{"@context":{"@vocab":"https://cir.nii.ac.jp/schema/1.0/","rdfs":"http://www.w3.org/2000/01/rdf-schema#","dc":"http://purl.org/dc/elements/1.1/","dcterms":"http://purl.org/dc/terms/","foaf":"http://xmlns.com/foaf/0.1/","prism":"http://prismstandard.org/namespaces/basic/2.0/","cinii":"http://ci.nii.ac.jp/ns/1.0/","datacite":"https://schema.datacite.org/meta/kernel-4/","ndl":"http://ndl.go.jp/dcndl/terms/","jpcoar":"https://github.com/JPCOAR/schema/blob/master/2.0/"},"@id":"https://cir.nii.ac.jp/crid/1390016604338342016.json","@type":"Article","productIdentifier":[{"identifier":{"@type":"DOI","@value":"10.2957/kanzo.64.567"}},{"identifier":{"@type":"NDL_BIB_ID","@value":"033156314"}},{"identifier":{"@type":"URI","@value":"http://id.ndl.go.jp/bib/033156314"}},{"identifier":{"@type":"URI","@value":"https://ndlsearch.ndl.go.jp/books/R000000004-I033156314"}},{"identifier":{"@type":"URI","@value":"https://www.jstage.jst.go.jp/article/kanzo/64/11/64_567/_pdf"}},{"identifier":{"@type":"URI","@value":"https://search.jamas.or.jp/link/ui/2024058667"}}],"dc:title":[{"@language":"en","@value":"Unresectable hepatocellular carcinoma after Fontan surgery: A case report"},{"@language":"ja","@value":"Fontan術後に発症した切除不能肝細胞癌の1例"},{"@language":"ja-Kana","@value":"Fontan ジュツゴ ニ ハッショウ シタ セツジョ フノウ カン サイボウ ガン ノ 1レイ"}],"dc:language":"ja","description":[{"type":"abstract","notation":[{"@language":"en","@value":"<p>The patient was a man in his 30s. During childhood, he underwent Fontan surgery for complete transposition of the great arteries type III. On July 20XX, he was referred to our hospital because of multiple hepatic masses detected by abdominal ultrasonography. Contrast-enhanced computed tomography revealed multiple hepatocellular carcinoma of up to 13 cm (Barcelona Clinic Liver Cancer Stage B). Despite the absence of signs of portal hypertension such as splenomegaly and no liver morphological abnormalities were obvious on imaging, a liver biopsy revealed a congestive hepatic fibrosis score of 3, indicating the progression of fibrosis. Surgery and RFA were not indicated because of intrahepatic multiple lesions. Furthermore, since the largest tumor protruded outside the liver and he was at risk of intra-abdominal rupture, transarterial chemoembolization was performed first. Thereafter, various anticancer drug treatments were performed according to recurrence, and the patient survived. Although the images did not suggest liver fibrosis, the special hemodynamics after Fontan surgery may have induced the progression of liver fibrosis; thus, this case emphasizes the importance of liver cancer surveillance.</p>"},{"@language":"ja","@value":"<p>症例は30代男性．幼少期に完全大血管転位III型に対してFontan手術が施行され，近医に定期的に通院していた．20XX年7月腹部USで多発肝腫瘤を指摘され当院紹介受診となった．造影CTにて最大13 cmの多発肝細胞癌と判明した（BCLC stage B）．画像上は門脈圧亢進所見や明らかな肝形態異常を認めなかったが，肝生検でCongestive Hepatic Fibrosis Score 3であり，実際には線維化の進展を認めていた．肝内多発のため外科手術やRFAの適応外であった．また最大径の腫瘍は肝外に突出しており，腹腔内破裂の危険性もあることから，まずTACEを施行した．再発に応じて各種抗癌剤治療を行い，生存中である．画像上は肝線維化を示唆する所見はなかったが，Fontan術後の特殊な循環動態では，肝線維化が進展している可能性があり，本症例を通して肝癌サーベイランスの重要性を再考する．</p>"}],"abstractLicenseFlag":"disallow"}],"creator":[{"@id":"https://cir.nii.ac.jp/crid/1410016604338342018","@type":"Researcher","foaf:name":[{"@language":"en","@value":"Hagiwara Satoru"},{"@language":"ja","@value":"萩原 智"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Gastroenterology and Hepatology, Kindai 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