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：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To investigate a prognostic score for stage II-III colorectal cancer (CRC) based on post-CEA and pT4 levels. METHODS: Two cohorts of stage II-III CRC patients who underwent curative surgery between 2011 and 2017 were included. The prognostic score (T-CEA score) was calculated as follows: T-CEA-0, post-CEA ≤ 5 ng/mL and pT1-3; T-CEA-1, post-CEA > 5 ng/mL or pT4; T-CEA-2, post-CEA > 5 ng/mL and pT4. RESULTS: The T-CEA scores of the 587 patients were as follows: T-CEA-0 (n = 436; 74%), T-CEA-1 (n = 129; 22%), and T-CEA-2 (n = 10; 2%). The 5-year recurrence-free survival (RFS) rates of the T-CEA-0, 1, and 2 groups were 80.3%, 54.8%, and 0%, respectively (P < 0.01), and the 5-year overall survival (OS) rates were 90.9%, 74.2%, and 0%, respectively (T-CEA-0 vs T-CEA-1: P < 0.01, T-CEA-1 vs T-CEA-2: P = 0.04). Multivariate analysis revealed that an elevated T-CEA score of 1 or 2 was a significant risk factor for poor RFS (HR: 2.89, P < 0.01) and OS (HR: 2.85, P < 0.01). CONCLUSION: The T-CEA score is a reliable and convenient prognostic score for stage II-III CRC.

DOI： 10.1007/s00595-023-02644-6

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

As liver disease progresses, intrahepatic vascular resistance increases (backward flow theory of portal hypertension) and collateral veins develop. Adequate portal hypertension is required to maintain portal flow into the liver through an increase in blood flow into the portal venous system (forward flow theory of portal hypertension). The splenic artery resistance index is significantly and selectively elevated in cirrhotic patients. In portal hypertension, a local hyperdynamic state occurs around the spleen. Splenomegaly is associated with a poor prognosis in cirrhosis and is caused by spleen congestion and by enlargement and hyperactivation of splenic lymphoid tissue. Hypersplenism can lead to thrombocytopenia caused by increased sequestering and breakdown of platelets in the spleen. The close relationship between the spleen and liver is reflected in the concept of the hepatosplenic axis. The spleen is a regulatory organ that maintains portal flow into the liver and is the key organ in the forward flow theory of portal hypertension. This review summarizes the literature on the role of the spleen in portal hypertension.

DOI： 10.1272/jnms.JNMS.2023_90-104

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Pseudoaneurysm is a potentially life-threatening complication after hepatobiliary pancreatic surgery. Although various measures have been taken to prevent the formation of postoperative pseudoaneurysms, completely avoiding complications can be difficult. An 83-year-old man underwent bile duct resection and systematic regional lymphadenectomies for distal cholangiocarcinoma. Polyethylene glycolic acid mesh with fibrin glue was applied to the pancreas around the distal stump and detached artery to prevent leakage of pancreatic juice and reinforce the arterial wall. Screening contrast-enhanced computed tomography on the 7th postoperative day indicated no pseudoaneurysm. The patient was discharged on the 20th postoperative day after an uneventful course. However, 4 days later, the patient visited the emergency outpatient department with a complaint of fever. Contrast-enhanced computed tomography revealed an abscess formation and a pseudoaneurysm around it. Emergency celiac arteriography revealed two pseudoaneurysms at the left hepatic artery and posterior superior pancreaticoduodenal artery; they were successfully treated with transcatheter arterial embolization using microcoils and covered stent placement. The patient was discharged 9 days after interventional radiology treatment. At the 14 months postoperative follow-up, the patient had no recurrence or stent obstruction. Multiple synchronous pseudoaneurysms are rare; accurately identifying the site by angiography and selecting appropriate treatment for each site is important.

DOI： 10.1007/s12328-022-01711-8

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：英語   掲載種別：研究論文（学術雑誌）  

AIM: The association between thrombolytic therapy and the outcome in patients with portal vein thrombosis (PVT) remains controversial. This study aimed to evaluate the outcome in patients with PVT who received antithrombin III-based therapy. METHODS: This study was a retrospective, multicenter study to investigate the liver-related events and the survival rates in 240 patients with PVT who received the therapy. RESULTS: The patients comprised 151 men and 89 women, with a median age of 69 years. The rate of favorable response, defined as maximum area of PVT changed to ≤75%, was 67.5% (162/240). The cumulative rates of liver-related events at 1, 2, and 3 years were 38.2%, 53.9%, and 68.5%, respectively. The multivariate analysis showed that viable hepatocellular carcinoma, absence of maintenance therapy, non-responder, and PVT progression were significantly associated with liver-related events. The PVT progression was observed in 23.3% (56/240). The multivariate analysis identified older age, absence of maintenance therapy, and non-responder as independent factors associated with PVT progression. The multivariate analysis revealed that younger age, no hepatocellular carcinoma, presence of maintenance therapy, and lower Model for End-stage Liver Disease-Sodium score significantly contributed to 3-year survival. Of the 240 patients, 13 (8.9%) prematurely discontinued treatment due to any adverse events. CONCLUSIONS: This study suggests that maintenance therapy, favorable response, and absence of PVT progression may suppress or control liver-related events in antithrombin III-based therapy for patients with PVT. Specifically, maintenance therapy could suppress not only liver-related events, but also PVT progression and improve the prognosis.

DOI： 10.1111/hepr.13840

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：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Esophageal gastrointestinal stromal tumors (E-GISTs) are often diagnosed early due to complaints such as dysphagia and are rarely found to be huge in size. Here, we report the treatment of a case of huge E-GIST successfully resected by minimally invasive surgery after neoadjuvant imatinib therapy. CASE PRESENTATION: An 86-year-old male patient with a 3-month history of dysphagia was referred to our hospital because of a suspected mediastinal tumor on chest X-ray. The chest computed tomography scan revealed a huge solid tumor, of about 100 mm in diameter, protruding into the left thoracic cavity. Histopathological examination results of fine-needle aspiration biopsy under endoscopic ultrasonography revealed a c-kit and CD34-positive esophageal gastrointestinal stromal tumor. The patient received neoadjuvant therapy with imatinib (400 mg/day) to reduce the size of the tumor and prevent rupture during resection. After 28 days of oral administration of imatinib, the tumor size decreased. However, the patient refused to continue treatment with imatinib and therefore underwent mediastino-laparoscopic transhiatal esophagectomy. We successfully resected the tumor completely with mediastino-laparoscopic surgical techniques. Esophageal reconstruction was performed using a gastric tube in the posterior sternal route. After an uneventful postoperative course, the patient was discharged postoperative day 14. Immunohistochemical findings of the resected specimen showed that the tumor cells were positive for c-kit, DOG-1 and CD34 and negative for smooth muscle actin and S100. CONCLUSIONS: Hybrid surgical procedure utilizing mediastino-laparoscopy might be useful for high-risk patient with esophageal tumors.

DOI： 10.1186/s40792-022-01464-z

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The treatment strategies for acute appendicitis, such as emergency appendectomy (EA), interval appendectomy (IA), and repeating nonoperative management (NOM), are controversial. In this study, we examined the preoperative factors that can be used to distinguish which patients should undergo IA. METHODS: We retrospectively identified 902 patients who underwent surgery for appendicitis in our hospital from January 2010 to December 2021. Of these patients, 776 were included in this study. The patients were divided into two groups: those with a periappendiceal fluid collection (PAFC) on preoperative computed tomography (PAFC-positive group, n = 170) and those without a PAFC (PAFC-negative group, n = 606). In each group, we compared patients who underwent EA and IA. RESULTS: In the PAFC-positive group, patients who underwent EA had a significantly higher postoperative complication rate than those who underwent IA (40.5% vs. 24.0%, p = 0.037). In the multivariate analysis, only the presence of PAFC was significantly associated with an increased risk of postoperative complications (odds ratio, 7.11; 95% confidence interval, 2.73-18.60; p < 0.001). The presence of PAFC alone was not significantly associated with an increased risk of IA or NOM failure (odds ratio, 1.48; 95% confidence interval, 0.19-11.7; p = 0.71). The rate of neoplasia on pathologic examination was significantly higher in the PAFC-positive than PAFC-negative group (7.6% vs. 1.5%, p < 0.001); the rate of carcinoma was also higher in the PAFC-positive group (2.4% vs. 0.17%, p = 0.02). CONCLUSIONS: The presence of PAFC on preoperative computed tomography was found to be a risk factor for postoperative complications but not IA or NOM failure. It was also correlated with neoplasia as the etiology of appendicitis. Therefore, PAFC positivity is useful as an indication for IA.

DOI： 10.1186/s13017-022-00437-9

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: A recent increase in the number of surgeries performed on obese patents has raised several issues. In this study, we examined the effects of obesity on laparoscopic and open distal gastrectomy. METHODS: A total of 262 patients with gastric cancer (cStage I) who underwent distal gastrectomy were classified into open distal gastrectomy (ODG) (145 patients) and laparoscopic distal gastrectomy (LDG) (117 patients) groups. According to their body mass index (BMI), they were subdivided into obese (BMI ≥ 25) and non-obese patients (BMI < 25) to examine the duration of surgery, blood loss, the number of lymph node dissections, postoperative hospital stay, and incidence of postoperative complications. RESULTS: The duration of surgery was longer and blood loss was higher for obese patients than for non-obese patients in both groups. The results for these two endpoints were significantly reduced in the LDG group than in the ODG group both in obese and non-obese patients. Furthermore, the number of lymph nodes dissected tended to be higher in the LDG group than in the ODG group in obese patients. Postoperative hospital stay was not significantly different between obese and non-obese patients in both groups, but was significantly shorter in the LDG group than in the ODG group regardless of the body weight. The incidence of postoperative complications was significantly higher in obese patients than in non-obese patients, although the difference between the groups was not significant. CONCLUSIONS: These findings indicate that LDG may be useful for obese patients with cStage I gastric cancer.

DOI： 10.1272/jnms.JNMS.2022_89-218

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Liver cancer, including hepatocellular carcinoma (HCC), is the fifth most common cause of cancer deaths in Japan. The main treatment options for HCC are surgical resection, liver transplantation, radiofrequency ablation (RFA), transarterial chemoembolization (TACE), and systemic chemotherapy. Here, recent medical treatments for HCC, including surgery, percutaneous ablation, transcatheter arterial chemoembolization/transcatheter arterial embolization, and drug therapy, are reviewed with a focus on Japan.

DOI： 10.1272/jnms.JNMS.2022_89-224

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Socratic method, which is an educational method to promote critical thinking through a dialogue, has never been practiced in a large number of people at the academic societies. METHODS: Modified Socratic method was performed for the first time as an educational seminar using an example case of moderate acute cholecystitis based on the evidence described in Tokyo Guidelines 2018. We adopted a method that Takada had been modifying for many years: the instructor first knows the degree of recognition of the audience, then the instructor gives a lecture in an easy-to-understand manner and receives questions from the audience, followed by repeated questions and answers toward a common recognition. RESULTS: Using slides, video, and an answer pad, 281 participants including the audience, instructors and moderators came together to repeatedly ask and answer questions in the five sessions related to the case scenario. The recognition rate of the topic of Critical View of Safety increased significantly before vs after this method (53.0% vs 90.3%). The seminar had been successfully performed by receiving a lot of praise from the participants. CONCLUSION: This educational method is considered to be adopted by many academic societies in the future as an effective educational method.

