記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Clostridium perfringens sepsis associated with massive intravascular hemolysis has an extremely poor prognosis. We here report a case of C. perfringens sepsis associated with massive intravascular hemolysis that developed secondary to a post-pancreaticoduodenectomy (PD) hepatic abscess. CASE PRESENTATION: A 70-year-old man with Type 2 diabetes underwent PD for an ampulla of Vater carcinoma. His postoperative course was uneventful. He was discharged on the 16th post-operative day (POD 16) after confirming no major abnormalities on abdominal contrast computed tomography (CT) on POD 14 or laboratory results on POD 16. Two days after discharge, he was readmitted because of fever and chills. Laboratory tests showed only a mild inflammatory reaction (white blood cell count, 11,980/mm3; C-reactive protein, 2.07 mg/dL). Abdominal CT showed an irregular, approximately 20-mm diameter, low-density area in the liver S6 region that had not been seen on a recent previous scan. We initially suspected postoperative cholangitis associated with biliary reconstruction and started empirical treatment with sulbactam/ampicillin after drawing blood for culture. Eight hours after admission, he developed septic shock with body temperature 40.0 ℃ and blood pressure 70/40 mm Hg. Laboratory findings showed a severe inflammatory reaction, severe anemia, and massive hemolysis (white blood cell count, 37,400/mm3; hemoglobin, 7.7 g/dL; total bilirubin, 8.05 mg/dL; direct bilirubin, 2.66 mg/dL; and lactate dehydrogenase, 1686 U/L). Hemoglobinuria was noted in the urinary catheter output. Repeat CT 9 h after admission showed the low-density area in S6 had become a gas-forming abscess. C. perfringens sepsis was strongly suspected on the basis of these findings and the abscess was drained percutaneously immediately after its diagnosis. His vital signs improved dramatically and he recovered within 24 h. Blood and abscess cultures grew C. perfringens 4 days after admission, leading to a definitive diagnosis of C. perfringens sepsis associated with massive intravascular hemolysis. He was discharged 18 days after admission. His sepsis has not recurred. CONCLUSIONS: Clostridium perfringens infection should be considered in patients who have undergone PD and present with gas-forming hepatic abscesses and/or sepsis associated with intravascular hemolysis. Prompt aggressive treatment is crucial, because C. perfringens infections can cause death within hours.

DOI： 10.1186/s40792-022-01402-z

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BackgroundPancreatic body and tail cancer easily invades the retroperitoneal tissue, including the transverse mesocolon. It is difficult to ensure a dissected peripancreatic margin using standard distal pancreatectomy for advanced pancreatic body and tail cancer.Thus, we developed a novel surgical procedure to ensure dissection of the peripancreatic margin. This involved performing dissection deeper than the fusion fascia of Toldt and further extensive en bloc resection of the root of the transverse mesocolon. We performed distal pancreatectomy with transverse mesocolon resection (DP-TCR) using the mesenteric approach and achieved good outcomes.MethodsThere are two main considerations regarding the surgical procedure using the mesenteric approach: 1) dissection deeper than the fusion fascia of Toldt (securing the vertical margin) and 2) modular resection of the pancreatic body and tail, with the root of the transverse mesocolon and adjacent organs in a horizontal direction (ensuring the caudal margin).ResultsFrom 2017 to 2019, we performed DP-TCR using the mesenteric approach for six patients with advanced pancreatic body and tail cancer. Histopathological radical surgery was possible in all patients who underwent DP-TCR. No perioperative complications of grade IIIa or above in the Clavien-Dindo classification were observed in any patients.ConclusionsWe believe that DP-TCR is useful as a radical surgery for advanced pancreatic body and tail cancer with extrapancreatic invasions.

DOI： 10.1272/jnms.JNMS.2021_88-408

PubMed

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記述言語：日本語   出版者・発行元：金原出版(株)  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：英語  

INTRODUCTION AND IMPORTANCE: Many cases of unresectable cancer that cause obstructive jaundice require treatment. Depending on the patient's condition in these cases, surgery may be performed to treat jaundice. The main goal of palliative surgery is to improve the quality of life. Therefore, palliative surgery for obstructive jaundice must be performed safely and quickly. CASE PRESENTATION: This case presents a 45-year-old man with fever and back pain who was diagnosed with pancreatic head cancer and multiple liver metastases. Chemotherapy was initiated; however, during the course of treatment, the patient developed hemorrhage from pancreatic cancer that had invaded the duodenum caused hematemesis and melena. Therefore, the chemotherapy could not be continued. Because the patient also developed obstructive jaundice and cholangitis, a gastrojejunostomy and cholecyst-jejunostomy was performed. The surgery was successful; however, the cancer continued to progress, and patient died 31 days after surgery. CLINICAL DISCUSSION: Biliary reconstruction can be difficult to perform safely and quickly due to many factors. This study shows that cholecyst-jejunostomy is effective for patients with end-stage cancer. In the long term, cholecyst-jejunostomy is not suitable for biliary reconstruction due to the possibility of bile congestion and cholecystitis. However, this easy and quick procedure is well indicated for emergency patients with a short life expectancy. CONCLUSION: As an easy and quick procedure for emergency patients with a short life expectancy, jejunal anastomosis of the gallbladder is an appropriate palliative surgery that is indicated for jaundice treatment.

DOI： 10.1016/j.ijscr.2021.01.020

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Pheochromocytoma is a rare disease. Adrenal gland tumors make intraoperative blood pressure control difficult. If the tumor is large, it may need to be differentiated from pancreatic tumors and may require combined resection of other organs. PRESENTATION OF CASE: A 73-year-old Japanese woman presented to our hospital with abdominal pain. Computed tomography revealed a left abdominal tumor of 15 cm diameter. Magnetic resonance imaging, abdominal ultrasonography, and fractionated catecholamine test results led to strong suspicions of pheochromocytoma. A surgery was performed to remove the large tumor while controlling the blood pressure in the perioperative period and preparing for the possibility of combined resection of other organs. DISCUSSION: Left adrenal tumors can be difficult to differentiate from pancreatic tumors if the lesion is large. Pheochromocytoma is a catecholamine-producing tumor, and surgery to remove the tumor can be risky if the blood pressure is not controlled in the perioperative period. CONCLUSION: Careful preparations must be made to resect a giant pheochromocytoma. Adrenal tumors should always be considered as a differential diagnosis for any lesion suspected of being a large pancreatic body tail tumor.

DOI： 10.1016/j.ijscr.2020.11.146

Scopus

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Hepatic portal venous gas (HPVG) is a potentially fatal condition. If vital signs are normal and laboratory data are not suggestive of any necrotic changes, a follow-up computed tomography after a conservative procedure can be performed at short intervals to conservatively monitor the patient.

DOI： 10.1002/ccr3.3534

Scopus

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Association of Rural Medicine  

DOI： 10.2185/jrm.2020-025

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Perianal abscesses exist in various forms depending on the location. Clinical examination and endorectal ultrasound (EUS) may be useful for the diagnosis of anal tumor.

DOI： 10.1002/ccr3.3205

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：英語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：英語  

Follicular pancreatitis (FP) is characterized by nodular mass composed of lymphoid hyperplasia and fibrosis. We here present radiological and pathological features of three cases of FP. The three patients were middle- or old-aged men, and nodular mass was pointed out at health examination. Computed tomography failed to demonstrate a mass. Magnetic resonance imaging demonstrated a mass in each case. 18F-fluorodeoxyglucose positron-emission tomography (FDG-PET) demonstrated two nodular masses with high standardized uptake value (SUV) in two cases and single mass in one case. The pathological examination disclosed two lesions with fibrosis and hyperplastic lymphoid follicles in two cases and one lesion in one case. Masses with high SUV appeared to correspond with the lesions of FP. Compared with the features of FDG-PET images of pancreatic ductal carcinoma, multiple lesions with high SUV favor a diagnosis of FP rather than pancreatic cancer. FDG-PET is useful for the diagnosis of FP.

