臨床外科71巻4号

2016年04月発行

特集 大腸癌肝転移—最新の治療ストラテジー 肝切除法・治療戦略のトピックス

多発肝転移に対する適応拡大をめざしたtwo-stage hepatectomyとALPPS

著者： 田中邦哉¹ 菊地祐太郎¹ 川口大輔¹ 村上崇¹ 廣島幸彦¹ 松尾憲一¹ 小杉千弘¹ 幸田圭史¹

所属機関： ¹帝京大学ちば総合医療センター外科

ページ範囲：P.443 - P.455

【ポイント】
◆化学療法の進歩と相まって切除適応が著しく拡大された肝転移手術において，安全性を担保しながら大量肝切除を完遂する手技上の工夫が必須となった．
◆従来の門脈塞栓併用切除や計画的2期的切除に加えて，昨今では新たな2期的切除術式であるALPPS手術が報告され，世界的に導入されつつある．
◆肝再生を促しながら残存予定肝容量を確保するこれら術式により切除適応は拡大されたが，再生機序の詳細や合併症リスクなど依然明らかとなっていない点も多い．
◆これらの特徴を十分理解したうえで治療に応用していくことが，今後の肝転移治療成績向上には必須である．

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