DOI： 10.1002/jhbp.1076

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)日本消化器内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Simple hepatic cysts are typically saccular, thin-walled masses with fluid-filled epithelial lined cavities. They arise from aberrant bile duct cells that develop during embryonic development. With the development of diagnostic modalities such as ultrasonography (US), CT, and MRI, simple hepatic cysts are frequently detected in clinical examinations. US is the most useful and noninvasive tool for diagnosis of simple hepatic cysts and can usually differentiate simple hepatic cysts from abscesses, hemangiomas, and malignancies. Cysts with irregular walls, septations, calcifications, or daughter cysts on US should be evaluated with enhanced CT or MRI, to differentiate simple hepatic cysts from cystic neoplasms or hydatid cysts. Growth and compression of hepatic cysts cause abdominal discomfort, pain, distension, and dietary symptoms such as nausea, vomiting, a feeling of fullness, and early satiety. Complications of simple hepatic cysts include infection, spontaneous hemorrhage, rupture, and external compression of biliary tree or major vessels. Asymptomatic simple hepatic cysts do not require treatment. Treatment for symptomatic simple hepatic cysts includes percutaneous aspiration, aspiration followed by sclerotherapy, and surgery. The American College of Gastroenterology clinical guidelines recommend laparoscopic fenestration because of its high success rate and low invasiveness. Percutaneous procedures for treatment of simple hepatic cysts are particularly effective for immediate palliation of patient symptoms; however, they are not generally recommended because of the high rate of recurrence. Management of simple hepatic cysts requires correct differentiation from neoplasms and infections, and selection of a reliable treatment.

DOI： 10.1272/jnms.JNMS.2022_89-115

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  

当科では2014年10月〜2021年12月まで184例の腹腔鏡下肝切除術を施行してきた。部分切除や外側区域切除から開始し,著者が2016年に日本内視鏡外科学会技術認定(肝)を取得した後から高難度手術を行うなど,step by stepで適応も広げて来た。安全性を最優先させて来たつもりであるが,そのなかでも致死的となりうる術中合併症も経験してきた。その経験,対処法を共有することが今後の腹腔鏡下肝切除術(Lap-H)の普及と安全性の担保になると考えたため当科での経験を報告する。(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：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）  

Bariatric surgery is performed worldwide to address morbid obesity. The benefits of this surgery are continued weight loss and decreased obesity-related complications. The relationship between bariatric metabolic surgery and reemployment has already been evaluated in Western countries, but there are few papers reporting these relationships in Japan since the number of bariatric metabolic surgery is small. Few Japanese studies have evaluated the effects of bariatric surgery on obesity stigma, which affects obese people's chances of employment and advancement, and may result in dismissal. We describe a 39-year-old man who underwent bariatric surgery after being dismissed from his job because of morbid obesity. Traditional weight loss methods failed to maintain weight loss. Preoperatively, the patient was treated for type 2 diabetes, hypertension, and abnormal lipid metabolism. He underwent sleeve gastrectomy and lost 50.4 kg (percent excess weight loss: 68.1%) in the first postoperative year. All medications were stopped after improved blood laboratory test results, and he was re-employed 8 months after surgery. Increased social activity associated with employment is a factor in suppressing rebound weight gain after bariatric surgery, and the weight loss associated with bariatric surgery helps decrease anti-obesity social stigma.

DOI： 10.1272/jnms.JNMS.2023_90-303

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Pancreatic body and tail cancer easily invades retroperitoneal tissue, including the transverse mesocolon. It is difficult to ensure a dissected peripancreatic margin with 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 a mesenteric approach and achieved good outcomes. METHODS: There are two main considerations for surgical procedures using a 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). RESULTS: From 2017 to 2019, we performed DP-TCR using a 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 Clavien-Dindo grade IIIa or worse perioperative complications were observed in any patient. CONCLUSIONS: We believe that DP-TCR is useful as a radical surgery for advanced pancreatic body and tail cancer with extrapancreatic invasion.

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：(有)科学評論社  

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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：(有)科学評論社  

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記述言語：日本語   出版者・発行元：神奈川県医師会  

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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）  

PURPOSE: Portal vein thrombosis (PVT) following hepatectomy is potentially life-threatening. We aimed to evaluate the incidence of PVT after hepatectomy for hepatocellular carcinoma and identify coagulation and fibrinolytic factors that could predict early-stage postoperative PVT. METHODS: A retrospective analysis was conducted on 65 hepatocellular carcinoma patients who underwent radical hepatectomy. The risk factors for postoperative PVT were identified based on univariate and multivariate analyses, and the levels of coagulation and fibrinolytic factors were measured during the perioperative period. RESULTS: The incidence of PVT after hepatectomy was 20.0%. The patients were divided into two groups: those with PVT (n=13; PVT group) and those without PVT (n=52; no-PVT group). The frequency of the use of the Pringle maneuver during surgery was higher in the PVT group than in the no-PVT group, and the postoperative/preoperative ratios of thrombin-antithrombin III complex (TAT) and of D-dimer were significantly higher in the PVT group. CONCLUSION: A high incidence of PVT was found in hepatocellular carcinoma patients after hepatectomy. The frequency of the Pringle maneuver is a potential risk factor for postoperative PVT, and the postoperative/preoperative TAT and D-dimer ratios may be used as early predictors of PVT after hepatectomy for hepatocellular carcinoma.

DOI： 10.1007/s00423-021-02125-9

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：英語   掲載種別：研究論文（学術雑誌）  

Portal hypertension is most commonly caused by chronic liver disease. As liver damage progresses, portal pressure gradually elevates and hemodynamics of the portal system gradually change. In normal liver, venous returns from visceral organs join the portal trunk and flow into the liver (hepatopetal blood flow). As portal pressure increases due to liver damage, congestion of some veins of the visceral organ occurs (blood flow to and from). Finally, the direction of some veins (the left gastric vein in particular) of the visceral organ change (hepatofugal blood flow) and develop as collateral veins (portosystemic shunt) to reduce portal pressure. Therefore, esophagogastric varices serve as drainage veins for the portal venous system to reduce the portal pressure. In chronic liver disease, as intrahepatic vascular resistance is increased (backward flow theory) and collateral veins develop, adequate portal hypertension is required to maintain portal flow into the liver through an increase of blood flow into the portal venous system (forward flow theory). Splanchnic and systemic arterial vasodilatations increase the blood flow into the portal venous system (hyperdynamic state) and lead to portal hypertension and collateral formation. Hyperdynamic state, especially around the spleen, is detected in patients with portal hypertension. The spleen is a regulatory organ that maintains portal flow into the liver. In this review, surgical treatment, interventional radiology, endoscopic treatment, and pharmacotherapy for portal hypertension (esophagogastric varices in particular) are described based on the portal hemodynamics using schema.

DOI： 10.1111/hepr.13614

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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  

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記述言語：日本語   出版者・発行元：(株)日本臨床社  

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記述言語：日本語   出版者・発行元：(株)日本臨床社  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

mTOR is involved in the proliferation of liver cancer. However, the clinical benefit of treatment with mTOR inhibitors for liver cancer is controversial. Protein disulfide isomerase A member 3 (PDIA3) is a chaperone protein, and it supports the assembly of mTOR complex 1 (mTORC1) and stabilizes signaling. Inhibition of PDIA3 function by a small molecule known as 16F16 may destabilize mTORC1 and enhance the effect of the mTOR inhibitor everolimus (Ev). The aim of the present study was to elucidate the usefulness of combination treatment with Ev and 16F16 in liver cancer using cultured Li-7 and HuH-6 cells. The proliferation of cultured cells was examined following treatment with 0.01 µM Ev, 2 µM 16F16 or both. The expression levels and phosphorylation of S6 kinase (S6K) and 4E-binding protein 1 (4E-BP1) were examined by western blotting. Li-7 was susceptible to Ev, and proliferation was reduced to 69.5±7.2% by Ev compared with that of untreated cells. Proliferation was reduced to 90.2±10.8% by 16F16 but to 62.3±12.2% by combination treatment with Ev and 16F16. HuH-6 cells were resistant to Ev, and proliferation was reduced to 86.7±6.1% by Ev and 86.6±4.8% by 16F16. However, combination treatment suppressed proliferation to 57.7±4.0%. Phosphorylation of S6K was reduced by Ev in both Li-7 and HuH-6 cells. Phosphorylation of 4E-BP1 was reduced by combination treatment in both Li-7 and HuH-6 cells. Immunoprecipitation assays demonstrated that PDIA3 formed a complex with 4E-BP1 but not with S6K. The small molecule 16F16 increased susceptibility to Ev in cultured liver cancer cells, which are resistant to Ev. The inhibition was associated with reduction of 4E-BP1 phosphorylation, which formed a complex with PDIA3. Combination treatment with Ev and 16F16 could be a novel therapeutic strategy for liver cancer.

DOI： 10.3892/ol.2020.12289

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：(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   掲載種別：研究論文（学術雑誌）  

In this study, we compared the outcomes of laparoscopic gastrectomy and open gastrectomy in the elderly. Laparoscopic surgery was comparable to laparotomy in terms of the operation time and number of lymph node dissections and was significantly associated with less bleeding volume, duration of postoperative hospital stay, and a lower postoperative complication rate. Surgical invasion and overall risk scores were significantly low as assessed by the Estimation of Physiologic Ability and Surgical Stress(E-PASS)system. Based on these findings, laparoscopic gastrectomy can be considered to be superior to open gastrectomy as a surgical technique for the elderly.

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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：英語   掲載種別：研究論文（学術雑誌）  

Portopulmonary hypertension (PoPH) is a well-known complication of liver cirrhosis. The aim of this study was to clarify the pulmonary hemodynamics and the prevalence and characteristics of PoPH in patients with portal hypertension. METHODS: The subjects were 335 patients with portal hypertension diagnosed by hepatic vein pressure gradient (HVPG). Among them, 186 patients received measurements of pulmonary artery pressure (PAP), pulmonary artery wedge pressure (PAWP) and pulmonary vascular resistance (PVR). PoPH was diagnosed by PAP >20 mmHg, PVR ≥3 Wood units (WU) and PAWP ≤15 mmHg. RESULTS: The Child-Pugh classification was class A in 53, B in 92 and C in 41 patients. Median (range) values of HVPG, PAP, PVR and PAWP were 18.4 (5.5-39.0) mmHg, 12.9 (6.6-40.8) mmHg, 0.8 (0.1-4.5) WU and 7.5 (2.2-15.4) mmHg, respectively. Of six patients with PAP >20 mmHg, four had autoimmune hepatitis or primary biliary cholangitis, with the prevalence being significantly higher than that in patients with PAP ≤20 mmHg. Meanwhile, no significant difference was noted in the hepatic functional reserve or HVPG between patients with PAP >20 mmHg and ≤20 mmHg. Only two patients met the diagnostic criteria of PoPH and both patients were Child-Pugh B. The Child-Pugh score and HVPG were not associated with PoPH. CONCLUSIONS: Our study demonstrated that only two patients were complicated by PoPH. High PAP values were noted in patients with primary biliary cholangitis or autoimmune hepatitis. However, the presence of PoPH and high PAP were not associated with the degree of hepatic functional reserve or HVPG.

DOI： 10.1111/hepr.13560

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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)日本門脈圧亢進症学会  

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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)  

食道胃静脈瘤の治療法には、内視鏡的治療、IVR、手術療法、薬物療法などがある。近年は内視鏡的治療が中心となっているが、難治例には他の治療法も選択される。食道胃静脈瘤は、門脈圧亢進により発達する側副血行路の一つで、亢進した門脈圧を減圧するdrainage veinの役割を担うため、治療により合併症が生じる場合もある。各疾患の血行動態を把握し一つの治療法に固執せず、その血行動態に即した治療法を選択することが重要である。(著者抄録)

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その他リンク： http://search.jamas.or.jp/link/ui/2021163204

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Correctly distinguishing metastasis and sarcoid-like reaction in patients with mediastinal lymphadenopathy is clinically important in esophageal cancer. A patient was a 52-year-old Japanese woman with superficial esophageal squamous cell carcinoma and rare case of sarcoid-like reaction. The patient was admitted with pharyngeal discomfort and an upper gastrointestinal endoscopy detected a superficial tumor in the middle thoracic esophagus. Biopsy confirmed a diagnosis of squamous cell carcinoma. Chest computed tomography (CT) showed enlarged lymph nodes around the trachea and in the bilateral hilum of the lung that were found to accumulate label on positron emission tomography CT. One course of chemotherapy in 5-fluorouracil, docetaxel and cisplatin did not affect the lymphadenopathy, which suggested that it was reactive rather than metastatic. The patient had undergone thoracoscopic esophagectomy with lymph node dissection. The pathohistology of the dissected lymph nodes showed noncaseating epithelioid-cell granuloma and no malignant cells. No clinical findings indicative of systemic sarcoidosis were observed, leading to a diagnosis of sarcoid-like reaction with the esophageal cancer. The patient has survived without recurrence for 4 years after beginning the initial treatment. Monitoring the response to chemotherapy may be helpful in distinguishing between metastasis and sarcoidosis-associated lymphadenopathy in esophageal cancer.

