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<title>肝癌治療の要点と盲点（電子版のみ） | 株式会社文光堂</title>


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<meta name="description" content="肝癌診療の現場では，「肝癌診療ガイドライン」が広く利用されているが，それだけでは解決できないケースにも遭遇する．例えば，治療アルゴリズムで推奨治療が複数記されている場合いずれを選ぶべきか？ 腫瘍数・径，肝障害度というアルゴリズムの決定因子以外の条件はどの程度考慮すべきか？ エビデンスが十分には確立していない治療は，どのように実践すべきか？ 本書は，そのような実臨床における様々な疑問に明快に答える一">

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		<h1 class="catchCopy">肝癌治療のエビデンスに基づいた最善の治療法を選択できる一冊！</h1>
		

		<h1 class="copy">診療ガイドラインに沿った</h1>
		<h1 class="title">肝癌治療の要点と盲点（電子版のみ）<span class="version"></span></h1>
		

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					編集：高山忠利（日本大学医学部消化器外科教授）
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					<span class="transparent">編集</span>　泉　並木（武蔵野赤十字病院消化器科部長）
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				<ul class="property"><li class="disc">B5判・434頁・4色刷</li><li class="disc">ISBN&nbsp;978-4-8306-1885-7</li><li class="disc">2013年3月15日発行</li></ul>

