肝動脈瘤に対し外科的治療および血管内治療を施行した3例

肝動脈瘤は内臓動脈瘤の約20％を占め，比較的稀な疾患である．今回われわれは異なる治療を行った3例の肝動脈瘤を経験したため，文献的考察を加えて報告する．1例目は腹腔動脈起始部狭窄あり，腹腔動脈から総肝動脈，脾動脈まで紡錘状に瘤化していた．腹腔動脈，左胃動脈を結紮し，瘤切除ののち，総肝動脈と脾動脈を吻合した．2例目は左肝動脈瘤破裂に対し，経カテーテル的コイル塞栓術（transcatheter arterial embolization:TAE）を行った．瘤の近位と遠位をコイリングし血流消失させた（isolation）．3例目は右肝動脈瘤に対しTAEを行い，瘤内コイリングし血流を消失させた（pack...

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Published in日本臨床外科学会雑誌 Vol. 74; no. 7; pp. 1973 - 1978
Main Authors 衛藤, 英一, 伊藤, 康博, 三原, 康紀, 林, 忍, 長島, 敦, 江川, 智久
Format Journal Article
LanguageJapanese
Published 日本臨床外科学会 2013
Subjects
TAE
肝動脈瘤
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ISSN1345-2843
1882-5133
DOI10.3919/jjsa.74.1973