DOI： 10.1007/s12328-020-01156-x

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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  

44歳男性、右側腹部痛を主訴とした。以前より軽い右側腹部痛を認めており、人間ドック検診で腹腔内腫瘤を指摘された。紹介受診時の血液検査で腫瘍マーカーは正常値であり、腹部造影CT検査所見では上行結腸周囲に隔壁が淡く造影される内部均一な多房性嚢胞性病変(径90×50mm大)と嚢胞内を走行する回結腸動静脈を認めたが、腹部MRI検査所見では嚢胞内の充実成分や拡散制限は認めなかった。また、PET-CT検査所見では異常集積はなく、下部消化管内視鏡検査所見では大腸粘膜面の異常や壁外性の圧排像を認めないことから、腸間膜嚢腫と診断して腹腔鏡下結腸右半切除術を行った。病理組織学的所見では内皮細胞で被覆された多数の管腔構造と断続的な平滑筋層の発達を認め、免疫染色でD2-40弱陽性より、上行結腸腸間膜内に発生した腸間膜リンパ管腫と診断した。術後1年経過時点で再発は認めない。

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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=J04260&link_issn=&doc_id=20201204310004&doc_link_id=10.1272%2Fmanms.16.201&url=https%3A%2F%2Fdoi.org%2F10.1272%2Fmanms.16.201&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）  

BACKGROUND: A Bochdalek hernia (BH) is a congenital defect of the diaphragm that generally presents in the newborn as life-threatening cardiorespiratory distress. In contrast, the diagnosis of a BH in adults is rare. Surgical repair for adult BH is recommended, but the optimal surgical method remains unclear. CASE PRESENTATION: A 75-year-old woman presented with progressive dyspnea and back pain, and a diagnosis of BH was made based on chest X-ray and computed tomography. Laparoscopic evaluation revealed a defect in the left posterior attachment of the diaphragm, and a left-sided BH without hernia sac was diagnosed. Parts of the stomach, small intestine, colon, pancreas, and spleen had prolapsed into the left thoracic cavity, without ischemic change, and these herniated organs were reduced to the abdominal cavity. A direct closure of the hernia orifice was possible by the laparoscopic suture technique using a mesh reinforcement. The patient made an uneventful recovery, and no recurrence was found in the 2-year follow-up. CONCLUSION: A recently published study reviewing detailed cases of repair of adult BH from 1999 to 2019 identified 96 cases, including the present case. The number of reports on laparoscopic and/or thoracoscopic surgery for BH in adults has recently increased, and the approach for repairing BH should be selected carefully on a case-by-case basis.

DOI： 10.1186/s40792-020-01003-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The Pringle maneuver is often used in liver surgery to minimize bleeding during liver transection. Many authors have demonstrated that intermittent use of the Pringle maneuver is safe and effective when performed appropriately. However, some studies have reported that the Pringle maneuver is a significant risk factor for portal vein thrombosis. In this study, we evaluated the effectiveness of portal vein flow after the Pringle maneuver and the impact that massaging the hepatoduodenal ligament after the Pringle maneuver has on portal vein flow. MATERIALS AND METHODS: Patients treated with the Pringle maneuver for hepatectomies performed to treat hepatic disease at our hospital between August 2014 and March 2019 were included in the study (N = 101). We divided these patients into two groups, a massage group and nonmassage group. We measured portal vein blood flow with ultrasonography before and after clamping of the hepatoduodenal ligament. We also evaluated laboratory data after the hepatectomy. RESULTS: Portal vein flow was significantly lower after the Pringle maneuver than before clamping of the hepatoduodenal ligament. The portal vein flow after the Pringle maneuver was improved following massage of the hepatoduodenal ligament. After hepatectomy, serum prothrombin time was significantly higher and serum C-reactive protein was significantly lower in the massage group than in the nonmassage group. CONCLUSION: Massaging the hepatoduodenal ligament after the Pringle maneuver is recommended in order to quickly recover portal vein flow during hepatectomy and to improve coagulability.

DOI： 10.1007/s00268-020-05570-7

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Solitary pulmonary metastasis from esophageal basaloid squamous cell carcinoma (BSCC) components is an extremely rare recurrence of esophageal squamous cell carcinoma (SCC). CASE PRESENTATION: A 68-year-old Japanese woman was found to have a suspected malignant mass, approximately 2 cm in diameter, in her left lower pulmonary lobe, at 66 months after undergoing a curative esophagectomy with three-field lymph node dissection for esophageal SCC with a focal basaloid component. After a CT-guided biopsy, pathological examination indicated a metastasis from esophageal BSCC components. She underwent a thoracoscopic partial resection of the left lower pulmonary lobe for the solitary pulmonary metastasis. The pathohistology of the resected specimen led to diagnosis of metastatic esophageal BSCC, which showed immunohistochemical findings similar to those of the primary esophageal carcinoma. The patient received two courses of adjuvant chemotherapy (5-fluorouracil, docetaxel plus nedaplatin) and recovered to resume a normal life with maintenance therapy. However, multiple lung and brain metastases were diagnosed at 2 years after the pulmonary metastasectomy. She survived 5 years and 6 months after the pulmonary metastasectomy, but died at 10 years and 6 months after her initial esophagectomy. CONCLUSION: This was a rare surgical resected case of solitary pulmonary metastasis from esophageal BSCC components.

DOI： 10.1186/s40792-020-00957-z

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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：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Postoperative pancreatic fistula (POPF) subsequent to pancreatectomy often causes activation of pancreatic juice, resulting in serious complications. In POPF, the types of pancreatic juices found are active and inactive, and the identification of these two types of pancreatic juice greatly contributes to the development of postoperative management after pancreatectomy. This study reports favorable results of the clinical application of the Förster resonance energy transfer (FRET) nanoprobe that was independently developed to distinguish between the active and inactive types of pancreatic juice. METHODS: The FRET nanoprobe developed was a nanoprotein capsule. It exuded a red color when the capsule structure was maintained. When activated protease in the pancreatic juice acts on it, the capsules are reduced quantitatively and FRET is abolished, resulting in a change in color from red to green. Pancreatic juice activation can be measured by the FRET signal. A total of 117 drainage fluid samples from 16 postpancreatoduodenectomy cases were obtained and evaluated. RESULTS: The diagnosis of pancreatic juice activation was possible using the FRET signal with a cut-off value of 1.6. Pancreatic juice activation was not associated with drainage fluid amylase (AMY) levels. The results demonstrated that pancreatic juice was activated when drainage fluid was infected. CONCLUSION: The use of a FRET nanoprobe enabled real-time detection of the presence or absence of pancreatic juice activation in pancreatic fistula after pancreatic surgery. There was an adequate correlation between infection and pancreatic juice activation regardless of drain AMY levels.

DOI： 10.1016/j.pan.2020.06.001

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Pyogenic spondylodiscitis is an extremely rare complication of esophagectomy for esophageal cancer. CASE PRESENTATION: A 70-year-old Japanese man, with a previous medical history of type 2 diabetes mellitus, coronary artery disease, and laryngeal cancer, received neoadjuvant chemotherapy and underwent thoracoscopic esophagectomy with gastric tube reconstruction for advanced esophageal cancer. Cervical esophagogastrostomy with circular-stapled end-to-side anastomosis was performed. However, partial necrosis in the gastric tube developed to form refractory anastomotic fistula. Two months after the initial surgery, debridement and free jejunal transfer reconstruction with the pectoralis major muscle flap were performed. Although the postoperative course of the second surgery was uneventful, the patient complained of severe lower back pain and fever. The patient was diagnosed with pyogenic spondylodiscitis according to the results of the magnetic resonance imaging. Enterobacter cloacae were isolated from the arterial blood culture. Sensitive antibiotics were administered continuously, and the patient required to use a lumbar corset for 2 months. Subsequently, his physiological signs and symptoms had completely disappeared. CONCLUSION: To the best of our knowledge, this case study is the first study that reported pyogenic spondylodiscitis of the lumbar spine, a complication of cervical anastomotic fistula after surgery for advanced esophageal cancer.

DOI： 10.1186/s40792-020-00922-w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Non-toxic herpes simplex virus (HSV) vectors can be generated by functional deletion of all immediate-early (IE) genes, providing a benign vehicle with potential for gene therapy. However, deletion of multiple IE genes raises manufacturing concerns and thus limits clinical application of these vectors. To address this issue, we previously developed a novel production cell line, called U2OS-ICP4/27, by lentiviral transduction of human osteosarcoma U2OS cells with two essential HSV IE genes, ICP4 and ICP27. To optimize the process of vector manufacturing on this platform, we evaluated several cell culture parameters of U2OS-ICP4/27 for high-titer and -quality production of non-toxic HSV vectors, revealing that the yields and functionality of these vectors can be significantly influenced by culturing conditions. We also found that several chemical compounds can enhance the replication of non-toxic HSV vectors and their release from producer cells into the supernatants. Notably, the vector produced by our optimized protocol displayed a greatly improved vector yield and quality and showed elevated transgene expression in cultures of primary dorsal root ganglion neurons. Taken together, our optimized production approach emerges as a relevant protocol for high-yield and high-quality preparation of non-toxic HSV-based gene therapy vectors.

DOI： 10.1016/j.omtm.2020.03.014

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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  

症例は71歳,男性。右下腹部痛を主訴に近医を受診し,急性腸炎の診断で抗生剤を処方されたが症状改善なく,2日後に当科紹介となった。来院時CT検査で糞石を伴う虫垂の腫大を認め,急性虫垂炎の診断で同日緊急手術の方針となった。術中所見で黒色変性を伴う腫大した虫垂を認め,虫垂は根部で360度捻転していた。虫垂捻転の診断で,捻転解除後に虫垂切除術を施行した。術後イレウスを認めたが,保存的加療で軽快し第8病日に退院となった。今回われわれは腹腔鏡下虫垂切除術を施行した虫垂捻転の1例を経験した。虫垂捻転は急性虫垂炎と同様の症状を呈する疾患ではあるが,早期から穿孔をきたしうる疾患であり手術加療を考慮すべきである。(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=2020&ichushi_jid=J02824&link_issn=&doc_id=20200512500011&doc_link_id=10.11231%2Fjaem.40.483&url=https%3A%2F%2Fdoi.org%2F10.11231%2Fjaem.40.483&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）  

Complete surgical excision is the standard treatment for hydrocele of the canal of Nuck. We developed a novel open posterior wall technique for laparoscopic transabdominal pre-peritoneal (TAPP) excision. A 38-year-old woman with a 5-month history of a painless reducible lump in the right groin had recently noticed a slight increase in the size of lump. Computed tomography showed a simple cystic lesion measuring 30 × 27.5 mm. We performed laparoscopic excision of the hydrocele by using the TAPP approach and the open posterior wall technique developed by us. Complete excision of the hydrocele was satisfactorily performed because the region from the external inguinal ring to the periphery could be clearly observed. After an uneventful postoperative course, the patient was discharged. Laparoscopic TAPP excision with open posterior wall technique was useful for complete excision of hydrocele of the canal of Nuck.