DOI： 10.1093/jscr/rjaa134

PubMed

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記述言語：日本語   出版者・発行元：金原出版(株)  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00620&link_issn=&doc_id=20200115090010&doc_link_id=10.18888%2Fop.0000001509&url=https%3A%2F%2Fdoi.org%2F10.18888%2Fop.0000001509&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：金原出版(株)  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We report a case of metastatic pancreatic-head mucinous carcinoma (with multiple lymph node and bone metastases) and review the relevant literature. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) was useful for diagnosis, and a satisfactory outcome was achieved after systemic chemotherapy with FOLFIRINOX followed by resection of the primary lesion as conversion surgery. The patient was a 55-year-old man. Hematological findings included elevated serum tumor marker levels: CEA 12.7 ng/mL, DUPAN-2 400 U/mL. Findings from several imaging modalities and EUS-FNA confirmed a clinicopathological diagnosis of metastatic pancreatic mucinous carcinoma with multiple bone and lymph node metastases. Five courses of modified FOIFIRINOX (m-FFX) were given as systemic chemotherapy, which had an antitumor effect. Subtotal stomach-preserving pancreaticoduodenectomy and extensive lymph-node dissection were thus performed. Histopathological analysis showed invasive ductal carcinoma, muc (pT3, pN1b, cM1). After surgery, the clinical course was notable for the absence of complications. Tegafur/gimeracil/oteracil (S-1) was started as maintenance adjuvant chemotherapy postoperatively, and no disease progression has been observed at 10 months after surgery.

DOI： 10.1272/jnms.JNMS.2019_86-502

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：日本膵・胆管合流異常研究会  

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記述言語：日本語   出版者・発行元：日本膵・胆管合流異常研究会  

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記述言語：日本語   出版者・発行元：日本膵・胆管合流異常研究会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.jnms.2019_86-411

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記述言語：日本語   出版者・発行元：(株)アークメディア  

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J01964&link_issn=&doc_id=20190624180003&doc_link_id=%2Fao7opnui%2F2019%2F003407%2F005%2F0677-0688%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fao7opnui%2F2019%2F003407%2F005%2F0677-0688%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：医学図書出版(株)  

Endoscopic retrograde cholangiopancreatography(ERCP)は肝胆膵疾患の診断と治療に不可欠な手技となり、ERCPを応用したさまざまな手技が活用されている。一方、ERCPの偶発症はときに重篤化し致命的な転帰となるため慎重を要す手技である。ERCPの偶発症のなかでも後腹膜穿孔は死亡率が高く、その診断、治療方針、予防が重要である。ERCP関連後腹膜穿孔の主な原因は、乳頭部穿孔ではESTの過長切開や不適切な切開方向、胆管穿孔では砕石処置具の挿入、膵管穿孔ではカテーテル操作、十二指腸穿孔ではファイバーの挿入による損傷である。後腹膜穿孔を疑う際にはファイバーを抜去する前に保存的加療を考慮して胆道ドレナージをできる限り挿入し、ERCP直後にCT検査を行い後腹膜液体貯留の程度を確認する。CTで後腹膜に液体貯留を認め、かつ発熱や疼痛のある症例は緊急手術を行う。後腹膜気腫のみ、もしくは少量の液体貯留のみで無症状の症例は保存的加療を行い経時的に疼痛や液体貯留をフォローし、腹部所見および画像所見の悪化がある際は緊急手術を考慮する。十二指腸をファイバーで完全に貫いて後腹膜穿孔をきたした症例は当初より緊急手術を考慮する。(著者抄録)

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

Endoscopic retrograde cholangiopancreatography(ERCP)は肝胆膵疾患の診断と治療に不可欠な手技となり、ERCPを応用したさまざまな手技が活用されている。一方、ERCPの偶発症はときに重篤化し致命的な転帰となるため慎重を要す手技である。ERCPの偶発症のなかでも後腹膜穿孔は死亡率が高く、その診断、治療方針、予防が重要である。ERCP関連後腹膜穿孔の主な原因は、乳頭部穿孔ではESTの過長切開や不適切な切開方向、胆管穿孔では砕石処置具の挿入、膵管穿孔ではカテーテル操作、十二指腸穿孔ではファイバーの挿入による損傷である。後腹膜穿孔を疑う際にはファイバーを抜去する前に保存的加療を考慮して胆道ドレナージをできる限り挿入し、ERCP直後にCT検査を行い後腹膜液体貯留の程度を確認する。CTで後腹膜に液体貯留を認め、かつ発熱や疼痛のある症例は緊急手術を行う。後腹膜気腫のみ、もしくは少量の液体貯留のみで無症状の症例は保存的加療を行い経時的に疼痛や液体貯留をフォローし、腹部所見および画像所見の悪化がある際は緊急手術を考慮する。十二指腸をファイバーで完全に貫いて後腹膜穿孔をきたした症例は当初より緊急手術を考慮する。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)南江堂  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00393&link_issn=&doc_id=20190520090034&doc_link_id=10.15106%2Fj_geka81_585&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_geka81_585&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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DOI： 10.1272/jnms.JNMS.2018_86-404

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

良性から低悪性度腫瘍に対する腹腔鏡下尾側膵切除術(Lap-DP)は、本邦でも2012年4月に保険収載され、その後、国内のさまざまな医療機関で実施されるようになった。今後は、施設ごとに手術手技をより一層向上させていくことが必要である。なかでも、脾臓を合併切除するLap-DPは、脾動静脈と膵実質・腫瘍との剥離操作が少なく、比較的標準化しやすい術式の一つであると考えられる。本稿では、同術式の施行手順・手法についてわかりやすく解説した。(著者抄録)

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記述言語：日本語   出版者・発行元：金原出版(株)  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00620&link_issn=&doc_id=20181115180002&doc_link_id=10.18888%2Fop.0000000921&url=https%3A%2F%2Fdoi.org%2F10.18888%2Fop.0000000921&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本膵・胆管合流異常研究会  

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記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞ポイント ◆膵中央切除術は膵体尾部腫瘍に対する膵機能温存術式であり,病変が膵頸部から膵体部に存在し核出術の適応がない場合に適応される.◆本術式は,腫瘍径の小さな低悪性度腫瘍に適応され,膵実質の剥離操作の範囲も少ないため,通常の脾動静脈温存の膵体尾部切除術よりも切除においては容易であるが,膵尾部側断端と消化管を確実に吻合するテクニックが求められる.◆われわれは,膵尾側の残膵は胃と吻合する.結節縫合による膵実質胃漿膜筋層縫合と,両端針を用いた連続縫合による膵管胃粘膜吻合を施行している.

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞ポイント ◆膵中央切除術は膵体尾部腫瘍に対する膵機能温存術式であり,病変が膵頸部から膵体部に存在し核出術の適応がない場合に適応される.◆本術式は,腫瘍径の小さな低悪性度腫瘍に適応され,膵実質の剥離操作の範囲も少ないため,通常の脾動静脈温存の膵体尾部切除術よりも切除においては容易であるが,膵尾部側断端と消化管を確実に吻合するテクニックが求められる.◆われわれは,膵尾側の残膵は胃と吻合する.結節縫合による膵実質胃漿膜筋層縫合と,両端針を用いた連続縫合による膵管胃粘膜吻合を施行している.

