@article{oai:hama-med.repo.nii.ac.jp:00000045,
 author = {横井, 佳博 and 蜂谷, 貴 and 倉地, 清隆 and 岡本, 和哉 and 土屋, 泰夫 and 奥村, 拓也 and 鈴木, 昌八 and 今野, 弘之 and 中村, 達},
 issue = {8},
 journal = {日本消化器外科学会雑誌, The Japanese Journal of Gastroenterological Surgery},
 month = {Aug},
 note = {従来, 肝静脈を介して右心房にまで進展した肝癌は, 癌の末期的病変として切除適応外と考えられていた．しかし, 右心房腫瘍塞栓は右心不全および肺塞栓により, 突然死を引き起こす可能性があることから, 可及的に摘除を必要とする病態である．症例は54歳の男性．肝左葉を主座とし, 骨転移を伴う進行肝癌であったが, CTで中および左肝静脈より, 下大静脈および右心房に腫瘍栓を形成していることが発見された．拡大肝左葉切除および体外循環下に心房腫瘍栓を摘除した．術後33日日に退院し, 術後12か月経過した現在も生存中である．肝細胞癌による右心房腫瘍の切除は, 自験例を含め, 本邦で18例が論文報告されている．肝原発巣を含めた根治的腫瘍摘除が行われた13例中, 3例は2年以上生存していることから, 心房に浸潤した進行肝癌に対しても, 肝内, 肝外転移のコントロールが可能であれば, 切除が推奨される．, Hepatocellular carcinoma (HCC) extending into the right atrium has generally been considered to represent the terminal stage of the disease. Importantly, this condition also poses the risk of sudden death caused by pulmonary embolism and right heart failure. Surgical removal of the intra-cardiac tumor thrombus appears to be a promising approach to prevent such a disaster. A 54-year-old man underwent extended left hepatectomy with removal of a right atrial tumor thrombus under extracorporeal circulation. The patient had an uneventful postoperative course and is alive, but with bone metastases and intrahepatic recurrence, 12 months after the opearation. We reviewed 18 Japanese cases who underwent surgical removal of right atrial HCC thrombi. All the cases had an uneventful postoperative course, and their mean survival was 11 months (range; 29 days to>4 years) after the operation. Three cases in which total resection of the tumor including the primary HCC are performed, remained alive for more than 2 years after the operation. Thus, surgical removal of an intracardiac tumor thrombus is a feasible and safe procedure. Although HCCs with intra-atrial tumor thrombi seem to be at a far advanced stage, total resection of the tumor including the primary HCC is of primary importance to achieve a favorable outcome.},
 pages = {1507--1511},
 title = {右心房まで進展した肝細胞癌の1切除例},
 volume = {33},
 year = {2000}
}