DOI： 10.1272/jnms.JNMS.2019_86-601

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

We examined the occurrence of complications following gastric cancer surgery in the elderly and its influence on the prognosis of reduction surgery.The study included 805 surgical cases of gastric cancer; elderly, middle-aged, and young patients were examined.In the elderly patients, there was a tendency to undergo reduction surgery.According to the gastric cancer treatment guidelines, 28.9% of the elderly patients, 5.3% of the middle-aged patients, and 0% of the young patients did not satisfy the criteria for lymph node dissection. The incidences of postoperative complications were 25.6%, 23.0%, and 13.4%in the elderly, middle-aged, and young patients, respectively, with a higher tendency seen in elderly patients.In elderly patients, the survival rate was examined separately for each postoperative complication, but no significant difference was noted.Additionally, the survival rate was assessed for the limited surgery and standard surgery groups; however, no significant difference was noted.Therefore, it is recommended that the optimal lymph node dissection range be determined in the elderly with respect to the general condition.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Most patients with colorectal liver metastases, who undergo hepatectomy, experience recurrence. Although the prognosis is poorer for patients with early recurrence (within 6 months after hepatectomy) compared with later recurrence, no biomarker has been identified to predict early recurrence. Minimal residual disease (MRD) in patients who undergo curative surgery is the main cause of recurrence. In cancer patients, long fragment cell-free DNA is detected, and the presence of long fragments of cell-free DNA after surgery can indicate MRD. In this study, we developed a novel biomarker to predict early recurrence of colorectal liver metastases using cell-free DNA. MATERIALS AND METHODS: Forty-one patients with colorectal liver metastases were enrolled. Peripheral blood samples were collected before and at 1 month after hepatectomy. Cell-free DNA was extracted from 1 ml plasma, and the long fragment/β-globin ratio, which can indicate MRD, was measured by real-time polymerase chain reaction. RESULTS: Three of 21 patients (14.3%) with decreases in the long cell-free DNA fragment/β-globin ratio after hepatectomy developed early recurrence compared with twelve of 20 patients (60.0%) with an increased ratio (P = 0.002). Patients with a decreased long fragment/β-globin ratio after hepatectomy had significantly longer recurrence-free survival compared with patients with an increased ratio (366 vs 102 days, P < 0.001). CONCLUSION: The cell-free DNA long fragment/β-globin ratio may serve as an effective biomarker of early recurrence in patients with colorectal liver metastases, who undergo hepatectomy.

DOI： 10.1016/j.ejso.2019.08.010

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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  

今回われわれは、高齢者胃癌手術の術後合併症の発生と縮小手術の予後に与える影響を検討した。対象は胃癌手術症例805例で、高齢者、中年者、若年者に分け検討した。胃癌治療ガイドラインに沿ったリンパ節郭清に満たなかった症例が高齢者28.9%、中年者5.3%、若年者0%で、高齢者では縮小手術を行う傾向を認めた。術後合併症発生率は高齢者25.6%、中年者23.0%、若年者13.4%であり、高齢者で高い傾向を認めた。高齢者で、術後合併症の有無で生存率を検討したが差はなかった。縮小手術群と定型手術群に分け生存率を検討したが差はなかった。高齢者では、全身状態を考慮した上で至適リンパ節郭清範囲を定めるべきだと思われた。(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）  

The indocyanine green (ICG) fluorescence method is reportedly useful for intraoperative visualization of hepatocellular carcinoma and metastatic liver cancer. Herein, we report the use of an ICG fluorescence navigation system for laparoscopic hepatectomy. The patient was a 73-year-old man with a surgical history of two laparotomies for hepatocellular carcinoma resection. During follow-up at our hospital, abdominal computed tomography revealed recurrence of hepatocellular carcinoma in the lateral area of the liver, after which the patient was hospitalized for surgery. His surgical history indicated that adhesions in the abdominal cavity were likely. We scheduled laparoscopic repeat hepatectomy (LRH) with an ICG fluorescence method in which ICG dye was injected intravenously 2 days before surgery. ICG fluorescence was easily detected intraoperatively. The advantages of the present approach are that it induces pneumoperitoneum and, with laparoscopic magnification, enables good visualization of the surgical field for LRH and clear intraoperative identification of the tumor, thus facilitating LRH. Laparoscopic partial resection of the liver (S3) was successfully performed; the operation time was 197 minutes and bleeding volume was 30 mL. Postoperative course was uneventful and he was discharged on postoperative day 10.

DOI： 10.1272/jnms.JNMS.2019_86-503

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Before the first laparoscopic hepatectomy (LH) was described in 1991, open hepatectomy (OH) was the only choice for surgical treatment of liver tumors. LH indications were initially based solely on tumor location, size, and type. Use of LH has spread rapidly worldwide because it reduces incision size. This review systematically assesses the current status of LH. As compared with OH, LH is significantly less complicated, requires shorter hospital stays, and results in less blood loss. The long-term survival rates of LH and OH are comparable. Development of new techniques and instruments will improve the conversion rate and reduce complications. Furthermore, development of surgical navigation will improve LH safety and efficacy. Laparoscopic major hepatectomy for HCC remains a challenging procedure and should only be performed by experienced surgeons. In the near future, a training system for young surgeons will become mandatory for standardization of LH, and LH will likely become better standardized and have broader applications.

DOI： 10.1272/jnms.JNMS.2019_86-411

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Patients with recurrent hepatocellular carcinoma or metastatic liver cancer from colorectal cancer after surgical resection have traditionally been treated with conventional open surgery. However, recent technical advances have facilitated laparoscopic repeat hepatectomy (LapRH), which has advantages over open laparotomy. We describe the results of LapRH at our institution and retrospectively compare short-term outcomes after LapRH and initial laparoscopic partial liver resection (LapPLR). METHODS: From April 2010 through December 2017, 24 patients (16 men, 8 women; median age, 69 years) underwent LRH for cancer recurrence or metastasis after initial partial hepatectomy at our institution. LapRH involved partial hepatectomy in 21 patients and lateral segmentectomy in 3 patients. Short-term outcomes (operative time, intraoperative blood loss, and postoperative hospital stay) for these 24 patients were compared with those for 117 patients who underwent initial LapPLR during the same period. RESULTS: There were no significant differences between the LapPLR and LapRH groups in baseline characteristics, including patient age and underlying disease. No LapRH procedure required conversion to open surgery. There were no statistically significant differences between the groups in median operation time (268 min for LapPLR, 294 min for LapRH; p = 0.55), blood loss (224.0 mL for LapPLR, 77.5 mL for LapRH; p = 0.76), or length of hospital stay (11.0 days for LapPLR, 10.2 days for LapRH; p = 0.83). CONCLUSIONS: LapRH for recurrent liver cancer yielded satisfactory outcomes when compared with those of initial hepatectomy. Further studies are needed, however, to confirm the present results.

DOI： 10.1272/jnms.JNMS.2019_86-410

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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  

切除不能進行再発胃癌に対するS-1+シスプラチン(CDDP)療法の実際の施行方法、有害事象対策と輸液療法室での外来化学療法への導入について検討した。S-1+CDDPが1st lineであった40例(男性30例、女性10例、平均64.6歳)を対象に、CDDP投与を入院で行ったA群13例、CDDP投与2回目以降を外来で行ったB群10例、輸液スピードを上昇させマグネシウムの使用を開始したC群17例に分類した。投薬コース数についてはA群で有意に少ない結果であった。化学療法開始前の血液生化学的所見に有意な差は認めなかった。クレアチニン上昇(腎機能障害)においてはA群とB群で明らかな差は認めなかった。また、C群ではA群、B群に比べクレアチニン上昇率が減少していた。S-1+CDDP療法は適切な患者指導と患者選択により、外来で施行できる可能性があると考えられた。

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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=J04260&link_issn=&doc_id=20190708480005&doc_link_id=%2Fcw1nimed%2F2019%2F001503%2F006%2F0128-0133%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcw1nimed%2F2019%2F001503%2F006%2F0128-0133%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：(NPO)日本食道学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Protein disulfide‑isomerase A3 (PDIA3) is a chaperone protein that modulates folding of newly synthesized glycoproteins and responds to endoplasmic reticulum (ER) stress. Previous studies reported that increased expression of PDIA3 in hepatocellular carcinoma (HCC) is a marker for poor prognosis. However, the mechanism remains poorly understood. The aim of the present study, therefore, was to understand the role of PDIA3 in HCC development. First, immunohistochemical staining of tissues from 53 HCC cases revealed that HCC tissues with high PDIA3 expression exhibited a higher proliferation index and contained fewer apoptotic cells than those with low expression. In addition, the knockdown of PDIA3 significantly inhibited cell proliferation and induced apoptosis in HCC cell lines. These results suggest that PDIA3 regulates cell proliferation and apoptosis in HCC. An examination of whether PDIA3 knockdown induced apoptosis through ER stress revealed that PDIA3 knockdown did not increase ER stress marker, 78 kDa glucose‑regulated protein, in HCC cell lines. Furthermore, the association between PDIA3 and the signal transducer and activator of transcription 3 (STAT3) signaling pathway were investigated in vitro and in vivo. Immunofluorescence staining and co‑immunoprecipitation experiments revealed colocalization and binding, respectively, of PDIA3 and STAT3 in HCC cell lines. The knockdown of PDIA3 decreased the levels of phosphorylated STAT3 (P‑STAT3; Tyr705) and downstream proteins of the STAT3 signaling pathway: The anti‑apoptotic proteins (Bcl‑2‑like protein 1, induced myeloid leukemia cell differentiation protein Mcl‑1, survivin and X‑linked inhibitor of apoptosis protein). In addition, PDIA3 knockdown provided little inhibitory effect on cell proliferation in HCC cell lines treated with AG490, a tyrosine‑protein kinase JAK/STAT3 signaling inhibitor. Finally, an association was demonstrated between PDIA3 and P‑STAT3 expression following immunostaining of 35 HCC samples. Together, the present data suggest that PDIA3 promotes HCC progression through the STAT3 signaling pathway.

DOI： 10.3892/ijo.2019.4710

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

At present the only method available to confirm microscopic infiltration of cancer into ductal margins during surgery, is intraoperative histological examination. In the present study, the status of the surgical margins and postoperative course were evaluated to determine any correlation between remnant carcinoma and postoperative survival. All consecutive patients who underwent resection for biliary tract cancer between January 2004 and May 2012 were identified from a database. Positive margin cases were divided into two groups, invasive carcinoma and carcinoma in situ (CIS). Immunohistochemical staining targeting Ki67 and p53 for positive margins was performed. Cases of major vessel invasion were significantly increased in the positive group compared with the negative group. The recurrence rate was significantly lower in the CIS group compared with the invasive group. The survival rate was significantly increased in the CIS group compared with the invasive group. The expression levels of p53 and Ki67 were significantly increased in the invasive group compared with the CIS group. No statistical correlations were observed between the expression of p53 or Ki67 and the survival or recurrence of disease. In the positive group, resected margin status was the principal factor associated with recurrence-free survival according to Cox-regression analysis. In conclusion, the status of the resected margins in the positive group was the most important factor for postoperative survival and recurrence in cholangiocarcinoma, not immunohistochemical staining targeting Ki67 and p53.

DOI： 10.3892/ol.2018.9479

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記述言語：日本語   出版者・発行元：(公社)日本医学放射線学会  

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Relatively high mortality and morbidity rates are reported after liver resection (LR). However, the early predictors of complications after LR are not clear. This study was performed to clarify the usefulness of procalcitonin (PCT) for the early prediction of complications after elective LR. METHODS: This observational study included 72 consecutive patients who underwent elective LR from December 2015 to March 2017. Patients were categorized into two groups: those with and without postoperative complications (Clavien-Dindo grade ≥II). The values of postoperative inflammatory markers (white blood cell [WBC] count, C-reactive protein [CRP] and PCT) were compared between the two groups. RESULTS: CRP and PCT were significantly higher in patients with than without complications; however, the WBC count showed no difference within 5 days postoperatively. The maximum area under the receiver operating characteristic curves within 2 days after LR using the WBC count, CRP and PCT were 0.608, 0.697 and 0.860, respectively, PCT had the best predictive ability in the early postoperative period. The PCT level peaked within 2 days postoperatively in 61 patients (85%). The maximum PCT level within 2 days postoperatively (PCT1-2) was significantly higher in patients with than without complications (0.52 vs. 0.19 ng/mL, p<0.001). A cutoff PCT1-2 level of 0.35 ng/mL achieved 80% sensitivity and 83% specificity. In patients without complications, there was no difference in PCT1-2 even when the surgical procedure differed (p=0.935). CONCLUSIONS: PCT1-2 is an early predictive marker after LR and can be similarly used regardless of the LR procedure.

