종양의 간문맥 침범을 경피적 에탄올주입술로 효과적으로 극복한 진행성 간세포암종 1예
A case of advanced hepatocellular carcinoma with portal vein tumor invasion controlled by percutaneous ethanol injection therapy
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주문맥 혈전을 동반하는 간세포암종의 예후는 매우 불량하므로 진행성 간세포암종 환자에서 간문맥 혈전이 주문맥을 침범하지 않도록 적극적인 치료를 시행하여야 하나 아직까지 이를 위한 적절한 방법이 없는 실정이다. 저자들은 간문맥 분지 혈전을 동반한 간세포암종 환자에서 간문맥 종양혈전 내에 경피적 에탄올주입술을 시행하여 주문맥으로의 종양혈전의 침범을 효과적으로 막음으로써 지속적인 경동맥항암화학색전술을 가능하게 하여 재발 또는 간기능의 악화 없이 임상적 완해의 소견을 보인 사례를 경험하였다. 환자는 간세포암종으로 경동맥화학색전술을 받은 60세의 남자 환자였으며, 치료 도중 우간문맥 내 종양혈전이 발생하였으나 주간문맥으로의 침범 소견은 없었다. 이에 3회에 걸쳐 초음파 유도하에 문맥 혈전 내에 경피적 에탄올주입술을 시행하였으며, 이후 문맥 혈전은 더 이상 주문맥 방향으로 침범하는 소견이 없었으며 따라서 지속적인 경동맥화학색전술이 가능하였다. 현재까지 총 19회의 경동맥화학색전술을 정기적으로 시행하여 영상검사로 관찰되는 생존 종양 없이 환자는 대상성 간기능 상태를 유지하고 있다. 따라서 간문맥 혈전이 동반된 경우에 혈전 내에 경피적 에탄올주입술과 같은 국소치료를 배제하지 말고 본 예와 같이 적극적인 치료를 시도할 경우 문맥 내 종양 성장 억제로 인한 부가적인 좋은 결과를 얻을 수 있을 것으로 판단한다.
Abstract
Portal vein invasion is a grave prognostic indicator in the setting of hepatocellular carcinoma (HCC). There is currently no effective method for preventing the invasion of HCC into the main portal vein. We report here a case of advanced HCC with portal vein tumor thrombosis that was effectively treated with percutaneous ethanol injection (PEI), having previously enabled subsequent successive transarterial chemoembolization (TACE). A 60-year-old male patient was diagnosed with a huge HCC, based on computed tomography and angiographic findings. Despite two sessions of TACE, the tumor invaded the right portal vein. PEI was performed on the malignant portal vein thrombosis, and three sessions thereof reduced the extent of tumor thrombi in the portal vein. Successive TACEs were performed to treat the HCC in the hepatic parenchyma. The patient was still living 19 months after the first PEI with no evidence of tumor recurrence, and his liver function remained well preserved.
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