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01539&link_issn=&doc_id=20180803340024&doc_link_id=10.11477%2Fmf.1407212135&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1407212135&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：日本膵臓学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Spandidos Publications  

The present study aimed to elucidate the clinicopathological characteristics of resected mucinous cystic neoplasm (MCN) with ovarian-type stroma and identify a surgical approach for MCN treatment, on the basis of Republic of Korean (Yonsei University College of Medicine, Seoul, South Korea) and Japanese (Nippon Medical School, Tokyo, Japan) bi-institutional collaboration. The present study retrospectively reviewed 55 MCNs with ovarian-type stroma using pathological re-examination. Clinicopathological features and preoperative clinical parameters were evaluated to predict malignant alterations in MCNs. The proportion of surgically treated MCNs has recently been increasing. All patients included in the present study were female, with a mean age of 47.9±13.3 years. Mural nodules were noted in 8 patients (14.5%) and the mean cyst size was 6.1±4.2 cm. A total of 9 patients (16.4%) were identified to exhibit non-invasive mucinous cystadenocarcinoma. The number of patients with small tumors (R2=-0.079, P=0.038) and asymptomatic pancreatic MCNs (P=0.022) was significantly increased (P&lt
0.05), which resulted in the more frequent application of minimally invasive surgery (P&lt
0.001). During the follow-up period (mean, 51.6 months
range, 1.1-242.8 months), no recurrence or tumor-associated mortality was identified. The presence of mural nodules (P=0.002) and a tumor size ≥4.5 cm (P=0.027) were identified as potential clinical parameters for predicting malignant transformation. The significance of mural nodules in predicting malignant transformation was increased in large MCNs (≥4.5 cm) of the pancreas compared with small MCNs (&lt
4.5 cm) (P=0.002). Overall, non-invasive pancreatic MCNs are not aggressive, and minimally invasive pancreatectomy may be an effective approach for suitable patients.

DOI： 10.3892/ol.2017.7627

Scopus

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Tokyo  

In the original publication of this article, Fig. 5 was published with incorrect color of the approximate lines of CBD and Control.

DOI： 10.1007/s00535-017-1418-y

Scopus

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Tokyo  

Background: Congenital biliary dilatation (CBD) is a congenital malformation involving both dilatation of the extrahepatic bile duct and pancreaticobiliary maljunction. Persistent reflux of pancreatic juice injures the biliary tract mucosa, resulting in chronic inflammation and higher rates of carcinogenesis in the biliary tract, including the gallbladder. Telomeres are repetitive DNA sequences located at the ends of chromosomes. Chromosomal instability due to telomere dysfunction plays an important role in the carcinogenesis of many organs. This study was performed to determine whether excessive shortening of telomeres occurs in the gallbladder mucosa of patients with CBD. Methods: Resected gallbladders were obtained from 17 patients with CBD, ten patients with cholecystolithiasis without pancreatic juice reflux, and 17 patients with normal gallbladders (controls) (median age of each group of patients: 37, 50, and 53 years, respectively). The telomere lengths of the gallbladder epithelium were measured by quantitative fluorescence in situ hybridization using tissue sections, and the normalized telomere-to-centromere ratio (NTCR) was calculated. Results: The NTCRs in the CBD, cholecystolithiasis, and control groups were 1.24 [interquartile range (IQR) 1.125–1.52], 1.96 (IQR 1.56–2.295), and 1.77 (IQR 1.48–2.53), respectively. The NTCR in the CBD group was significantly smaller than that in the cholecystolithiasis and control groups (p = 0.003 and 0.004, respectively), even in young patients. Conclusions: Our findings indicate that telomere shortening in the gallbladder mucosa plays an important role in the process of carcinogenesis in patients with CBD. These results support the recommendation of established guidelines for prophylactic surgery in patients with CBD because CBD is a premalignant condition with excessive telomere shortening.

DOI： 10.1007/s00535-017-1411-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: We introduced laparoscopic simulator training for medical students in 2007. This study was designed to identify factors that predict the laparoscopic skill of medical students, to identify intergenerational differences in abilities, and to estimate the variability of results in each training group. Our ultimate goal was to determine the optimal educational program for teaching laparoscopic surgery to medical students. METHODS: Between 2007 and 2015, a total of 270 fifth-year medical students were enrolled in this observational study. Before training, the participants were asked questions about their interest in laparoscopic surgery, experience with playing video games, confidence about driving, and manual dexterity. After the training, aspects of their competence (execution time, instrument path length, and economy of instrument movement) were assessed. RESULTS: Multiple regression analysis identified significant effects of manual dexterity, gender, and confidence about driving on the results of the training. The training results have significantly improved over recent years. The variability among the results in each training group was relatively small. CONCLUSIONS: We identified the characteristics of medical students with excellent laparoscopic skills. We observed educational benefits from interactions between medical students within each training group. Our study suggests that selection and grouping are important to the success of modern programs designed to train medical students in laparoscopic surgery.

DOI： 10.1007/s00464-017-5643-5

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：英語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：金原出版(株)  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

DOI： 10.1111/ases.12317

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

腹腔鏡は時として開腹術では遭遇し得なかった局所解剖を描出し、それらは新たな知見として開腹術にも応用される。膵鉤部支持組織の解剖を、神経叢・mesopancreasおよびそれらと癒合する上腸間膜動静脈、腹腔動脈、横行結腸間膜、十二指腸・空腸間膜、Treitz靱帯を中心に新たな視点から再認識し、腹腔鏡下膵頭十二指腸切除術(Lap-PD)施行時の安全面に配慮した同部の至適な術野展開法ならびに切除の仕方について解説した。本法は、Lap-PDのみならず開腹術でも有用な手法であると考えている。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Laparoscopic anti-reflux surgery (LARS) is generally the treatment of choice for patients with gastroesophageal reflux disease (GERD). This report describes our experiences in performing LARS on patients with GERD, and focuses retrospectively on the pathophysiology of individual patients and the current status of Japanese patients who have undergone LARS. We demonstrate that patients with non-erosive reflux disease resistant to proton pump inhibitors (PPI-resistant NERD) and high-risk giant hernia, whom we are sometimes hesitant to treat surgically, can be safely and successfully treated with LARS (depending on the pathophysiology of individual patients). METHODS: Between January 2007 and June 2015, 37 patients underwent LARS at Nippon Medical School Hospital. These patients were retrospectively subgrouped according to pathophysiology; 9 of them had PPI-resistant NERD (Group A), 19 had a giant hiatal hernia (Group B), and 9 had erosive esophagitis (Group N). Patient characteristics, intraoperative bleeding, operation duration, perioperative complications, and length of hospital stay were determined, along with symptomatic outcomes and patient satisfaction. RESULTS: Patients in Group A were the youngest (average: 43.9 years), and those in Group B were the oldest (75.9 years) (P=0.002). The percentage of high-risk patients, as determined by performance status (P=0.047) and American Society of Anesthesiologists physical status classification (P=0.021), was highest in Group B, whereas the percentage of patients with mental disorders was highest in Group A (P=0.012). There were no significant differences among the groups in terms of intraoperative bleeding, surgery duration, or postoperative hospital stay. Thirty-three patients (89.2%), including all 19 in Group B, expressed excellent or good postoperative satisfaction levels. CONCLUSIONS: The characteristics of the patients who underwent LARS at our hospital differed according to pathophysiology and from those in western countries. Satisfactory outcomes depended on the pathophysiology of individual patients.

DOI： 10.1272/jnms.84.25

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We compared the therapeutic outcomes of mediastinoscopy-assisted transhiatal esophagectomy (MATHE) with transthoracic esophagectomy (TTE), and with video-assisted thoracoscopic esophagectomy (VATS-E) for the treatment of esophageal cancer. Twenty patients underwent MATHE in our institute from 2001 to 2005 were enrolled. We evaluated the therapeutic outcomes, including perioperative complications and long-term prognosis after surgery, and compared these with 15 patients who underwent TTE during the same time period and 15 who underwent VATS-E at a later date. MATHE was performed safely and the long-term prognosis were satisfactory compared with TTE. However, the number of dissected mediastinal lymph nodes, total blood loss, and sophistication of the procedure were inferior to VATS-E. MATHE represents a less invasive surgical procedure. However, in light of the risk of leaving lymph node metastasis around the tracheal bifurcation in patients with tumor invasion beyond the muscularis mucosa, MATHE should only be adopted in a minority of patients.