DOI： 10.1515/cclm-2018-0196

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：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Detection of gene mutations is important for planning molecular targeted therapy. Although most gene mutations are concordant between primary colon cancers and their liver metastases, new mutations can emerge in metastases. The liquid biopsy is a newly developed, gene analytic method to detect mutations in metastatic tumors. In this prospective study, we evaluated the applicability of liquid biopsies in the detection of mutations in primary and metastatic tumors. METHODS: We included 22 patients with liver metastases from colorectal cancer and extracted DNA from primary colorectal tumors, metastatic liver tumors, and peripheral blood (liquid biopsy). Next-generation sequencing (NGS) and digital PCR were performed to detect mutations in these three sample types. RESULTS: We found a total of 36 different mutations in samples from primary tumors, liver metastases, and liquid biopsies using NGS. Twenty-eight of these mutations were found in all three types of samples, whereas liquid biopsy did not identify four mutations that had been found in both primary tumors and liver metastases, but did identify four mutations that were found in liver tumors but not in primary tumors. The sensitivity of liquid biopsies for detecting mutations in liver metastases was 64% (23/36) using NGS and 89% (32/36, P = 0.02) using dPCR. The specificities of NGS and dPCR were 100% (23/23) and 100% (32/32), respectively. CONCLUSIONS: Emerging mutations, which are not found in primary tumors, can be detected in their metastases and liquid biopsies.

DOI： 10.1016/j.ejso.2018.01.224

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：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The vein that runs between ventral and dorsal Segment 8 is called the anterior fissure vein (AFV). AFV is sometimes needed as a boundary for Subsegmentectomy in Segment 8. The aim of the present study was to investigate the AFV to determine whether the AFV can be used a landmark for subsegmentectomy of the liver at Segment 8. METHODS: We analyzed data from 151 patients who had undergone abdominal computed tomographic (CT) examinations. The position of the AFV is identified by determining whether the AFV drains flows into the proximal, medial, or distal portion of the middle hepatic vein (MHV) or right hepatic vein (RHV). Furthermore, the proximal region is divided into 2 halves; the proximal portion is designated as P1 and the distal portion is designated as P2. RESULTS: The AFV could be identified in 78.8% (119/151) of the patients. The AFV flowed into the MHV in 84.9% of the patients and into the RHV in 15.1%. Among the former, the AFV flowed into the proximal MHV in 69.7% of the patients. CONCLUSIONS: Although the AFV might not be easily identifiable, the AVF can be used to determine the border between the ventral and dorsal portions of Segment 8. The AFV should thus be used as a landmark for Subsegmentectomy.

DOI： 10.1016/j.ejso.2018.01.607

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)日本病理学会  

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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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掲載種別：研究論文（学術雑誌）  

<h4>Purpose</h4>After undergoing the Kasai procedure for biliary atresia (BA), most patients develop severe splenomegaly that tends to be improved by liver transplantation. However, fluctuations in splenic volume long after transplantation remain to be elucidated.<h4>Patients and methods</h4>Seventy-one consecutive patients who had undergone pediatric living donor liver transplantation (LDLT) for BA were followed up in our outpatient clinic for 5 years. They were classified into 3 groups according to their clinical outcomes: a good course group (GC, n = 41) who were maintained on only 1 or without an immunosuppressant, a liver dysfunction group (LD, n = 18) who were maintained on 2 or 3 types of immunosuppressants, and a vascular complication group (VC, n = 11). Splenic and hepatic volumes were calculated by computed tomography in 464 examinations and the values compared before and after the treatment, especially in the VC group.<h4>Results</h4>Splenic volume decreased exponentially in the GC group, with splenic volume to standard spleen volume ratio (SD) being 1.59 (0.33) 5 years after liver transplantation. Splenic volume to standard spleen volume ratios were greater in the VC and LD groups than in the GC group. Patients in the VC group with portal vein stenosis developed liver atrophy and splenomegaly, whereas those with hepatic vein stenosis developed hepatomegaly and splenomegaly. Interventional radiation therapy tended to improve the associated symptoms.<h4>Conclusions</h4>Fluctuations in splenic volume long after pediatric LDLT for BA may reflect various clinical conditions. Evaluation of both splenic and hepatic volumes can facilitate understanding clinical conditions following pediatric LDLT.

DOI： 10.1016/j.transproceed.2018.03.071

PubMed

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記述言語：日本語   出版者・発行元：金原出版(株)  

DOI： 10.18888/op.0000000638

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

PubMed

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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  

肝切除後胆汁漏はもっとも術直後の患者のQOLを下げ、医療費を押し上げる要因である。その頻度は4〜12.8%といわれている。肝管空腸吻合が加わるとその頻度はさらに増加する。肝切除例530例の胆汁漏、腹腔内膿瘍発生率を単純肝切除と胆道再建のある肝切除に分類し検討した。単純肝切除例は胆汁漏20例(4.3%)、腹腔内膿瘍5例(1.1%)であり、胆道再建例はそれぞれ13例(21.7%)、2例(3.3%)であった。胆道再建例は胆汁漏の発生は多いが、閉鎖式吸引ドレーンにより腹腔内膿瘍は減らせると思われる。腹腔内ドレーン排液の培養においては胆道再建例では100%陽性であり、腸管由来と考えられる腸球菌、緑膿菌、クレブシェラ属、エンテロバクター属などが起炎菌であった。胆道再建のある肝切除例は胆汁漏の発生は高く、ドレーンなどにより腹腔内膿瘍の予防が重要である。(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=2018&ichushi_jid=J04188&link_issn=&doc_id=20180925350009&doc_link_id=%2Fdg9srgif%2F2018%2F001501%2F011%2F0057-0062%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg9srgif%2F2018%2F001501%2F011%2F0057-0062%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語  

A follow-up endoscopy in a 71-year-old Japanese man who had undergone a left lateral segmentectomy for HCC two years ago revealed an approximately 2 cm in diameter pedunculated polypoid mass in the middle part of the thoracic esophagus. Immunohistochemical staining of the endoscopic biopsy revealed a metastatic HCC esophageal tumor. As the patient's disease could be radically removed by preoperative examinations, we resected the metastatic esophageal tumor via right thoracotomy and esophagogastrostomy reconstruction. Histological examination of the resected specimen revealed that the esophageal tumor was compatible with a HCC metastasis. This is an extremely rare case of a solitary metastasis to the esophagus from HCC in the literature.

DOI： 10.1155/2018/8685371

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Recently, some reports have revealed a relationship between post-hepatectomy prognosis in hepatocellular carcinoma (HCC) and hepatic fibrosis markers. We evaluated the relationship between these markers of hepatic fibrosis, clinicopathological findings, and prognosis. METHODS: Three hundred and sixty patients underwent hepatectomy for HCC in the Nippon Medical School Hospital between 1993 and 2013. We divided these patients into two groups: normal serum hyaluronic acid (HA) levels and abnormal levels. We also divided patients into groups with normal serum type IV collagen levels and abnormal levels. RESULTS: The overall survival rate and recurrence-free survival rate of the normal group were significantly higher than those of the abnormal group. In the normal hyaluronic acid group, serum albumin and prothrombin time were significantly higher than in the abnormal group, and age, hepatitis C virus antibody (HCV)-Ab positivity, Child-Pugh grade B, liver cirrhosis, indocyanine green retention rate at 15 min (ICGR15), type IV collagen level, and type IV collagen 7s level were significantly lower than those in the abnormal group. In the normal type IV collagen group, HCV-Ab positivity, liver cirrhosis, ICGR15, HA level, and type IV collagen 7s level were significantly lower than those in the abnormal group, and the serum albumin level was significantly higher than that in the abnormal group. Multivariate analysis independently revealed the significant effect of serum type IV collagen on the overall survival rate as well as the significant effect of serum HA on the recurrence-free survival rate in patients who underwent hepatectomy for HCC. CONCLUSIONS: Preoperative examinations of serum hyaluronic acid levels and type IV collagen levels are imperative for hepatic resection for HCC because these markers are significantly associated with liver function and prognosis.

DOI： 10.1272/jnms.JNMS.2018_85-34

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：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=2017&ichushi_jid=J00620&link_issn=&doc_id=20171206140005&doc_link_id=10.18888%2Fop.0000000504&url=https%3A%2F%2Fdoi.org%2F10.18888%2Fop.0000000504&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：(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：(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：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)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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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：(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：(NPO)日本高齢消化器病学会  

超高齢者肝細胞癌(HCC)症例における肝切除術の意義を検討した。HCC肝切除術554例のうち80歳以上26例(4.7%)を高齢者群、80歳未満528例を若年者群として、累積生存率、無再発生存率、術後合併症を比較した。さらに予後因子、サルコペニアを検討した。高齢者群の3年生存率、無再発生存率はそれぞれ68.4%、44.3%で若年者群と差はなかった。合併症率、術死率は高齢者群が有意に多かったが、有意な予後因子はなかった。サルコペニアを表す骨格筋量は胃癌、大腸癌高齢者手術例と比較すると、全例平均以上であった。超高齢者HCCに対する肝切除術は適切な症例・術式選択と術後管理を行うことで若年者と同等の成績を得ることが可能である。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本病理学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: This multi-institutional study aimed to assess the benefits of anterior approach for right hepatectomy with hanging maneuver (ARH-HM) for hepatocellular carcinoma (HCC) compared with conventional right hepatectomy (CRH). METHODS: From January 2000 to December 2012, 306 patients with HCC ≥5 cm were divided into two groups: ARH-HM (n = 104) and CRH (n = 202). RESULTS: After one-to-one propensity score-matched analysis, 72 ARH-HM and 72 CRH patients presented comparable background factors. Patients in the ARH-HM group demonstrated significantly less intraoperative blood loss (480 vs. 1,242 g, P < 0.001) and a lower frequency of red cell concentrate transfusion (21.1% vs. 50.7%, P < 0.001) compared with patients in the CRH group. The 5-year overall survival rate was significantly better in the ARH-HM group compared with the CRH group (50.2% vs. 31.4%, P = 0.021). Limited to patients with HCC ≥10 cm, recurrence-free and overall survival of the ARH-HM group was significantly greater than those of the CRH group. CONCLUSION: In comparison with CRH, ARH-HM for large HCC can provide better overall survival rates with a decrease in intraoperative blood loss and transfusion rates. Survival impact was evident especially in patients with HCC ≥10 cm.

DOI： 10.1002/jhbp.431

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

DOI： 10.2957/kanzo.58.91

Scopus

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00263&link_issn=&doc_id=20170227130004&doc_link_id=10.2957%2Fkanzo.58.91&url=https%3A%2F%2Fdoi.org%2F10.2957%2Fkanzo.58.91&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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）  

Limy bile syndrome extending to the common bile duct (CBD) is a rare condition that lacks a standardized treatment. Laparoscopic cholecystectomy with laparoscopic choledocholithotomy by CBD exploration is preferred because it preserves the function of the sphincter of the Vater's papilla and allows treatment of both lesions. A 37-year-old man who was receiving entecavir for chronic hepatitis B developed right upper quadrant pain. Abdominal ultrasonography revealed a calcified shadow in the gallbladder and CBD. Abdominal imaging revealed a liquid-like material identified by a calcified shadow in two phases separated by a fluid-fluid level. Abdominal and 3-D drip infusion cholangiography CT showed stones in the gallbladder and CBD with limy bile. The patient underwent laparoscopic cholecystectomy and choledocholithotomy. Intraoperatively, white-yellow-colored bile and stones were drained from the CBD. A C-tube was placed. Postoperatively, remnant stones and radiopaque materials were absent. The stones comprised of >95% calcium carbonate.

