Kenichi Kumazawa

Transradial approach for transcatheter arterial chemoembolization in patients with hepatocellular carcinoma: comparison with conventional transfemoral approach.

We evaluated the clinical usefulness and safety of transradial approach for transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) compared with that of conventional transfemoral approach. The two groups (radial group, n = 177; femoral group, n = 150) of cases were retrospectively compared with regard to the successful rate of angiography or TACE, time required for catheterizaiton and complications. Hepatic angiography and TACE were completed in 174 (98.3%) of 177 cases in the radial group. There was no intergroup difference of time required for catheterization. Minor complications (dull pain, numbness) occurred in 8 (4.6%) patients in the radial group, and there were lower complications in the radial group compared to the femoral group. TACE by our new transradial approach was found to have therapeutic efficacy with lower complications comparable to that of the conventional transfemoral approach.

A Case of Cancer of the Gallbladder Diagnosed on the Onset of Biliary Ascariasis.

症例は72歳の女性で, 反復する上腹部痛を主訴に当科紹介となった.腹部超音波検査および造影computed tomography (CT) 検査では胆嚢頸部に辺縁不整な分葉する約2cm大の隆起性病変を認めた.Endoscopic Retrograde Cholangiopancreatography (ERCP) では総胆管内に運動性のある1本の紐状の透亮像が描出された.胆道内寄生虫迷入症および胆嚢癌と診断し, 寄生虫摘出と胆嚢摘除術および胆管, 肝床切除を施行した.病理組織学的診断では腫瘍はpapillary adenocarcinoma, 深達度ss, hinf0, binf0, n0, stage II, 根治度Aであり, 虫体は体長約15cmの雌蛔虫であった.本症例は無石例であり, 初発症状の上腹部痛は胆道内に迷入した蛔虫が原因と考えられ, 迷入を契機に併存する胆嚢癌が比較的早期に発見された貴重な症例と考えられた.

INVESTIGATION OF THE GALLBLADDER CARCINOMA ACCOMPANIED WITH ACUTE CHOLECYSTITIS

An investigation was made on the causes and diagnosis in 5 cases of gallbladder carcinoma ac-companied with acute cholecystitis which had different pathosis and causes each other. One case was of acute cholecystitis caused by calculus impaction accompanied with abiogenetic carcinoma without any relationship between the carcinoma and cholecystitis. Of the remaining 4 cases of cholecystitis caused by a gallbladder carcinoma, one case developed acute cholecystitis with an impacted calculus which was accompanied with edema in the neck due to wide-spreading invasion of carcinoma in the main gallbladder; another one case developed acute cholecystitis with occlusion of the cystic duct due to a gallbladder carcinoma arising in the duct; and two cases developed acute cholecystitis, because tumor necrosis tissue due to a gallbladder carcinoma fully occupied the lumen of the gallbladder. The pathosis and causes of cholecystitis were different from each other as mentioned above, and unclear images due to inflammation sometimes disturbed us in making the preoperative diagnosis. Accordingly, it is necessary to carry out careful observation and inspection always with attention to possible complication of carcinoma, even if the image diagnoses exhibit acute cholecystitis.

STUDY OF COMPLICATIONS AFTER RESECTION OF BILIARY TRACT CANCER

Seventy-two patients who underwent resection of biliary tract cancer in the department were examined for early and late postoperative complications. They included 32 patients with gallbladder cancer, 28 with bile duct cancer and 12 with papillary cancer, treated by pancreatoduodenectomy (26 cases), combined hepatectomy and pancreatectomy (13 cases), two or more hepatic segmentectomy (10 cases) and other methods (23 cases). Early postoperative complications, occurring within two months after surgery, were found in 23 (31.9%) patients, and 9 (12.5%) died consequently. Hyperbilirubinemia (10 cases), sutural insufficiency (8 cases) and after-bleeding (6 cases) were conspicuous, showing high incidences of 60.0% and 53.8% after two or more hepatic segmentectomy and after combined hepatectomy and pancreatectomy, respectively. Late complications occurred in 7 (46.7%) of 15 patients who had no recurrence for 2 or more years after surgery, and 4 (26.7%) died. The four patients died had undergone pancreatoduodenectomy, their complications being nutritional disturbance in two and chronic hepatic disorder in other two. Severe complications were found only after pancreatoduodenectomy, other surgical techniques being associated with mild complications. Considering the fact that 5 deaths from cancer occurred two or more years after surgery, total body management of patients long after pancreatoduodenectomy is important. In selecting the method of surgery for biliary tract cancer, due attention should be paid not only to the radicality of the operation but also to possible postoperative complications.

A Patient with Advanced Gallbladder Cancer Aliving 5 Years after Simultaneous Resection of the Liver and Pancreas.

近年, 進行胆嚢癌に対し肝膵同時切除が行われるようになってきた.しかし, その予後はきびしく長期生存例はきわめて少ないのが現状である.そのなかでわれわれは最近肝膵同時切除兼右半結腸切除を行い5年の生存を得た症例を経験した.症例は54歳, 男性.1986年5月, 右季肋部痛出現し6月2日当科入院.肝, 十二指腸, 結腸へ直接浸潤のみられる進行胆嚢癌と診断された.6月18日拡大肝右葉切除兼膵頭十二指腸切除兼右半結腸切除を施行した.進展様式は胆道癌取扱い規約に準じるとpat-Gbfn, por, int, INFβ, si, hinf3, binf0, n (-), P0, H0でR3絶対治癒切除であった.術後大きな合併症はなく第84病日に退院.44kgであった体重は現在51kgまで回復している.CTで脂肪肝は認めるが再発徴候はなく生存中である.本症例が長期生存できたのは進行癌にも関わらず肝十二指腸靱帯への浸潤とリンパ節転移のながったことが大きな要因と考えられる.

Variations in the disappearance rate of indocyanine green

Time-associated changes in the disappearance rate of indocyanine green from the blood (K·ICG) as an index of liver function, were studied. Blood was drawn 5 times at 3-minute intervals from 31 patients. Early, intermediate, and late K·ICG values were 0.087±0.040, 0.082±0.038, and 0.076±0.033 min−1, respectively, showing serial decreases. When blood was drawn 8 times at 2-minute intervals from 22 other patients, the means of the K·ICG values at 11 time points showed a nearly linear relationship (r=−0.986). These findings indicated that K·ICG is approxomated by a linear function of time, K(t)=−K′·t+K0. According to this function, K·ICG is considered to decrease by 1.96% every minute. The K·ICG value determined by the conventional method is, therefore, a mean disappearance rate of 15 minutes, and K0 is considered to reflect the initial reaction speed.