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：英語   出版者・発行元：(一社)日本癌学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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出版者・発行元：International College of Surgeons  

DOI： 10.9738/intsurg-d-15-00015.1

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：英語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPANDIDOS PUBL LTD  

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal solid malignancies, and there is an urgent need for new therapeutic strategies based on the molecular biology of PDAC. Signal transducers and activators of transcription 5 (STAT5) are known to be activated in a variety of malignancies and involved in tumor proliferation, apoptosis, and invasion, whereas the expression and biological role of STAT5b in PDAC are less clearly defined. In the present study, we examined the expression and role of STAT5b in human pancreatic cancer cell lines. Expressions of STAT5b mRNA and protein were detected in eight kinds of pancreatic cancer cells. Confocal microscopy and western blot analysis indicated that STAT5b is localized in both cytoplasm and nuclei. Immunoprecipitation analysis revealed tyrosine phosphorylation of STAT5b in pancreatic cancer cells. These results indicate that STAT5b in pancreatic cancer cells is constitutively activated. STAT5b shRNA clones in PANC-1 cells, which express relatively high levels of STAT5b, exhibited reduced chemoresistance against gemcitabine, adhesion and invasion compared to sham. On the other hand, AsPC-1 and BxPC3 cells, which express relatively low levels of STAT5b, exhibited reduced chemoresistance compared to PANC-1 cells. Moreover, STAT5b overexpression clones in AsPC-1 cells exhibited increased chemoresistance compared to sham. STAT5b shRNA clones in PANC-1 cells were more sensitive to the proapoptotic actions of gemcitabine, as evidenced by PARP and cleaved caspase-3 activation. Gemcitabine also significantly reduced Bcl-xL levels in the STAT5b shRNA-expressing cells. We also investigated the clinicopathological characteristics of STAT5b expression of PDAC. Although a significant correlation between STAT5b expression and overall survival rates was not observed, a significant correlation with main pancreatic duct invasion was observed. These findings suggest that STAT5b confers gemcitabine chemoresistance and promotes cell adherence and invasiveness in pancreatic cancer cells. Targeting STAT5b may lead to novel therapeutic strategies for PDAC.

DOI： 10.3892/or.2016.4727

Web of Science

PubMed

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記述言語：英語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

腹腔鏡下膵切除術における胆道と膵臓の再建術について報告した。胆道再建に関しては、われわれの作製したSwineウエットラボ実習モデルによる両端針を用いた連続縫合の運針法と、その手順および運針のコツについて解説した。膵管内乳頭粘液性腫瘍などの膵管内に腫瘍細胞が浮遊している可能性のある腫瘍に対しては、われわれは膵頭十二指腸切除術においても自動縫合器を使用して膵臓を切離している。尾側膵の再建術に関しては、膵切離後に膵断端直上に作製した切開創からステープルによって閉じられた主膵管を開放し、同創から膵消化管吻合を行っている。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: The postoperative results of laparoscopic distal pancreatectomy for solid pseudopapillary neoplasm of the pancreas (SPN), including the effects of spleen-preserving resection, are still to be elucidated. METHODS: Of the 139 patients who underwent laparoscopic pancreatectomy for non-cancerous tumors, 14 consecutive patients (average age, 29.6 years; 1 man, 13 women) with solitary SPN who underwent laparoscopic distal pancreatectomy between March 2004 and June 2015 were enrolled. The tumors had a mean diameter of 4.8 cm. Laparoscopic spleen-preserving distal pancreatectomy was performed in eight patients (spleen-preserving group), including two cases involving pancreatic tail preservation, and laparoscopic spleno-distal pancreatectomy was performed in six patients (standard resection group). RESULTS: The median operating time was 317 min, and the median blood loss was 50 mL. Postoperatively, grade B pancreatic fistulas appeared in two patients (14.3%) but resolved with conservative treatment. No patients had postoperative complications, other than pancreatic fistulas, or required reoperation. The median postoperative hospital stay was 11 days, and the postoperative mortality was zero.None of the patients had positive surgical margins or lymph nodes with metastasis. The median follow-up period did not significantly differ between the two groups (20 vs 39 months, P = 0.1368). All of the patients are alive and free from recurrent tumors without major late-phase complications. CONCLUSION: Laparoscopic distal pancreatectomy might be a suitable treatment for patients with SPN. A spleen-preserving operation is preferable for younger patients with SPN, and this study demonstrated the non-inferiority of the procedure compared to spleno-distal pancreatectomy.

DOI： 10.1111/ases.12256

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

ERCPは胆膵疾患の診断に不可欠な手技となり,ERCPを応用したさまざまな手技が活用されている一方,ERCPの偶発症は重篤化しやすく慎重を要す手技である。ERCP合併症の中でも後腹膜穿孔は死亡率が高く,その診断と対処が重要である。1999年1月から2015年5月までのERCP自験例4,076例のうちERCPの後腹膜穿孔を10例(0.25%)に認め,その原因と対応を検討した。穿孔部位は,乳頭部3例,胆管3例,膵管2例,十二指腸2例であり,原因は,乳頭部穿孔ではEST,胆管穿孔では砕石処置具の挿入,膵管穿孔ではカテーテル操作,十二指腸穿孔では内視鏡の挿入による損傷であった。後腹膜穿孔を疑う際にはENBDや胃管で減圧しCTで後腹膜穿孔の重症度を確認する。CTで後腹膜に液体貯留を認め,かつ発熱や疼痛のある症例は緊急手術を行う。後腹膜気腫のみ,もしくは少量の液体貯留のみで無症状の症例は保存的加療を行い経時的に疼痛や液体貯留をフォローし,所見の悪化がある際は緊急手術を考慮する。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J02824&link_issn=&doc_id=20160226430008&doc_link_id=10.11231%2Fjaem.36.79&url=https%3A%2F%2Fdoi.org%2F10.11231%2Fjaem.36.79&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KARGER  

Objectives: Pancreatic cancer is characterized by genomic complexity and chromosomal instability, and atypical mitotic figures are morphological features of this phenotype. In the present study, we determined the frequency and the clinicopathological and prognostic significance of mitotic figures in pancreatic cancers.
Methods: We surveyed the mitotic figures of the normal ductal epithelium, acinar cells, pancreatic intraepithelial neoplasias, and pancreatic cancers on hematoxylin-and-eosin stained tissue specimens (n = 121).
Results: Pancreatic cancer cells showed significantly higher mitotic indices as compared with the ductal cells, acinar cells, and pancreatic intraepithelial neoplasias. Both normal and atypical mitosis were significantly elevated only in pancreatic cancers. In pancreatic cancers, approximately 30% of total mitosis was atypical including multipolar, lag-type, ring and asymmetrical mitosis, and anaphase bridges. The Kaplan-Meier curves in pancreatic cancers showed significant correlations between total mitosis and disease free survival. Furthermore, the cases with multipolar mitosis showed poorer prognosis than those without. Lymph node metastasis and multipolar mitosis were independent prognostic factors for overall survival of patients with pancreatic cancer. In addition, lymph node metastasis and total mitosis were independent factors for disease free survival.
Conclusion: These findings suggest that routinely obtained pathological specimens, even small biopsy or cytological specimens, can provide valuable information concerning the prognosis of pancreatic cancers. Copyright (C) 2015, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved.