DOI： 10.1111/ases.12317

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The prognosis of hepatocellular carcinoma (HCC) is unfavorable following complete tumor resection. The aim of the present study was to identify a molecule able to predict HCC prognosis through comprehensive protein profiling and to elucidate its clinicopathological significance. Comprehensive protein profiling of HCC was performed by liquid chromatography-tandem mass spectrometry. Through the bioinformatic analysis of proteins expressed differentially in HCC and non-HCC tissues, protein disulfide-isomerase A3 (PDIA3) was identified as a candidate for the prediction of prognosis. PDIA3 expression was subsequently examined in 86 cases of HCC by immunostaining and associations between PDIA3 expression levels and clinicopathological characteristics were evaluated. The Ki-67 index and apoptotic cell death of carcinoma cells were examined by immunostaining and terminal deoxynucleotidyl transferase dUTP nick-end labeling assay in 24 cases. The results demonstrated that PDIA3 was expressed in all 86 HCC cases; 56 HCC cases (65%) exhibited high expression of PDIA3 and 30 (35%) exhibited low expression. The disease-free and overall survival times of HCC patients with high PDIA3 expression were significantly shorter than in HCC patients with low expression. Furthermore, increased expression of PDIA3 was associated with an elevated Ki-67 index, indicating increased cancer cell proliferation and a reduction in apoptotic cell death. Taken together, these results suggest that PDIA3 expression is associated with tumor proliferation and decreased apoptosis in HCC, and that increased expression of PDIA3 predicts poor prognosis. PDIA3 may therefore be a key molecule in the development of novel targeting therapies for patients with HCC.

DOI： 10.3892/ol.2016.5304

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：(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：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：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：(株)ヴァンメディカル  

肝硬変は蛋白質やエネルギー栄養不良の頻度が高く、肝不全用経腸栄養剤であるBCAA製剤の栄養療法が推奨されている。また、肝細胞癌を伴う肝硬変に対しても経腸栄養が用いられているが、発癌抑制などの結果に一定のものはない。我々が行った肝細胞癌に対する肝切除周術期におけるBCAA製剤の効果に関する前向き試験においても再発や予後向上には寄与せず、術後QOLの改善のみを認めた。しかし特に高齢者の肝細胞癌肝切除患者においては、BCAA投与により術後合併症を減らし、予後を改善する可能性がある。(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）  

BACKGROUND: Portal vein embolization (PVE) is useful to expand the indications of major hepatectomy; however, its oncologic effects are not fully understood. This study aimed to confirm the efficacy of preoperative PVE for hepatocellular carcinoma patients. STUDY DESIGN: Between 2000 and 2012, five hundred and ten patients with hepatocellular carcinoma undergoing right-side hemihepatectomy were enrolled (PVE group, n = 162 and non-PVE group, n = 348). To equalize background factors, one-to-one propensity case-matched analysis and multivariate analysis were performed. Short- and long-term outcomes were evaluated. RESULTS: Propensity score-matched patients, 148 in each group, were selected. The percentage of resected liver volume on admission was significantly greater in the PVE group (60.5% vs 48.3%; p < 0.001), but decreased considerably after PVE, from 60.5% to 50.3% (p < 0.001). The 5-year cumulative recurrence-free survival (36.4% vs 35.3%) and overall survival (58.6% vs 52.8%) rates were comparable. Extrahepatic recurrences were less common in the PVE group (18.1% vs 38.8%; p = 0.004). Independent prognostic factors for recurrence-free survival were morbidity (hazard ratio [HR] = 1.56), multiple tumors (HR = 1.97), red cell concentrate administration (HR = 1.57), older age (HR = 2.09), and massive portal invasion (HR = 2.33); and those for overall survival were morbidity (HR = 2.37), multiple tumors (HR = 1.71), and massive hepatic venous invasion (HR = 3.49). CONCLUSIONS: Even though hepatocellular carcinoma patients who underwent preoperative PVE and right-side hemihepatectomy had a significantly larger resected liver volume on admission, they have a comparable long-term prognosis as patients with up front hepatectomy. In addition, PVE might decrease extrahepatic recurrences.

DOI： 10.1016/j.jamcollsurg.2016.03.023

PubMed

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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：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）  

The incidence of hepatocellular carcinoma (HCC) is rising worldwide. Spontaneous rupture of HCC occasionally occurs, and ruptured HCC with intraperitoneal hemorrhage is potentially life-threatening. The most common symptom of ruptured HCC is acute abdominal pain. The tumor size in ruptured HCC is significantly greater than that in non-ruptured HCC, and HCC protrudes beyond the original liver margin. In the acute phase, hemostasis is the primary concern and tumor treatment is secondary. Transcatheter arterial embolization (TAE) can effectively induce hemostasis. The hemostatic success rate of TAE ranges 53-100%. A one-stage surgical operation is a treatment modality for selected patients. Conservative treatment is usually given to patients in a moribund state with inoperable tumors and thus has poor outcomes. Patients with severe ruptures of advanced HCC and poor liver function have high mortality rates. Liver failure occurs in 12-42% of patients during the acute phase. In the stable phase, tumor treatment, such as transarterial chemoembolization or hepatic resection should be concerned. The combination of acute hemorrhage and cancer in patients with ruptured HCC requires a two-step therapeutic approach. TAE followed by elective hepatectomy is considered an effective strategy for patients with ruptured HCC.

DOI： 10.1111/hepr.12498

PubMed

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記述言語：日本語   出版者・発行元：(株)南江堂  

食道・胃静脈瘤に対する手術療法には,直達手術とシャント手術がある.ほかに脾摘術,脾肺固着術,肝移植,Budd-Chiari症候群に対する静脈再建術やバイパス手術などもある.手術療法は長年にわたる門脈血行動態研究に基づき理論的に工夫・改良され,長期成績は良好となった.現在では侵襲面から保存的療法の難治例に対する最終手段となっているが,難治例はより複雑な血行動態となっており,外科医は門脈血行動態のより深い理解が必要である.(著者抄録)

DOI： 10.15106/J00393.2016089685

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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=J00393&link_issn=&doc_id=20160113090003&doc_link_id=issn%3D0016-593X%26volume%3D78%26issue%3D1%26spage%3D15&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0016-593X%26volume%3D78%26issue%3D1%26spage%3D15&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

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）  

Laparoscopic liver resection (LLR) became common in Japan when advanced techniques and instruments for the procedure became available and the national medical insurance began covering partial resection and lateral segmentectomy. A successful LLR requires a gentle and powerful hold on the specimens, a steady operating field, and fast and rapid compression of the bleeding point to achieve hemostasis. In this paper we describe two instruments developed in our department by attaching the SECUREA™ endoscopic surgical spacer to the forceps and suction tube used for LLR. The instruments are useful and practical for any type of LLR, even in the hands of less experienced surgeons.

DOI： 10.1272/jnms.83.107

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Cecal volvulus is characterized by torsion of the cecum around its own mesentery. However, cecal volvulus rarely develops soon after elective laparoscopic cholecystectomy. We report on a case of cecal volvulus that developed in a 54-year-old women 1 day after elective laparoscopic cholecystectomy and was successfully treated via colonoscopic decompression. The symptoms gradually improved in conjunction with recovery from postoperative ileus. Whether the incidence of volvulus has increased with the use of laparoscopic procedures, including laparoscopic cholecystectomy, has yet to be determined. Considering the current trend toward minimally invasive surgery, cecal volvulus should be considered in patients who have postoperative abdominal pain and distention.

DOI： 10.1272/jnms.83.172

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Portal vein thrombosis (PVT) is a rare complication of liver transplantation which can lead to graft failure and patient death. Treatment can be difficult, especially in cases of PVT from the intrahepatic portal vein to the proximal jejunal veins. A 55-year-old woman had undergone living-donor liver transplantation with splenectomy for end-stage liver cirrhosis due to hepatitis C with hepatocellular carcinoma. Ten months after transplantation, massive ascites and slight abdominal pain developed, and computed tomography revealed a PVT between the intrahepatic portal vein and the superior mesenteric vein. Repeated interventional radiology procedures were used in combination with thrombolysis, thrombectomy, and metallic stent replacement to obtain favorable portal flow to the graft. Five years after being treated, the patient is well, with favorable portal flow having been confirmed. In conclusion, repeated and assiduous interventional radiological treatment combined with thrombolytic therapy, thrombectomy, and metallic stent replacement could be important for severe PVT.

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：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The aim of the present study was to clarify the surgical outcome and long-term prognosis of laparoscopic liver resection (LLR) compared with conventional open liver resection (OLR) in patients with colorectal liver metastases (CRLM). METHODS: A one-to-two propensity score matching (PSM) analysis was applied. Covariates (P < 0.2) used for PSM estimation included preoperative levels of CEA and CA19-9; primary tumor differentiation; primary pathological lymph node metastasis; number, size, location, and distribution of CRLM; existence of extrahepatic metastasis; extent of hepatic resection; total bilirubin and prothrombin activity levels; and preoperative chemotherapy. Perioperative data and long-term survival were compared. RESULTS: From 2005 to 2010, 1,331 patients with hepatic resection for CRLM were enrolled. By PSM, 171 LLR and 342 OLR patients showed similar preoperative clinical characteristics. Median estimated blood loss (163 g vs 415 g, P < 0.001) and median postoperative hospital stay (12 days vs 14 days; P < 0.001) were significantly reduced in the LLR group. Morbidity and mortality were similar. Five-year rates of recurrence-free, overall, and disease-specific survival did not differ significantly. The R0 resection rate was similar. CONCLUSIONS: In selected CRLM patients, LLR is strongly associated with lower blood loss and shorter hospital stay and has equivalent long-term survival comparable with OLR.

DOI： 10.1002/jhbp.261

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：(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：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The aim of this study was to compare the long-term outcomes and perioperative outcomes of laparoscopic liver resection (LLR) with those of open liver resection (OLR) for hepatocellular carcinoma (HCC) between well-matched patient groups. METHODS: Hepatocellular carcinoma patients underwent primary liver resection between 2000 and 2010, were collected from 31 participating institutions in Japan and were divided into LLR (n = 436) and OLR (n = 2969) groups. A one-to-one propensity case-matched analysis was used with covariates of baseline characteristics, including tumor characteristics and surgical procedures of hepatic resections. Long-term and short-term outcomes were compared between the matched two groups. RESULTS: The two groups were well balanced by propensity score matching and 387 patients were matched. There were no significant differences in overall survival and disease-free survival between LLR and OLR. The median blood loss (158 g vs. 400 g, P < 0.001) was significantly less with LLR, and the median postoperative hospital stay (13 days vs. 16 days, P < 0.001) was significantly shorter for LLR. Complication rate (6.7% vs. 13.0%, P = 0.003) was significantly less in LLR. CONCLUSION: Compared with OLR, LLR in selected patients with HCC showed similar long-term outcomes, associated with less blood loss, shorter hospital stay, and fewer postoperative complications.

