Two-Stage Laparoscopic Splenectomy and Hand-Assisted Laparoscopic Partial Hepatectomy for a Case of Liver Cancer Complicated by Cirrhosis

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  • 肝硬変合併肝癌に対し二期的に腹腔鏡下脾摘・肝部分切除を施行した１例

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Abstract

The patient in this case was a 72-year-old woman in whom a recurrence was found after visiting the Department of Gastroenterology for transcatheter arterial embolization (TAE) therapy for cirrhosis and cancer in the liver S6. She was subsequently referred to our department for surgery. Thrombocytopenia had developed; therefore, laparoscopic splenectomy was performed with the aim of improving the platelet count and reducing the amount of bleeding during the subsequent hepatectomy. An increased platelet count was observed soon after surgery, and the patient was discharged from the hospital on day 12 without complications. As the second stage about one month later, a partial hepatectomy was performed via hand-assisted laparoscopic surgery (HALS), and the patient was discharged on day 16. Recent cases in which splenectomy is conducted to control thrombocytopenia in patients with both cirrhosis and liver cancer have been reported. The purpose of this procedure is to control intraoperative bleeding in patients with thrombocytopenia, thus making it possible to perform hepatectomy safely and with reduced blood loss. It is also somewhat better cosmetically, and is thought to be a useful treatment for patients with cirrhosis and liver cancer.

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