DOI： 10.1016/j.pan.2015.10.005

Web of Science

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.83.107

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The purpose of this study is to investigate whether two types of laparoscopic spleen-preserving distal pancreatectomy (Lap-SPDP) techniques are being implemented safely. The study compares the clinical outcomes from laparoscopic Warshaw operation (Lap-W) with those from laparoscopic splenic vessels preserving SPDP (Lap-SPDP-VP) and considers the role of those operations. METHODS: On August 2013, the Warshaw technique was introduced to our institution and 17 patients with a lesion in the distal pancreas who underwent Lap-SPDP by December 2015 were enrolled. Six patients who underwent a Lap-W and 11 patients who underwent a Lap-SPDP-VP were investigated retrospectively. RESULTS: In the Lap-W and Lap-SPDP-VP patients, the sizes of the tumors were 46.5±31.2 and 25.7±14.9 mm [Probability (P) value =0.0913)]; the operative times were 287 min (range, 225-369 min) and 280 min (range, 200-496 min); the blood loss was 95 mL (range, 50-200 mL) and 60 mL (range, 0-650 mL); the length of the postoperative hospital stay was 12 days (range, 8-43 days) and 11 days (range, 7-28 days); median follow-up was 19 months (range, 13-28 months) and 23 months (range, 6-28 months), respectively. There was no case of symptomatic spleen infarction in either group. However, partial infarctions of the spleen without symptoms were observed by computed tomography in three out of six cases (50%) in the Lap-W. No patient required reoperation and the postoperative mortality was zero in both groups. All patients were alive and recurrence-free at the end of the follow-up period. Collateral veins around the spleen developed in 83.3% (five out of six patients) in the Lap-W and developed in 12.5% (one out of eight patients) in the Lap-SPDP-VP. A significant difference was observed between groups (P=0.0256). Gastric varices developed in 33.3% (two out of six patients) in the Lap-W. However, no case of rupture of varices, or other late phase complications was observed in either group. CONCLUSIONS: Both the Lap-W and Lap-SPDP-VP were found to be safe and effective, and in cases in which the detachment work of the splenic vessels from the tumor or the pancreatic parenchyma is difficult, performing Lap-W, rather than Lap-SPDP-VP, is considered appropriate. While Lap-SPDP is recommended for patients with benign or low grade malignant diseases, long-term follow-up to monitor hemodynamic changes in splenogastric circulation is considered needed.

DOI： 10.21037/tgh.2016.03.24

PubMed

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.83.172

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Definitive assessment of laparoscopic skill improvement after virtual reality simulator training is best obtained during an actual operation. However, this is impossible in medical students. Therefore, we developed an alternative assessment technique using an augmented reality simulator. METHODS: Nineteen medical students completed a 6-week training program using a virtual reality simulator (LapSim). The pretest and post-test were performed using an object-positioning module and cholecystectomy on an augmented reality simulator(ProMIS). The mean performance measures between pre- and post-training on the LapSim were compared with a paired t-test. RESULTS: In the object-positioning module, the execution time of the task (P < 0.001), left and right instrument path length (P = 0.001), and left and right instrument economy of movement (P < 0.001) were significantly shorter after than before the LapSim training. With respect to improvement in laparoscopic cholecystectomy using a gallbladder model, the execution time to identify, clip, and cut the cystic duct and cystic artery as well as the execution time to dissect the gallbladder away from the liver bed were both significantly shorter after than before the LapSim training (P = 0.01). CONCLUSIONS: Our training curriculum using a virtual reality simulator improved the operative skills of medical students as objectively evaluated by assessment using an augmented reality simulator instead of an actual operation. We hope that these findings help to establish an effective training program for medical students.

DOI： 10.1111/ases.12209

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：英語   出版者・発行元：(一社)日本癌学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/ases.12221

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Insulinoma is a very serious functional tumor. Surgeons should confirm complete resection of insulinomas before completing the operation, even in laparoscopic surgery. METHODS: Between August 2007 and September 2014, 15 consecutive patients with biochemical evidence of an insulinoma underwent laparoscopic pancreatectomy. Intraoperatively, a peripheral arterial blood sample was taken, and insulin was measured by quick insulin assay. Insulin levels were determined before anesthesia induction, every 30 min thereafter, and every 30 min for at least 1 h after tumor resection to confirm insulin levels did not increase before surgery was completed. RESULTS: All 15 patients (3 men and 12 women, average age 57.2 years) successfully underwent laparoscopic resection. One patient had two tumors, and the remaining 14 patients had one tumor each (three in the head, five in the body, and eight in the tail of the pancreas). Preoperative localization and regionalization studies identified the tumor correctly through CT (12/15 [80.0%]), MRI (9/12 [75.0%]), angiography (11/13 [84.6%]), endoscopic ultrasonography (7/10 [70.0%]), and selective arterial calcium injection (14/14 [100%]). Intraoperative ultrasonography detected 13 of 15 tumors (86.7%), and intraoperative blood insulin monitoring confirmed the complete resection of 16 of 16 tumors (100%). All patients were discharged with normal insulin levels and have been followed up for 3-88 months. There has been no recurrence of symptoms in any patients and none has died. CONCLUSION: Complete removal of an insulinoma can be reliably predicted by intraoperative blood insulin monitoring even in laparoscopic pancreatectomies.

DOI： 10.1111/ases.12187

PubMed

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：英語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：英語   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

DOI： 10.1272/jnms.82.122

Web of Science

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記述言語：英語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：英語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 56-year-old woman with an 8-year history of dysphagia and chest pain received a diagnosis of diffuse esophageal spasm by esophageal high-resolution manometry (HRM). Approximately 2 years of medical therapy was ineffective, and the patient's symptoms were worsening. Therefore, surgery was considered to be the most optimal treatment for this patient. The right thoracoscopic approach was selected because a long myotomy from the distal to proximal level of the esophagus was needed based on the HRM findings. The operation was performed in the prone position with establishment of pneumothorax. The total length of the myotomy was 16 cm, and the operation was finished within 2 hours. After the operation, the symptoms were considerably improved and no contractions were detected by HRM. The HRM findings before the operation were classified as rapid contractions with normal latency based on the 2012 Chicago classification of esophageal motility. Treatment for patients with rapid esophageal contractions with normal latency has not been previously described; however, treatment for diffuse esophageal spasm was considered to be pertinent to this patient. In conclusion, right thoracoscopic esophageal long myotomy in the prone position with establishment of pneumothorax may be useful when a proximal-level esophagomyotomy is required based on preoperative mapping by HRM.

DOI： 10.1097/MCG.0000000000000123

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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PubMed

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：The Medical Association of Nippon Medical School  

Laparoscopic incisional hernia repair with mesh is widely performed in Western countries as a treatment that is considered more reliable than conventional open repair. However, this procedure is not common in Japan. We report our experiences with this procedure using a new type of mesh (Ventralight ST ^TM, Medicon, Osaka, Japan). This procedure is indicated for almost all patients with incisional hernia but was difficult to perform for patients with giant hernia of the flank after nephrectomy. The procedure is performed with the patient in the supine position and 4 or 5 ports. One port is a 12-mm port, and the others are 5-mm ports. First, the 12-mm port is inserted in the left hypochondrium by the optical method. After pneumoperitoneum is established, we observe the abdominal cavity with a 5-mm flexible endoscope and insert the other ports, while dissecting peritoneal adhesions as necessary. We measure the hernia and trim the mesh to secure at least a 3-cm overlap with the normal abdominal wall. We insert the mesh through the 12-mm port, lift it to make tight contact with the abdominal wall by means of a transfixed thread, and fix the mesh with spiral tackers. We have performed this procedure for 14 patients. The mean operative duration was 127 minutes, and the average postoperative hospital stay was 5.9 days. There were no complications except for seroma, and the patient satisfaction was extremely high. In conclusion, laparoscopic incisional hernia repair with mesh is a useful and promising treatment that will, we believe, be introduced in many institutions in Japan.