DOI： 10.1002/jhbp.276

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：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：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：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)日本門脈圧亢進症学会  

DOI： 10.11423/jsph.21.155

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J03767&link_issn=&doc_id=20150721240008&doc_link_id=10.11423%2Fjsph.21.155&url=https%3A%2F%2Fdoi.org%2F10.11423%2Fjsph.21.155&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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   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：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)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

高齢化社会の進行に伴い,消化器外科治療を受ける患者の年齢は急速に上昇している.85歳以上である超高齢者は加齢による多臓器にわたる併存疾患,臓器機能低下,栄養不良,免疫機能低下さらに認知能力の低下などのリスクを抱えている.こうしたリスクと根治性のバランスから,手術適応,手術術式を決定する必要がある.術後合併症を回避するために縮小手術や低侵襲手術を選択することも多い.近年,低侵襲治療である腹腔鏡下手術が超高齢者に対しても行われ,良好な成績が報告されている.しかし,一度術後合併症を併発すると死に直結するため,加齢に伴う各臓器の特性を理解したうえで,個々の症例ごとに繊細な周術期管理を行う必要がある.(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：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

対象は62例(男42例、女20例、平均年齢62.3歳)で、原疾患は肝硬変(LC)が47例、癌性腹膜炎(Ca)が15例であった。LC群はCa群に比して生存率が有意に高く、両群ともに尿量・腹囲は術後有意に改善した。また、LC群ではChild-Pugh B群(22例)がC群(25例)に比して有意に生存率が高く、Child-Pugh B・C群ともに尿量・腹囲は術後有意に改善した。シャントの閉塞は13例に認め全例再挿入を施行し、閉塞率は24.2%であった。シャント造設に伴う合併症は、凝固異常、心不全、カテーテル逸脱、皮下膿瘍、敗血症の計8例であった。術後早期の死亡例は2例(3.2%)に認め、いずれもLC群であった。腹腔-静脈シャント術は予後の改善よりもQOLの改善に貢献すると考えられ、原疾患の種類や肝硬変の進行度にかかわらず有用であると思われた。

DOI： 10.11423/jsph.20.213

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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=J03767&link_issn=&doc_id=20141225350003&doc_link_id=10.11423%2Fjsph.20.213&url=https%3A%2F%2Fdoi.org%2F10.11423%2Fjsph.20.213&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(株)メディカルレビュー社  

利尿薬治療により軽減できない、あるいは早期再発を防止できない中等量以上の腹水は難治性腹水と定義され、患者のQOLを著しく低下させる。その成因には進行肝硬変に伴う門脈圧亢進症および神経体液性因子の著しい異常があり、循環血液量の増加、有効循環血液量の減少、腎でのNa・水排泄の著減を特徴とする。根本治療は肝移植であるが、QOLを改善しうる対症療法に腹水穿刺排液、腹腔-静脈シャント術、経頸静脈的肝内門脈大循環シャント術、腹水濾過濃縮再静注法があり、治療にあたってはそれぞれの手技の適応、限界、有害事象をよく理解する必要がある。本稿では、これらの治療法の現状と問題点について文献的考察を加え検討した。症例ごとの肝機能、腎機能、合併症の程度を考慮して適切な治療法を選択し、難治性と判断した場合は早期に治療を切り替えて行うことがQOLの改善に最もつながると考える。(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)  

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：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)日本外科感染症学会  

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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：(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：(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：(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：(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：(NPO)Microwave Surgery研究会  

70歳代男。アルコール性肝硬変にて内科フォローアップ中に腹部CT、MRI検査で肝S5に肝細胞癌を認めた。肝細胞癌の診断で腹腔鏡下肝S5部分切除を施行した。術後は良好に経過し、術後第8病日に退院した。術後7ヵ月の腹部造影CT検査で、前回切除部背側の肝S5に動脈相で造影効果を認め、平衡相でwash outする腫瘤を認めた。腹部造影MRI検査では、肝S5に動脈相で造影効果があり、肝細胞造影相で低信号を呈する腫瘤を認めた。肝細胞癌再発と判断し、腹腔鏡下肝S5部分切除を施行した。術後、胸水貯留を認めるも保存的に軽快し、第16病日に退院した。2回目の手術より1年5ヵ月経過した現在、無再発生存中である。

DOI： 10.3380/jmicrowavesurg.32.7

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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=J03235&link_issn=&doc_id=20141126250002&doc_link_id=10.3380%2Fjmicrowavesurg.32.7&url=https%3A%2F%2Fdoi.org%2F10.3380%2Fjmicrowavesurg.32.7&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.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  

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)

DOI： 10.11477/mf.4426101150

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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=J03270&link_issn=&doc_id=20140922100020&doc_link_id=10.11477%2Fmf.4426101150&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.4426101150&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：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：(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：日本胆道学会  

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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〜2012年の11年間に部分的脾動脈塞栓術(PSE)を施行した門脈圧亢進症170例189回(男性111例、女性78例、59.6±10.3歳)を対象に、PSEの長期成績・予後について検討した。62例は肝細胞癌(HCC)を合併し、Child-Pugh分類はA81例、B71例、C37例、観察期間は平均23.3ヵ月、Child C症例においても最長観察期間60ヵ月であった。術前血小板は7.3×10^4mm3、術後2週間12.4×10^4mm3、2年9.3×10^4mm3、と術前より有意に上昇した。術後4、6、8、10年目の各術前値との変化率は1.56、1.43、2.53、0.83と術後8年目まで術前値より有意に高値であった。Child A、C症例がB症例に比べ高かった。血清アルブミン(Alb)値、プロトロンビン(PT)値、総ビリルビン(T-B)値の術前値はそれぞれ7.3g/dl、65.5%、1.5mg/dlであった。Child分類別でそれぞれ有意な差があった。Alb値、PT値は術後2年目まで有意に術前値より高値であったが、T-B値は術前2年目から術前値より悪化していた。PSEの長期予後において血小板数は長期にわたり改善されていた。特にChild C症例にその効果が著明に現れた。しかし、Alb値、PT値、T-B値に対するPSEによる効果は4年以降には認められなかった。

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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：(株)オプトロニクス社  

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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：ELSEVIER SCIENCE INC  

With the increasing number of long-term survivors of living donor liver transplantation, the occurrence of secondary cancer is sometimes reported. Solid tumors such as lymphomas are mainly observed. However, only 8 cases of leukemia have been reported so far. For patients younger than 15 years old, leukemia developed in 4 within 3 years after the liver transplantation, whereas acute lymphoblastic leukemia developed in only 1 patient. This is the first case report of a patient in whom FLT3-ITD-positive acute myeloid leukemia (AML) developed more than 10 years after living donor liver transplantation for congenital biliary atresia. AML developed in a 14-year-old boy 11 years after living donor liver transplantation from his father. The patient received the transplant at the age of 3 years and was treated with tacrolimus and methylprednisolone for transplant rejection. Eleven years posttransplantation, he visited the hospital with general malaise and anemia. Blood tests revealed an elevated white blood cell count of 60,100/mu L, and the patient was diagnosed with AML. Chromosome analysis revealed a t(6; 9) (p23 q34) translocation; moreover, genetic testing revealed a FLT3-ITD-positive mutation. We started treatment in accordance with the Tokyo Children's Cancer Study Group AML99 protocol. With chemotherapy treatment, the patient achieved complete remission. After chemotherapy, we performed stem cell transplantation from his father. Other patients were reported in relatively early stages after liver transplantation, but our case was more than 10 years posttransplantation. The association with the onset of congenital bile duct atresia and leukemia is still not clear, but we consider the possibility that long-term immunosuppressive drugs contribute to developing leukemia.

DOI： 10.1016/j.transproceed.2013.11.014

Web of Science

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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)日本肝臓学会  

症例は71歳、男性。近医で施行された腹部超音波検査にて肝S7に径50mm大の腫瘍を指摘され、当院紹介となった。腫瘍マーカーはAFP、PIVKA-IIが高値であり、腹部CT、MRI、経動脈性血管造影CTで肝S7、S3に腫瘤を認めた。肝S3の腫瘤の造影効果は典型的ではなかったが、腫瘍マーカーの上昇およびB型肝炎ウイルスの既往感染の背景を考慮し、多発肝細胞癌と診断。肝S7亜区域切除術+肝S3部分切除術を施行した。病理組織学的検査で肝S7の腫瘍は数層からなる索状構造を形成しており、中分化型肝細胞癌と診断した。肝S3の腫瘍は、肝内胆管癌と細胆管細胞癌が混在しており、細胆管細胞癌成分を伴った肝内胆管癌と診断した。胆管癌であり部分切除では不十分と判断し、肝外側区域切除術およびリンパ節郭清を追加施行した。肝細胞癌と細胆管細胞癌成分を伴った肝内胆管癌の同時性重複癌の切除報告例は少なく、稀少性からも貴重な症例と思われたので、文献的考察を加え報告する。(著者抄録)

DOI： 10.2957/kanzo.55.106

Scopus

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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=J00263&link_issn=&doc_id=20140226060003&doc_link_id=10.2957%2Fkanzo.55.106&url=https%3A%2F%2Fdoi.org%2F10.2957%2Fkanzo.55.106&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1272/jnms.81.354

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：(株)東京医学社  

脾機能亢進症への対応としては、主として脾摘と部分的脾動脈塞栓術(PSE)がある。本稿では脾摘とPSEの功罪について述べた。脾摘ではChild-Pugh 10点以上(Child-Pugh C)、PSEでは血管造影剤過敏症症例と、Child-Pugh 12点以上を原則適応外としている。合併症は、脾摘では重症感染症が稀に起こるため、術前に肺炎球菌ワクチン投与が必要である。時に門脈血栓が出現するが、近年は術後抗凝固療法により減少しつつある。PSEでは左側腹部痛、発熱、腹水貯留、左胸水貯留で、稀に脾膿瘍が起こる。両方法とも脾機能亢進症に対し有効であるが、脾摘のほうが効果は確実である。しかし、PSEは低侵襲で全身状態に合わせて梗塞範囲を加減でき、しかも後日追加治療が可能である。また、脾の一部を温存できる。脾機能亢進症に対する脾温存の是非が解明されていない現在、治療成績も両方法遜色のないことから、患者の希望や各施設の特色から判断して治療法を選択すべきである。(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：(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：(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：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)日本肝臓学会  

膵神経内分泌腫瘍(neuroendocrine tumor:NET)術後19年目の肝転移再発が疑われた1切除例を経験した。症例は58歳、男性。19年前に当院にて膵頭部腫瘍に対して膵頭十二指腸切除術施行。膵島細胞癌(2010年WHO分類ではNET G2)と診断された。再発なく経過し、以後、近医にてフォローアップされていた。1年前に腹部CT検査にて肝S6に多血性の径10mm大の腫瘍を指摘され、増大傾向を呈したため当院紹介となった。腹部造影CT検査にて肝S6に径20mm大の遅延相まで造影効果の持続する腫瘤を認めた。増大傾向であり、用手補助腹腔鏡下肝S6部分切除術を施行した。病理組織学的検査で類円形の核を有する細胞がロゼット状に増生している所見を呈し、免疫染色にてクロモグラニンA、シナプトフィジンが陽性であり、神経内分泌腫瘍と診断した。肝原発NETとの鑑別は困難であるが、本症例は膵内分泌腫瘍の肝転移再発と推測された。膵NET術後10年以上経過してからの再発症例は稀であるため、文献的考察を加え報告する。(著者抄録)

DOI： 10.2957/kanzo.54.326

Scopus

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J00263&link_issn=&doc_id=20130531150003&doc_link_id=10.2957%2Fkanzo.54.326&url=https%3A%2F%2Fdoi.org%2F10.2957%2Fkanzo.54.326&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.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：(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：(有)科学評論社  

75歳以上の肝細胞癌(HCC)症例416例を対象に、安全かつ有効な治療法としての肝切除術の意義について検討した。75歳以上63例を高齢者群、75歳未満353例を若年者群に分類し、両群の累積生存率、累積無再発生存率、術後併症を比較した。また、高齢者群の予後因子も検討した。その結果、1)累積生存率・累積無生存率はともに両群間に有意差はみられなかった。2)術後合併症は高齢者群で術後肺炎の群に比べて有意に頻発したが、他の合併症については有意差は無かった。3)高齢者群の予後因子を単変量解析で解析すると、予後因子はChild Pugh分類のB以上のみであった。

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Introduction. Leiomyosarcomas of vascular origin are particularly rare tumors occurring mainly in the inferior vena cava (IVC). They are malignant, slow-growing tumors with a poor prognosis. This paper reports on a rare case of surgical resection of an IVC leiomyosarcoma mimicking a hepatic tumor. Case Presentation. A 65-year-old Japanese male was admitted for evaluation of an abdominal tumor. Enhanced computed tomography of the abdomen revealed a slightly enhanced heterogeneous tumor, 18 mm in diameter, between the Spiegel lobe of the liver and the IVC in early-phase images, with no enhancement or washout in late-phase images. We diagnosed this tumor as either a hepatic tumor in the Spiegel lobe or a retroperitoneal tumor such as leiomyosarcoma or liposarcoma and performed a laparotomy. On the basis of surgical findings, we extirpated the tumor by performing a wedge resection of the wall of the IVC and suturing the primary IVC wall. Pathological findings led to a further diagnosis of the tumor as a leiomyosarcoma originating in the IVC. Thirty-seven months after the operation, multiple liver and lung metastases were detected, and the patient died from multiple organic failures. Conclusion. We experienced a rare case of a leiomyosarcoma of IVC mimicking hepatic tumor.