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Abstract 肝動脈瘤は内臓動脈瘤の約20％を占め，比較的稀な疾患である．今回われわれは異なる治療を行った3例の肝動脈瘤を経験したため，文献的考察を加えて報告する．1例目は腹腔動脈起始部狭窄あり，腹腔動脈から総肝動脈，脾動脈まで紡錘状に瘤化していた．腹腔動脈，左胃動脈を結紮し，瘤切除ののち，総肝動脈と脾動脈を吻合した．2例目は左肝動脈瘤破裂に対し，経カテーテル的コイル塞栓術（transcatheter arterial embolization:TAE）を行った．瘤の近位と遠位をコイリングし血流消失させた（isolation）．3例目は右肝動脈瘤に対しTAEを行い，瘤内コイリングし血流を消失させた（packing）．3例とも術後経過は良好であった．肝動脈瘤に対する治療として，それぞれ解剖学的な局在を考慮し，外科的治療，血管内治療を適切に選択することが，良好な結果につながると考える．
AbstractList 肝動脈瘤は内臓動脈瘤の約20％を占め，比較的稀な疾患である．今回われわれは異なる治療を行った3例の肝動脈瘤を経験したため，文献的考察を加えて報告する．1例目は腹腔動脈起始部狭窄あり，腹腔動脈から総肝動脈，脾動脈まで紡錘状に瘤化していた．腹腔動脈，左胃動脈を結紮し，瘤切除ののち，総肝動脈と脾動脈を吻合した．2例目は左肝動脈瘤破裂に対し，経カテーテル的コイル塞栓術（transcatheter arterial embolization:TAE）を行った．瘤の近位と遠位をコイリングし血流消失させた（isolation）．3例目は右肝動脈瘤に対しTAEを行い，瘤内コイリングし血流を消失させた（packing）．3例とも術後経過は良好であった．肝動脈瘤に対する治療として，それぞれ解剖学的な局在を考慮し，外科的治療，血管内治療を適切に選択することが，良好な結果につながると考える．
Author 三原, 康紀
衛藤, 英一
江川, 智久
林, 忍
伊藤, 康博
長島, 敦
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References 11) Redman HC, Reuter SR : Arterial collaterals in the liver hilus. Radiology 1970 ; 94 : 575-579
9) O'Driscoll D, Olliff SP, Olliff JF : Hepatic artery aneurysm. Br J Radiol 1999 ; 72 : 1018-1025
14) Tohma T, Cho A, Okazumi S, et al : Communicating arcade between the right and left hepatic arteries : evaluation with CT and angiography during temporary balloon occlusion of the right or left hepatic artery. Radiology 2005 ; 237 : 361-365
10) Michels NA : Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 1966 ; 112 : 337-347
17) Baggio E, Migliara B, Lipari G, et al : Treatment of six hepatic artery aneurysms. Ann Vasc Surg 2004 ; 18 : 93-99
13) Miyazaki M, Ito H, Nakagawa K, et al : Unilateral hepatic artery reconstruction is unnecessary in biliary tract carcinomas involving lobar hepatic artery : implications of interlobar hepatic artery and its preservation. Hepatogastroenterology 2000 ; 47 : 1526-1530
7) 竹本　圭，善甫　宣，宮本　俊他:肝動脈瘤に対して外科的治療および血管内治療を行った2例．日血管外会誌　2008;17:25-28
8) 古北　由，藤原　聡，後藤　正他:後腹膜血腫を来した腹腔動脈起始部狭窄を伴う背側膵動脈瘤の1例．胆と膵　2010;31:793-797
12) Plengvanit U, Chearanai O, Sindhvananda K, et al : Collateral arterial blood supply of the liver after hepatic artery ligation, angiographic study of twenty patients. Ann Surg 1972 ; 175 : 105-110
1) Stanley JC, Wakefield TW, Graham LM, et al : Clinical importance and management of splanchnic artery aneurysms. J Vasc Surg 1986 ; 3 : 836-840
4) Shanley CJ, Shah NL, Messina LM : Common splanchnic artery aneurysms : splenic, hepatic, and celiac. Ann Vasc Surg 1996 ; 10 : 315-322
6) Curran FT, Taylor SA : Hepatic artery aneurysm. Postgrad Med J 1986 ; 62 : 957-959
2) Psathakis D, Muller G, Noah M, et al : Present management of hepatic artery aneurysms. Symptomatic left hepatic artery aneurysm ; right hepatic artery aneurysm with erosion into the gallbladder and simultaneous colocholecystic fistula—a report of two unusual cases and the current state of etiology, diagnosis, histology and treatment. Vasa 1992 ; 21 : 210-215
5) 稗田　雅，辻川　哲，村瀬　知他:塞栓術を施行した真性肝動脈瘤の1例．臨放　2003;48:992-995
16) 児島　邦，二川　俊:肝動脈瘤，外傷性肝動脈瘤．別冊日本臨牀，領域別症候群シリーズ，肝・胆道系症候群，日本臨牀社，大阪，1995，p199-201
15) Gunji H, Cho A, Tohma T, et al : The blood supply of the hilar bile duct and its relationship to the communicating arcade located between the right and left hepatic arteries. Am J Surg 2006 ; 192 : 276-280
3) 宇野　耕，中島　正，安田　健他:動脈塞栓術にて治癒しえた肝動脈瘤胆道穿破の1例．日消誌　1994;91:115-118
References_xml – reference: 14) Tohma T, Cho A, Okazumi S, et al : Communicating arcade between the right and left hepatic arteries : evaluation with CT and angiography during temporary balloon occlusion of the right or left hepatic artery. Radiology 2005 ; 237 : 361-365
– reference: 4) Shanley CJ, Shah NL, Messina LM : Common splanchnic artery aneurysms : splenic, hepatic, and celiac. Ann Vasc Surg 1996 ; 10 : 315-322
– reference: 1) Stanley JC, Wakefield TW, Graham LM, et al : Clinical importance and management of splanchnic artery aneurysms. J Vasc Surg 1986 ; 3 : 836-840
– reference: 16) 児島　邦，二川　俊:肝動脈瘤，外傷性肝動脈瘤．別冊日本臨牀，領域別症候群シリーズ，肝・胆道系症候群，日本臨牀社，大阪，1995，p199-201
– reference: 5) 稗田　雅，辻川　哲，村瀬　知他:塞栓術を施行した真性肝動脈瘤の1例．臨放　2003;48:992-995
– reference: 8) 古北　由，藤原　聡，後藤　正他:後腹膜血腫を来した腹腔動脈起始部狭窄を伴う背側膵動脈瘤の1例．胆と膵　2010;31:793-797
– reference: 9) O'Driscoll D, Olliff SP, Olliff JF : Hepatic artery aneurysm. Br J Radiol 1999 ; 72 : 1018-1025
– reference: 2) Psathakis D, Muller G, Noah M, et al : Present management of hepatic artery aneurysms. Symptomatic left hepatic artery aneurysm ; right hepatic artery aneurysm with erosion into the gallbladder and simultaneous colocholecystic fistula—a report of two unusual cases and the current state of etiology, diagnosis, histology and treatment. Vasa 1992 ; 21 : 210-215
– reference: 13) Miyazaki M, Ito H, Nakagawa K, et al : Unilateral hepatic artery reconstruction is unnecessary in biliary tract carcinomas involving lobar hepatic artery : implications of interlobar hepatic artery and its preservation. Hepatogastroenterology 2000 ; 47 : 1526-1530
– reference: 17) Baggio E, Migliara B, Lipari G, et al : Treatment of six hepatic artery aneurysms. Ann Vasc Surg 2004 ; 18 : 93-99
– reference: 12) Plengvanit U, Chearanai O, Sindhvananda K, et al : Collateral arterial blood supply of the liver after hepatic artery ligation, angiographic study of twenty patients. Ann Surg 1972 ; 175 : 105-110
– reference: 6) Curran FT, Taylor SA : Hepatic artery aneurysm. Postgrad Med J 1986 ; 62 : 957-959
– reference: 10) Michels NA : Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 1966 ; 112 : 337-347
– reference: 15) Gunji H, Cho A, Tohma T, et al : The blood supply of the hilar bile duct and its relationship to the communicating arcade located between the right and left hepatic arteries. Am J Surg 2006 ; 192 : 276-280
– reference: 11) Redman HC, Reuter SR : Arterial collaterals in the liver hilus. Radiology 1970 ; 94 : 575-579
– reference: 7) 竹本　圭，善甫　宣，宮本　俊他:肝動脈瘤に対して外科的治療および血管内治療を行った2例．日血管外会誌　2008;17:25-28
– reference: 3) 宇野　耕，中島　正，安田　健他:動脈塞栓術にて治癒しえた肝動脈瘤胆道穿破の1例．日消誌　1994;91:115-118
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SubjectTerms TAE
肝動脈瘤
Title 肝動脈瘤に対し外科的治療および血管内治療を施行した3例
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