DOI： 10.1272/manms.11.16

CiNii Books

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その他リンク： https://jlc.jst.go.jp/DN/JLC/20007059658?from=CiNii

記述言語：日本語   出版者・発行元：The Medical Association of Nippon Medical School  

Laparoscopy allows 10 to 15 times greater magnification of intra-abdominal tissues, organs, and vessels than an open approach. Laparoscopic surgery also improves visualization of the intra-abdominal organs for all surgeons involved in the operation, especially of the retroperitoneal organs, including the pancreas, neighboring vessels, duodenum, adrenal gland, and kidney. In this respect, laparoscopic pancreatic surgery is obviously superior to an open approach, where the ribs and organs anterior to the pancreas obstruct the operative field. Improved visualization also enables precise dissection using forceps. With regard to laparoscopic surgery for pancreatico-biliary malignancies, it is especially important to create a good operative field when dissecting the lymph nodes and pancreatic nerve plexuses where cancer cells easily infiltrate, and to perform R0 resection, which increases long-term survival in patients with pancreatico-biliary malignancies. Additionally, laparoscopic surgery is very useful in educating future healthcare professionals, because it provides the same visual field to all surgeons involved in the operation. The disadvantages of laparoscopic surgery over an open approach include the limited range of motion and the limited sense of touch, because laparoscopy is performed using a number of forceps inserted through trocars. Endoscopic surgeons must determine the most appropriate operative method for each patient, assessing whether laparoscopic pancreatectomy is suitable or not through a full understanding of the advantages and disadvantages of laparoscopic procedures. To date, we have performed laparoscopic pancreatectomies in more than 200 patients. The objective of this overview is to provide a better understanding of how far laparoscopic pancreatectomy has been standardized, based on our major experiences and a review of the literature.

DOI： 10.1272/manms.11.93

CiNii Books

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その他リンク： https://jlc.jst.go.jp/DN/JLC/20011202286?from=CiNii

記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

膵尾部嚢胞性病変に対する腹腔鏡下脾臓・脾動静脈温存膵尾部切除術式(Lap-SPDP)の手術手技について解説した。脾臓温存術式は10番、11番、18番リンパ節を郭清する必要のない疾患に対して施行されるべき術式であるため、手術手技の記載に先立ち同病変に対する脾臓温存術式の適応について考察した。手術手技に関しては、膵尾部病変に対する脾臓温存術式という表題に即して、膵切離は脾動脈分岐部より左側で行われることを想定し、同術式における脾動静脈の露出法および膵実質からの遊離手法を中心に解説することとした。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Laparoscopic distal pancreatectomy (Lap-DP) has been recognized worldwide as a feasible and highly beneficial procedure. The aim of this study is to investigate whether Lap-DP techniques are being implemented safely by surgeons training to perform this procedure. METHODS: We retrospectively compared the perioperative outcomes of Lap-DP in patients operated on by the surgeon originating this procedure at our hospital (expert surgeon group [E group], n = 47) and patients operated on by surgeons training to perform this procedure (training surgeons group [T group], n = 53). RESULTS: The median operating times for the E group and T group were 321 min (range, 150-653 min) and 314 min (range, 173-629 min), respectively; these times were not significantly different (P = 0.4769). The median blood loss in the T group (100 mL; range, 0-1950 mL) was significantly smaller than in the E group (280 mL; range, 0-1920 mL) (P = 0.0003). There were no significant intergroup differences in other operative results: combined operation ratio, spleen- and splenic vessels-preserving ratio, hand-assisted procedure ratio, and the ratio of transition to open. The frequency of pancreatic fistulas in the E group and T group was 12.8% and 16.9%, respectively; these rates were not significantly different (P = 0.5886). There were no significant differences between the two groups in terms of other complications and reoperation rates. The median hospital stay for the E group was significantly shorter than for the T group (10 vs 13 days; P = 0.0307). CONCLUSION: This retrospective analysis shows that teaching safe Lap-DP techniques to surgeons is reflected in stable perioperative outcomes.

DOI： 10.1111/ases.12131

PubMed

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記述言語：日本語   出版者・発行元：(株)南江堂  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J00393&link_issn=&doc_id=20141128090024&doc_link_id=10.15106%2FJ00393.2015059109&url=https%3A%2F%2Fdoi.org%2F10.15106%2FJ00393.2015059109&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

The patient, a 56-year-old woman, was found during routine checkup to have a disorder of hepatic function. Abdominal ultrasonography showed an ill-defined hypoechoic mass in the head and body of the pancreas; however, no blood-flow signal was observed within the tumor on Doppler ultrasonography. Abdominal computed tomography showed a low-density area in the arterial and portal venous phases. The lesion was visualized as an area of low signal intensity on both T1- and T2-weighted magnetic resonance images, whereas fluorodeoxyglucose positron emission tomography showed fluorodeoxyglucose accumulation in the tumor. Although a preoperative diagnosis was difficult to make, a rapid cytologic examination revealed evidence of a pancreatic endocrine tumor, and subtotal stomach-preserving pancreaticoduodenectomy with portal vein resection was performed. Histopathological examination showed tumor cell nests scattered in abundant fibrotic tissue; the tumor cells had proliferated in a cord-like fashion and showed immunostaining for chromogranin A. Staining for fibroblast activation protein a was seen in the fibroblastic cells contained within the fibrous stroma surrounding the tumor cell nests, whereas both the fibroblastic cells in the tumor and those in the stroma showed a high rate of staining for thrombospondin. We presume that tumor-associated fibroblasts were involved in the fibrosis of the tumor stroma.

DOI： 10.1272/jnms.81.346

Web of Science

PubMed

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：英語   出版者・発行元：(一社)日本癌学会  

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記述言語：日本語   出版者・発行元：日本膵・胆管合流異常研究会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

近年,腹腔鏡下肝切除術(laparoscopic hepatectomy:LH)の発展,普及は目覚ましいが,脈管処理手技が容易かつ安全に施行できれば,さらなる適応拡大へ進むと考えられる.当科で考案した,2.5mm短切ネラトンカテーテルを装着したENDO MINI-RETRACTによる脈管処理法は,術者片手での操作により繊細な動きと両手での協調操作が可能で,先端が細いため刺入の抵抗が少なく,カーブが小さいため一次分枝Glisson鞘や微小脈管の剥離が可能である.さらに,5mmポートからの挿入が可能で,糸などの脱着が容易であるなどの特徴を持つため,LHにおいて簡便,安全かつ有用な工夫である.(著者抄録)

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

We report a case of locally advanced pancreatic tail adenosquamous carcinoma that was treated by performing R0 resection after neoadjuvant chemotherapy with S-1 and gemcitabine. A 75-year-old man visited our hospital because of left lateral abdominal pain. On the basis of computed tomography and endoscopic biopsy findings, an 80-mm locally advanced pancreatic tail carcinoma with direct invasion to the gastric upper body, splenic flexure of the colon, and left kidney was diagnosed. Combined chemotherapy with S-1 and gemcitabine was initiated for reduction in the tumor size. After 11 courses of treatment, computed tomography revealed a partial response in tumor size reduction. Grade 3 neutropenia was observed as an adverse event. Distal pancreatectomy, proximal gastrectomy, partial resection of the descending colon, resection of the left kidney and left adrenal gland, and D2 lymph node dissection were performed. The pathological diagnosis was adenosquamous carcinoma in the pancreatic tail, and an R0 resection was achieved. However, a month after surgery, multiple distant liver metastases were observed. Neoadjuvant chemotherapy with S-1 and gemcitabine may reduce the tumor size in locally advanced pancreatic tail adenosquamous carcinoma and increase the R0 resection rate. However, treatment for distant metastasis is warranted in cases of pancreatic adenosquamous carcinoma.