				
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">肝癌診療の現場では，「肝癌診療ガイドライン」が広く利用されているが，それだけでは解決できないケースにも遭遇する．例えば，治療アルゴリズムで推奨治療が複数記されている場合いずれを選ぶべきか？ 腫瘍数・径，肝障害度というアルゴリズムの決定因子以外の条件はどの程度考慮すべきか？ エビデンスが十分には確立していない治療は，どのように実践すべきか？ 本書は，そのような実臨床における様々な疑問に明快に答える一冊．<br>☆図版145点，表組98点，カラー写真96点，モノクロ写真130点</section><section class="preface">序文<br><br>　厚生労働省診療ガイドライン支援事業により「科学的根拠に基づく肝癌診療ガイドライン作成に関する研究班（班長・幕内雅敏）」が組織され，「肝癌診療ガイドライン─ 2005年版─」が纏められました．これは，総数7,118論文から厳選されたエビデンスに基づくわが国初のガイドラインとして高い評価を受け，肝癌診療の現場で広く利用されています．その後，新たな知見を取り入れた2009年版が出版され，今後は日本肝臓学会が主体となり3〜4年ごとに改訂がなされる予定です．<br>　さて，診療ガイドラインとは「特定の臨床状況のもとで，適切な判断や決断を下せるよう支援する目的で体系的に作成された文書」です．肝癌の治療においては，手術（切除・移植），経皮的局所療法，肝動脈塞栓療法，化学療法など複数の有力な治療法の中から，個々の患者にとって最善の治療を提供しなければいけません．その際の拠り所となるのがガイドラインといえましょう．<br>　しかし，診療の現場においては，必ずしもガイドラインだけでは解決できないケースにも遭遇します．まず，治療アルゴリズムで推奨治療が複数記されている場合，いずれを選ぶべきなのでしょうか？ 次に，腫瘍数・径，肝障害度というアルゴリズムの決定因子以外の条件は，どの程度考慮すべきなのでしょうか？ さらに，エビデンスが十分には確立してはいない治療は，どのように実践すべきなのでしょうか？ そのような実臨床における様々な疑問に答えられるよう，今回「診療ガイドラインに沿った肝癌治療の要点と盲点」を企画しました．<br>　本書は，臨床現場のニーズに沿って肝癌治療の全ての領域を系統的に構成してあります．<br>　「Ⅰ．肝癌治療選択のKnack ＆ Pitfalls」では，診療ガイドラインの意義を概説した上で，アルゴリズムに沿った治療方針を，実例を挙げて論じます．外科・内科・放射線科それぞれの立場から自らの推奨する治療法を，エビデンスを挙げて主張する一方，他科からの異論・反論も併記することで公正を期しました．提示したCase studyは，明日からの肝癌診療の現場で必ずや大きな指針を与えるものと考えます．<br>　「II．再発肝癌治療選択のKnack ＆ Pitfalls」では，これまでのガイドラインでは言及されていなかった，再発肝癌の治療法について，現時点でのコンセンサスを先取りの形で纏めました．<br>　「III．肝癌治療実践のKnack ＆ Pitfalls」では，肝切除・ラジオ波焼灼療法・肝動脈化学塞栓療法・肝移植・化学療法・放射線治療の基礎・実際・成績を纏めました．最善の治療法を選択するには，自ら行う治療法の長所と限界を知ると同時に，他の治療法の現況を把握する必要があると考えるからです．<br>　「IV．肝癌治療成績向上のKnack ＆ Pitfalls」では，治療の質を支えている病理診断を解説し，サーベイランスと発癌制御の将来像を記しました．さらに，12のCurrent issueと7のTechnical adviceを追加することで，新たな知識・技術の提供を意図しました．<br>　本書により肝癌治療の全体像を的確に把握でき，エビデンスに基づいた最善の治療法を選択する能力が飛躍的に向上することを確信するとともに，国民病と言われる肝癌，その撲滅の一助になることを祈念しております．<br><br>2013年3月<br>日本大学教授　高山忠利<br>武蔵野赤十字病院副院長　泉　並木</section><section class="indexes">I．肝癌治療選択のKnack &amp; Pitfalls<br>　1 ．肝癌診療ガイドラインの意義<br>　2．肝癌診療ガイドラインの評価<br>　3．肝癌治療アルゴリズムの解説<br>　4．アルゴリズム構成因子の診断と評価<br>　（1）腫瘍数の診断<br>　　①外科での方法<br>　　②内科での方法<br>　　③実地での留意点<br>　　　a) EOB造影MRIの意義<br>　　　b) どこまでが治療対象か？<br>　（2）腫瘍径の診断<br>　　①外科での方法<br>　　②内科での方法<br>　　③実地での留意点<br>　（3）血管侵襲の診断<br>　　①外科での方法<br>　　②内科での方法<br>　　③実地での留意点<br>　　　a) dynamic CTの役割<br>　　　b) 経動脈性造影ＣＴの有用性<br>　　　c) 血管造影を施行しない場合<br>　（4）肝障害度の評価<br>　　　①標準的な方法<br>　　　②実地での留意点<br>　　　　a) ICG試験は必須か？<br>　　　　b) 利尿剤投与時の腹水評価は？<br>　　　　c) 分岐鎖アミノ酸内服時のアルブミン値<br>　　　　d) 核酸アナログ内服時の肝障害度<br>　5．