional (3D) computed tomography (CT) volumetric analysis using SYNAPSE VINCENT imaging software and anatomical resection of se...gment VIII using ultrasound-guided vessel compression. Preoperative abdominal CT revealed a liver mass measuring 5.0 cm in diameter, and the patient was diagnosed with hepatocellular carcinoma. Liver function was preserved. Preoperative 3D volumetry using SYNAPSE VINCENT revealed the volume of the entire liver to be 1,339 mL and the volume of segment VIII to be 327 mL. Anatomical hepatic resection of segment VIII was performed using ultrasound-guided vessel compression. Operative duration was 372 min and estimated blood loss was 760 mL. Resected liver volume was 290 g. The patient's postoperative course was uneventful, and there has been no evidence of recurrence since the surgery.
症例は90 歳．男性．発熱，呼吸器症状にて当院紹介．右肺炎の診断にて加療を行った．その際の精査にて肝S8 に径5cm の造影効果を持つ単発性腫瘍を認めた．既往歴は胃癌に対して胃全摘術，脾臓摘出術，胆囊摘出術後，狭心症に対して経カテーテル的治療後．HCV 抗体陽性，Child Pugh 分類grade A，肝障害度A．肝細胞癌の臨床診断に基づき，全身状態改善後に外科的手術を施行する方針とした．SYNAPSE VINCENT を用いた術前画像評価を行い，予測肝容積および肝S8 領域脈管走行を確認し，術前肝切除シミュレーションを施行した．術中超音波装置を用いた徒手的阻血法によりS5 グリソンを温存させながらS8 グリソン枝を阻血し，肝切離前に肝S8 demarcation line を確認した．肝S8 亜区域切除術を施行した．術後経過は概ね良好で術後23 日目に退院となった．以後無再発生存中である．show more
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