PubMed

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は75歳、男性。左側腹部痛を主訴に受診した。腹部CT検査にて膵尾部に80mm大の辺縁不整な腫瘤を認め、胃、結腸、左腎に直接浸潤を認めた。局所進行膵尾部癌(cT4N1M0)と診断し、gemcitabine/S-1による化学療法を開始した。11コース終了後に直接浸潤(胃、結腸、左腎)は認めるが、腫瘍径は59mm大まで縮小し、FDG-PET検査で遠隔転移を認めなかったため手術を施行した。膵体尾部切除、噴門側胃切除、結腸部分切除、左腎、副腎摘出、D2リンパ節郭清術を施行し、R0手術を施行し得た。病理学的検査では腺扁平上皮癌であった。術後経過は良好であったが、1ヵ月後の腹部CT検査にて多発肝転移を認めた。膵腺扁平上皮癌は膵癌のなかでもまれな疾患であり、治療抵抗性とされる。今回、局所進行膵腺扁平上皮癌に対し、術前化学療法が奏効しR0手術を施行し得た症例を経験したため若干の文献的考察を加えて報告する。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J00296&link_issn=&doc_id=20140526410027&doc_link_id=%2Fab8gtkrc%2F2014%2F004105%2F028%2F0669-0672%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2014%2F004105%2F028%2F0669-0672%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：金原出版(株)  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

肝切除術は準無菌手術である。そのため手術創感染予防のために手術前および術中の予防的抗菌薬の投与で十分とされている。しかし、肝膿瘍など感染病変に対する肝切除術後は術前の感受性に基づいた抗菌薬の投与が必要である。症例は65歳、男性。十二指腸乳頭部癌に対して膵頭十二指腸切除後、仮性動脈瘤からの出血に対して総肝動脈塞栓を行った。塞栓後2週間目に腹部CTにて肝膿瘍を認めたため経皮経肝膿瘍ドレナージを行った。しかしその後、多発肝膿瘍、胆管炎を繰り返し、ドレナージや抗菌薬の投与では感染コントロール不能と判断し、根治治療のため肝右葉切除を行った。術前より肝膿瘍ドレーンから陰性桿菌を中心に多菌腫が検出されていたため、感受性に従い術後予防的抗菌剤はカルバペネム系薬の投与を行った。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J04188&link_issn=&doc_id=20140312480013&doc_link_id=%2Fdg9srgif%2F2014%2F001101%2F014%2F0081-0086%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg9srgif%2F2014%2F001101%2F014%2F0081-0086%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：The Medical Association of Nippon Medical School  

The incidence of aspiration pneumonia related to gastroesophageal reflux disease in Japan is increasing as the population ages. Such pneumonia tends to recur and to be refractory to conservative treatment because gastroesophageal reflux persists. Laparoscopic surgery provides a reliable treatment for gastroesophageal reflux but is not commonly performed in Japan, especially for patients with poor performance status. We report our experience treating patients with aspiration pneumonia caused by gastroesophageal reflux. The patients had severe pneumonia that recurred after medical management and resulted in prolonged hospitalization. These patients were referred for surgical treatment and underwent laparoscopic surgery to treat the underlying gastroesophageal reflux. In patients with poor performance status, we also performed laparoscopic gastrostomy for two reasons: 1) to provide a drainage route from the stomach if antireflux effect of surgery was inadequate and 2) to provide a feeding route if performance status did not improve and oral intake was impossible. The outcomes were excellent, the patients were discharged soon after surgery, and aspiration pneumonia has not recurred to date. In conclusion, laparoscopic antireflux surgery is a useful and promising treatment for patients with recurrent aspiration pneumonia. It may shorten hospital stays and thus reduce medical costs.

DOI： 10.1272/manms.10.182

CiNii Books

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その他リンク： https://jlc.jst.go.jp/DN/JALC/10041343752?from=CiNii

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

True splenic cysts are uncommon and are associated with elevated serum and intracystic tumor marker CA 19-9 levels. A 33-year-old woman presented to our hospital with a chief complaint of epigastralgia. Computed tomography of the abdomen showed a 10-cm cystic lesion in the spleen. The serum carbohydrate antigen (CA) 19-9 level was 3,347 U/mL (normal, &lt;37 U/mL). Total laparoscopic splenectomy was performed, and the serum level of CA 19-9 had normalized 2 weeks later. Pathological examination showed a benign true epidermal cyst of the spleen with strong immunohistological staining for CA 19-9. Splenic epidermoid cysts most often occur in young women, and laparoscopic surgery to remove cysts of this type is minimally invasive. Thus, laparoscopic surgery should be the method of first choice for most cases of splenic benign true cyst.

DOI： 10.1272/jnms.80.470

Web of Science

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(NPO)小切開・鏡視外科学会  

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記述言語：日本語   出版者・発行元：(NPO)小切開・鏡視外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

69歳女性。背部痛、食思不振にて近医受診。膵頭部腫瘤の診断にて当院紹介。腹部CTにて膵頭部に腫瘍性病変指摘。上部消化管内視鏡にて十二指腸浸潤疑われ生検にて腺癌を認めた。膵頭部癌の診断にて膵頭十二指腸切除術を施行し、病理組織学的検査で破骨細胞様巨細胞型退形成膵管癌と診断された(pStageIII)。術後補助化学療法にてゲムシタビン半年間使用したが、肝S7に転移巣出現したため、テガフール・ギメラシル・オテラシルカリウム(S-1)へ変更。約3年間S-1内服し肝転移消失。その後S-1を1年間内服続行し終了。現在局所再発や転移巣出現なく2年経過し、術後6年生存中である。破骨細胞型退形成性膵管癌は稀な腫瘍であり治療方法は未だ確立されていない。破骨細胞様巨細胞型退形成膵管癌術後肝転移に対しS-1が奏功し長期生存中の症例を経験したので若干の考察を加えて報告する。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J02025&link_issn=&doc_id=20131101100002&doc_link_id=%2Fcq0pancr%2F2013%2F002805%2F002%2F0622-0626%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcq0pancr%2F2013%2F002805%2F002%2F0622-0626%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

We performed surgery for proton pump inhibitor-resistant non-erosive reflux disease patients whose symptom index, confirmed by combined multichannel intraluminal impedance-pH monitoring, was positive. Laparoscopic Nissen fundoplication was performed in five patients and laparoscopic Toupet fundoplication in 3 patients. In 6 of 8 patients, non-acid or minor acid reflux caused the symptoms. Satisfaction percentages assessed 1 year postoperatively were 12.5 % (excellent) and 87.5 % (good).The number of total reflux events decreased to 28.5 +/- A 14.4 % postoperatively. The symptom index decreased from 63.8 to 20.8 %. It is controversial whether the surgery reduces weakly acidic reflux to the same degree as acid reflux. Previous reports discuss the effect of laparoscopic Nissen fundoplication on acid and weakly acidic reflux; however, the results of these studies are contradictory. In our cases, laparoscopic Toupet fundoplication as well as Nissen fundoplication improved symptoms, and reduced acid and non-acid reflux similarly. These findings strongly support the importance of surgical intervention in proton pump inhibitor-resistant non-erosive reflux disease patients.

DOI： 10.1007/s10388-013-0360-1

Web of Science

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BIOMED CENTRAL LTD  

BACKGROUND: Although gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, they are very rare. This study evaluated clinical and histopathological characteristics of duodenal GISTs to identify factors useful in predicting prognosis for patients with these tumors. METHODS: A retrospective study was performed on 20 patients who had undergone surgery between 1987 and 2009 for duodenal GISTs. Clinical, histopathological, and immunohistochemical data were evaluated. Survival analyses were conducted using Kaplan-Meier estimates. RESULTS: In 12 patients (60%), duodenal GISTs were diagnosed incidentally. Eight cases (40%) were classified as high risk grade GISTs. Skeinoid fibers (SkF), which are eosinophilic globular hyaline deposits in the extracellular interstitium of the tumor, were found in 12 patients. Skeinoid fibers were not recognized in 8 cases, and these included 3 cases (37.5%) where tumors recurred after surgery and the patient died. Tumors without SkF were larger (81 ± 92 vs. 23 ± 8 mm, P < 0.001) and had a higher mitotic count (224.0 ± 336.6 vs. 0.0 ± 0.0 /50 high-power field, P < 0.001) than those with SkF. Survival time was shorter in patients with tumors lacking SkF (52.9 ± 50.7 vs. 108.9 ± 86.5 months, P = 0.019). CONCLUSIONS: We have identified clinical and histopathological characteristics that were useful in predicting the prognosis of patients with duodenal GISTs. In this study, 60% of the tumors were found incidentally, SkF were not recognized in tumors from 40% of patients, and all cases of post-operative tumor recurrence and death occurred in this subgroup of patients.