アルゴリズムに沿った治療方針 （Case study）<br>　　（1）肝障害度A,B ＆ 単発<br>　　　①肝切除を選ぶ場合<br>　　　　内科からの異論・反論<br>　　　②RFAを選ぶ場合<br>　　　　外科からの異論・反論<br>　　（2）肝障害度A,B＆2,3個＆3cm以内<br>　　　①肝切除を選ぶ場合<br>　　　　内科からの異論・反論<br>　　　②RFAを選ぶ場合<br>　　　　 外科からの異論・反論<br>　　（3）肝障害度A,B＆2,3個＆3cm超<br>　　　①肝切除を選ぶ場合<br>　　　　内科からの異論・反論<br>　　　②TACEを選ぶ場合<br>　　　　外科からの異論・反論<br>　　（4）肝障害度A,B＆4個以上<br>　　　①TACEを選ぶ場合<br>　　　　他施設からの意見<br>　　　②HAICを選ぶ場合<br>　　　　 他施設からの意見<br>　6．考慮すべき他の条件<br>　　（1）腫瘍条件<br>　　　①腫瘍形態<br>　　　②腫瘍マーカー<br>　　　③腫瘍局在<br>　　　④肝外転移<br>　　（2）患者条件<br>　　　①年齢<br>　　　②Performance status<br>　　　③合併症<br>　　（3）術前治療<br>　　　①胃・食道静脈瘤治療<br>　　　②脾摘出・脾動脈塞栓<br>II．再発肝癌治療選択のKnack &amp; Pitfalls<br>　（1）単発再発<br>　（2）多発再発<br>　（3）局所再発<br>　（4）血管侵襲<br>　（5）肝外転移<br>　（6）肝機能悪化<br>III．肝癌治療実践のKnack &amp; Pitfalls<br>　1．肝切除<br>　（1）肝切除の fundamental<br>　（2）肝切除のpractice<br>　　　①手技のエッセンス<br>　　　　a) 肝実質離断<br>　　　　b) 肝離断デバイス<br>　　　　c) 術中超音波<br>　　　　d) 系統的亜区域切除<br>　　　　e) 腹腔鏡下左葉切除<br>　　　　f) 腹腔鏡下右葉切除<br>　　　②適応と禁忌<br>　　　③合併症とその対策<br>　　　④治療困難例<br>　　　　a) 高度脈管侵襲<br>　　　　b) 多発肝癌<br>　　　　c) 破裂肝癌<br>　　　　d) リンパ節転移<br>　（3）肝切除のoutcome<br>　2．RFA<br>　（1）RFAのfundamental<br>　（2）RFAのpractice<br>　　　①手技のエッセンス<br>　　　　a) モノポーラ電極<br>　　　　b) 展開針<br>　　　　c) クールチップ針<br>　　　　d) バイポーラ電極<br>　　　②適応と禁忌<br>　　　③合併症とその対策<br>　　　④治療困難例<br>　　　　a) Bモード上の検出困難<br>　　　　b) 造影超音波の活用<br>　　　　c) fusion imageの活用<br>　　　　d) 3Dシミュレーション<br>　　（3）RFAのoutcome<br>　3．TACE<br>　（1）TACEのfundamental<br>　（2）TACEのpractice<br>　　　①手技のエッセンス<br>　　　　a) アプローチとカテーテル選択<br>　　　　b) リピオドール<br>　　　　c) ビーズ<br>　　　　d) 抗癌剤<br>　　　　e) 最適な塞栓範囲<br>　　　②治療目的<br>　　　③適応と禁忌<br>　　　④治療困難例<br>　（3）TACEのoutcome<br>　4．肝移植<br>　（1）肝移植のfundamental<br>　（2）肝移植のpractice<br>　　　①移植前検査<br>　　　②左葉グラフト<br>　　　③右葉グラフト<br>　　　④免疫抑制剤と拒絶時対応<br>　　　⑤脳死肝移植の現実<br>　（3）肝移植のoutcome<br>　5．化学療法<br>　（1）低用量FP療法<br>　（2） 5-FU併用インターフェロン<br>　（3）分子標的薬<br>　6．放射線治療<br>　（1）定位照射<br>　（2）陽子線<br>　（3）重粒子線<br>IV．肝癌治療成績向上のKnack &amp; Pitfalls<br>　1 ．治療の質を支える病理<br>　2．サーベイランスと発癌制御<br>　（1）腫瘍マーカー<br>　（2）バイオマーカー<br>　（3）背景肝の治療<br>　（4）インスリン抵抗性改善<br>索引<br><br>●Current issue　　門脈侵襲肝癌への対応 <br>●Current issue　　肝癌術後長期生存の条件<br>●Current issue　　肝癌切除後の再発予防は必要か？<br>●Current issue　　肝癌RFA後の再発予防は必要か？<br>●Current issue　　肝切除の3Dシミュレーション<br>●Current issue　　早期肝癌治療のリードタイム<br>●Current issue　　TACEをRFAに先行させるべきか？<br>●Current issue　　AFP-L3分画の意義<br>●Current issue　　肝移植へのbridging therapy<br>●Current issue　　改正臓器移植法で変化したこと<br>●Current issue　　肝癌の発生とインスリン抵抗性<br>●Current issue　　nonBnonC肝癌の切除成績<br>◎Technical advice　門脈塞栓の実際<br>◎Technical advice　複雑な肝切除<br>◎Technical advice　血管合併切除・再建<br>◎Technical advice　ICG蛍光下肝切除<br>◎Technical advice　RFA穿刺のコツ<br>◎Technical advice　焼灼法の使い分け<br>◎Technical advice　破裂肝癌へのTAE</section></article>
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