DOI： 10.1186/1477-7819-11-202

Web of Science

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(有)科学評論社  

2002年1月〜2011年12月の10年間に胆嚢摘出術を施行した後期高齢者(高齢者)167例において急性胆嚢炎に対して早期・緊急腹腔鏡下胆嚢摘出術(LC)施行群(A群)の周術期経過を、同時期の高齢者早期・開腹胆嚢摘出術施行群(B群)、高齢者待機的LC施行群(C群)、75歳未満で早期・緊急LC施行群(D群)の4群間に分け比較検討した。対象はA群12例(平均年齢81歳)、B群10例(79歳)、C群123例(79歳)、D群18例(34〜74・平均60歳)であった。その結果、A群で術後入院日数が有意に長期間であった以外、術中出血量・手術時間・開腹移行率・合併症については他の3群との間に差は認められなかった。以上より、早期・緊急手術の必要な後期高齢者急性胆嚢炎でのLCの適応は症例を選択した場合には十分妥当性があるものと考えられた。しかし、施設によってはLCに熟練している医師が常に対応可能でないことも考えられる状況を踏まえてLCの適否を判断すべきであり、緊急手術に対応できない場合には胆嚢ドレナージを考慮することも必要と考えられた。

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

We report a choledochal cyst that was successfully treated with laparoscopic surgery. A 32-year-old Japanese woman was referred to our hospital with a suspected choledochal cyst. Magnetic resonance cholangiopancreatography and computed tomography showed the common bile duct to be grossly dilated to the hepatic confluence. A diagnosis of type-Ia choledochal cyst in the Todani classification was made, and laparoscopic resection was performed. The patient was placed in the lithotomy position under general anesthesia, and 4 ports were inserted. After the cystic duct was dissected, the hepatoduodenal ligament was incised and a choledochal cyst was identified. Next, the common bile duct was mobilized and dissected away from the surrounding vessels and tissues. Taping of the common bile duct allowed better exposure and dissection of the surrounding tissues. Mobilization of the bile duct and dissection of the surrounding tissue was performed to the bifurcation of the common hepatic duct. Then the common hepatic duct was transected just distal to the choledochal cyst. The inferior common bile duct was dissected from the pancreas to identify the distal end of the choledochal cyst and the pancreaticobiliary junction behind the duodenum. The narrow segment of the choledochal cyst was identified and divided after distal closure with clips. After the gall bladder was dissected from the liver bed, the choledochal cyst and gallbladder were removed. A Roux limb was created extracorporeally via the umbilical incision. The jejunum 30 cm distal to the ligament of Treitz was removed through the transumbilical incision and transected. To create the Roux limb, the mesentery of the jejunum was also extracorporeally separated. A 50-cm Roux limb was made by means of side-to-side anastomosis with an endostapler. After a jejunostomy for hepaticojejunostomy anastomosis was created, the Roux limb was returned to the abdominal cavity. Then, pneumoperitoneum was started again, and the Roux limb was brought up laparoscopically in a retrocolic fashion. An end-to-side hepaticojejunostomy was intracorporeally established with a continuous, single-layer full-thickness 4-0 vicryl suture. Total operation time was 715 minutes. Intraoperative body fluid loss was 250 mL, and the postoperative course was uneventful with no major complications. The patient was discharged from hospital on the 12th postoperative day. She remains asymptomatic with normal liver function after 24 months of follow-up. (J Nippon Med Sch 2013; 80: 160-164)

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

We report a rare case of adenocarcinoma of the minor papilla of the duodenum treated with transduodenal minor papillectomy. A 64-year-old woman was treated for an asymptomatic duodenal tumor detected on gastroduodenoscopy. Endoscopy showed a 15-mm sessile mass in the descending duodenum proximal to the major papilla. The major papilla was a villous 24-mm-diameter polypoid tumor. Histopathologic examination of the biopsy specimen showed tubular adenoma with moderate epithelial atypia. Transduodenal major and minor papillectomies were performed. The orifice of the duct of Santorini and the pancreatic duct were re-approximated to the duodenal wall to prevent acute pancreatitis caused by scarring and stenosis of the duct orifice. Histological findings were consistent with well-differentiated adenocarcinoma limited to the minor duodenal papilla, without infiltration of the duodenal wall submucosa, and confirmed complete resection. The patient had an uneventful postoperative course and has remained asymptomatic, without evidence of tumor recurrence or stenosis of the pancreatic duct orifice, for 4 years. (J Nippon Med Sch 2013; 80: 165-170)

DOI： 10.1272/jnms.80.165

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

When distal pancreatectomy is carried out for left-sided pancreatic cancer, splenectomy is usually performed not only for margin-negative resection but also for effective clearance of the splenic hilar lymph nodes (LNs). However, the incidence of splenic hilar LN metastasis in these patients has not been definitively determined.
From April 2010 to June 2011, in a pilot study, we analyzed the medical records of twelve patients who had undergone radical antegrade modular pancreatosplenectomy. Potential remnant soft tissue around the splenic hilum, which would be left following an extended Warshaw's procedure, was dissected and sent to a pathologist. Three Japanese medical centers conducted a retrospective survey of splenic hilar lymph node metastasis in left-sided pancreatic cancer to support our study.
In the pilot study, all twelve patients had adenocarcinoma with a median tumor size of 2 cm. Six patients had LN metastasis and a median number of 4 splenic hilar LNs were evaluated; however, no splenic hilar LN metastasis was noted. In the Japanese multicenter survey (n = 85), only four patients had splenic LN metastasis. Small (&lt; 3 cm) and proximal (neck/body) left-sided pancreatic cancer might not be associated with splenic hilar LN metastasis (P &lt; 0.05).
In well-selected left-sided pancreatic cancer, the incidence of splenic hilar LN metastasis is low enough that splenectomy-omitting radical distal pancreatectomy would be feasible. The rationale for routine splenectomy should be re-evaluated, and the oncologic effects of the preserved spleen need to be investigated further.

DOI： 10.1007/s00534-012-0549-z

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：6  

DOI： 10.1272/jnms.80.446

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.80.250

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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DOI： 10.1111/j.1758-5910.2012.00145.x

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Dedifferentiated liposarcoma of the mesentery is an extremely rare tumor.
A 71-year-old man with a 2-month history of abdominal distention was admitted to our department for evaluation and treatment of an abdominal mass. Computed tomography and magnetic resonance imaging revealed an 11 X 9 cm mass lesion with fat density in the upper right abdominal cavity, displacing the ascending and transverse colon ventrally. Abdominal angiography showed small feeding vessels of the tumor from the ileocolic artery and the middle colic artery. On basis of these findings, liposarcoma arising from the mesocolon ascendens was diagnosed, and complete removal of the tumor and central pancreatectomy (partial resection of the body of the pancreas) were performed. The histopathological diagnosis was dedifferentiated liposarcoma, and the patient is free from recurrence 6 months after surgery. The treatment strategy for abdominal dedifferentiated liposarcoma is surgical resection with a wide surgical margin. (J Nippon Med Sch 2012; 79: 385-390)

DOI： 10.1272/jnms.79.385

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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