DOI： 10.1155/2013/235698

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Laparoscopic hepatectomy has become a widespread procedure in Japan, now that the national medical insurance system covers partial resection and lateral segmentectomy. An important procedure during laparoscopic hepatectomy is the division of the vascular pedicles. In this paper we report a practical and useful method for vascular division with an Endo Mini-Retract(TM) retractor and a shortened Nelaton catheter (2.5-mm-diameter) developed in our department.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Whether hepatic resection is indicated for elderly patients with hepatocellular carcinoma (HCC) remains controversial. METHODS: This retrospective study evaluated surgical outcomes and prognostic factors in elderly patients with HCC who underwent hepatectomy. Overall survival rates and disease-free survival rates after hepatectomy were compared between 63 patients with HCC who were 75 years or older (elderly group) and 353 patients with HCC who were younger than 75 years (younger group). Prognostic factors in the elderly group were evaluated by means of multivariate analysis with a Cox's proportional-hazards model. RESULTS: Overall survival rates at 3 and 5 years were respectively 56.2% and 40.2% in the elderly group and 63.4% and 46.6% in the younger group. Disease-free survival rates at these times were 34.9% and 34.9% in the elderly group and 30.8% and 21.5% in the younger group. These differences were not significant. Multivariate analysis revealed a significant association between Child-Pugh class and outcomes (P=0.01). CONCLUSIONS: The safety and survival benefits of hepatectomy in carefully selected elderly patients with HCC are similar to those in younger patients.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A liver tumor metastatic from a sigmoid colon carcinoma was diagnosed in a 70-year-old man. Because hepatectomy was not indicated, the patient was treated with a combination of oxaliplatin, levofolinate, and fluorouracil (5-FU) (modified FOLFOX 6 regimen). After 15 cycles of chemotherapy, this regimen was considered to have been ineffective; therefore, treatment was started with the topoisomerase inhibitor irinotecan and an intravenous infusion of 5-FU and levofolinate (FOLFIRI). After receiving irinotecan and levofolinate, the patient had chills, a severe cough, and dyspnea. We diagnosed pulmonary edema as a side effect due to oxaliplatin, and the chemotherapeutic regimen was changed from FOLFIRI to FOLFOX plus bevacizumab. After the third cycle of oxaliplatin and levofolinate, pulmonary edema recurred, and a preshock state developed again. We suspected that either oxaliplatin or irinotecan had caused the pulmonary edema and, therefore, administered levofolinate, 200 mg/m(2); 5-FU, 400 mg/m(2); and bevacizumab, 330 mg/m(2); intravenously on day 1, followed by 5-FU, 2,400 mg/m(2), as a continuous intravenous infusion at 46 hours without either of oxaliplatin, levofolanate, and bevacizumab. After being treated with levofolinate again, the patient suddenly complained of severe dyspnea; this symptom confirmed that levofolinate had caused the pulmonary edema. To our knowledge, severe pulmonary edema caused by levofolinate has not been reported previously. This adverse effect was clinically significant because it led to the patient's death.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Cystic echinococcosis (CE) is a rare afferent infectious disease in Japan. This paper reports a case of a hepatic cyst being diagnosed after surgical resection. A 40-year-old Syrian male was admitted for evaluation of a hepatic cyst. Serum antibodies of echinococcosis were negative. Enhanced computed tomography of the abdomen revealed a large cystic lesion, 9 cm in diameter, in the left lateral sector of the liver, which had many honeycomb-like septa and calcified lesions. Magnetic resonance imaging of this lesion revealed high intensity in the T2 weighted image. We preoperatively diagnosed this lesion as cystadenocarcinoma or CE and performed a left hepatectomy. Pathological examination revealed the presence of protoscolices in the fluid of the cysts and led to a diagnosis of this lesion as CE. In conclusion, on seeing patients with huge hepatic cysts who come from an epidemic area, we should consider hepatic CE.

DOI： 10.1155/2013/271256

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Bleeding from gastric varices (GVs) is generally considered more severe than that from esophageal varices (EVs) but occurs less frequently. We review the risk factors for bleeding EVs and GVs. GVs were divided into 2 groups: cardiac varices (CVs, Lg-c) and fundal varices (FVs), i.e., varices involving the fundus alone (Lg-f) or varices involving both the cardia and fundus (Lg-cf). Elevated pressure in the portal vein is a risk factor for bleeding EVs. The portal pressure in patients with GVs and a gastrorenal shunt is lower than that in patients with EVs. The large size of varices is a risk factor for bleeding EVs. Red color signs are elevated red areas that are important for predicting the risk of variceal bleeding, and red wale markings, dilated venules oriented longitudinally on the mucosal surface, have been considered to be the sign with the highest risk. Red color signs are rare in FVs, possibly because of the pronounced thickness of the mucosal layer. Bleeding EVs are not associated with use of antiulcer drugs or nonsteroidal anti-inflammatory drugs (NSAIDs). Although, in patients with bleeding GVs, "occasional" use of an oral NSAID is an important step leading to variceal hemorrhage, especially from FVs, even if the mucosa is protected by antiulcer drugs. Constipation, vomiting, severe coughing, and excessive consumption of alcohol may precipitate rupture of EVs.

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

DOI： 10.11423/jsph.18.215

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J03767&link_issn=&doc_id=20121207380008&doc_link_id=10.11423%2Fjsph.18.215&url=https%3A%2F%2Fdoi.org%2F10.11423%2Fjsph.18.215&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.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：英語   掲載種別：研究論文（学術雑誌）  

Resectability of hepatic metastases which have developed from lung cancer is limited and only a few reports have been published. We report two cases of a surgical resection of liver metastases arising from lung cancer. A 77-year-old male underwent a lower left lobectomy to treat a primary large cell lung carcinoma. Eight months later, abdominal computed tomography revealed a slightly enhanced heterogeneous tumor measuring 50 mm in diameter in the right liver, segment 8. We performed a hepatic anterior sectionectomy. The pathological findings were similar to those of the primary carcinoma. After six months, there was no evidence of a recurring lesion. A 65-year-old female underwent an upper right lobectomy to treat a primary adenocarcinoma. Twenty months later, abdominal computed tomography revealed a heterogeneous tumor measuring 20 mm in diameter in the right liver, segment 7. We performed a hepatic posterior sectionectomy. The pathological findings were similar to those of the primary lung carcinoma. After twenty months, the patient died from an unresectable recurrent carcinoma in the lung and brain. No recurrence was detected in the liver. We recommend that surgical resection be considered for solitary metastatic liver tumors which develop from lung cancer.

PubMed

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

肝胆膵領域におけるステンティング療法について胆管ステントと膵管ステントに分けて述べる。胆管ステントでは、切除不能悪性胆道狭窄に対しては、金属ステント(Expandable metallic Stent:EMS)、悪性胆道狭窄術前および良性胆道狭窄に対しては、Plastic stentが適応である。胆管(肝管)消化管吻合部の減圧および狭窄防止目的として、内ステント(internal stent)や外ステント(external stent)が留置される。膵管ステントでは、良性疾患に対する膵液ドレナージ目的として、主にPlastic stentが使用される。膵消化管吻合部の減圧および狭窄防止目的には、節付き膵管チューブをexternal stentとして使用しているが、internal stentを留置する施設やstentを使用しない施設もある。さまざまなステントが開発され、目的に応じて留置するステントの種類も異なってくる。各ステントには長所短所があるため、各ステントの特性を把握し使用することが肝要である。(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=2012&ichushi_jid=J00001&link_issn=&doc_id=20121203400007&doc_link_id=%2Faa6icutc%2F2012%2F003610%2F008%2F0747-0753%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2012%2F003610%2F008%2F0747-0753%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：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：(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：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   掲載種別：研究論文（学術雑誌）  

Lymph node (LN) metastases from hepatocellular carcinoma (HCC) are considered uncommon. We describe the surgical resection of a solitary para-aortic LN metastasis from HCC. A 65-year-old Japanese man with B-type liver cirrhosis was admitted for the evaluation of a liver tumor. He had already undergone radiofrequency ablation, transcatheter arterial chemoembolization, and percutaneous ethanol injection therapy for HCC. Despite treatment, viable regions remained in segments 4 and 8. We performed a right paramedian sectionectomy with partial resection of the left paramedian section of the liver. Six months later, serum concentrations of alpha-fetoprotein (189 ng/mL) and PIVKA-2 (507 mAU/mL) increased. Enhanced computed tomography of the abdomen revealed a tumor (20 mm in diameter) on the right side of the abdominal aorta. Fluorine-18 fluorodeoxyglucose positron emission tomography revealed an increased standard uptake value. There was no evidence of recurrence in other regions. Esophagogastroduodenoscopy and colonoscopy revealed no malignant tumor in the gastrointestinal tract. Para-aortic LN metastasis from HCC was thus diagnosed. We performed lymphadenectomy. Histopathological examination revealed that the tumor was largely necrotic, with poorly differentiated HCC on its surface, which confirmed the suspected diagnosis. After 6 mo tumor marker levels were normal, with no evidence of recurrence. Our experience suggests that a solitary para-aortic LN metastasis from HCC can be treated surgically.

DOI： 10.3748/wjg.v18.i23.3027

PubMed

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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)日本肝臓学会  

消化管間質腫瘍(gastrointestinal stromal tumor:GIST)の転移巣は肝臓が最も多く原発巣切除から2年以内に発生することが多い。今回、我々は術後12年目に切除しえた胃GIST肝転移と考えられた1例を経験した。症例は80歳男性。既往歴として12年前に胃粘膜下腫瘍に対して胃部分切除術を施行されていた。腹部CTにて肝右葉に75mm大の辺縁不整、内部不均一な腫瘍を指摘された。造影超音波検査では動脈相にて腫瘍内に不規則に流入する血流を認め、Kupffer相では低エコー領域となった。転移性肝腫瘍、肝内胆管癌などが疑われ肝右葉切除術を施行した。病理所見にて腫瘍内部に紡錘形の核と細胞質を持つ細胞が不規則に索状を呈して増生しており、免疫染色にてc-kit、CD34陽性でありGISTの肝転移と診断された。12年前に施行された胃粘膜下腫瘍はGISTと推測され、本腫瘍は胃GIST肝転移であると考えられた。(著者抄録)

DOI： 10.2957/kanzo.53.225

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J00263&link_issn=&doc_id=20120514180005&doc_link_id=10.2957%2Fkanzo.53.225&url=https%3A%2F%2Fdoi.org%2F10.2957%2Fkanzo.53.225&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.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：(一社)日本腹部救急医学会  

<はじめに>膵切除後動脈性出血は,致死的となる重篤な合併症であるが,近年,Interventional Radiology治療の進歩がめざましく,術後動脈性出血の治療戦略にも大きな変化をもたらしている。本稿において,当科における膵切除術後動脈性出血に対するIVR治療の意義を検討したので報告する。<対象と方法>膵切除を要した,2005年1月〜2009年12月までの後期(133例)とそれ以前の前期(197例)で,術後出血を認めた症例(前期:13例(6.6%),後期:4例(3.0%))を対象とし,両群間で比較検討を行った。<結果>前期では5例にIVRを行い,止血成功は3例であった。止血不能の2例は,直後の緊急手術にて全例止血された。初回からIVRを行わず開腹止血術を施行した他の7例では,止血成功例は4例のみで,止血不能となった3例は全例死亡した。その他の1例では,出血後にそのまま心停止となったため,IVRや開腹止血術にも進めなかった。後期では4例で術後出血を認め,有意差は認めなかったものの,術後出血の頻度は減少した。全例にIVRを行い,止血は全例で可能で,死亡例を認めなかった。<結論>膵切除後の動脈性出血は,手術手技や術後管理の発展などにより頻度が低下したが,発生時はIVR治療を第一選択に考慮すべきである。すなわち,迅速な診断,速やかな外科医とIVR治療医との連携による処置が重要となる。(著者抄録)

DOI： 10.11231/jaem.32.575

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J02824&link_issn=&doc_id=20120425370001&doc_link_id=10.11231%2Fjaem.32.575&url=https%3A%2F%2Fdoi.org%2F10.11231%2Fjaem.32.575&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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：(株)日本メディカルセンター  

部分的脾動脈塞栓術(PSE)について解説する.血管造影剤過敏症とChild-Pugh 13点以上を原則適応外としている.手技は脾動脈脾門部で造影し,脾動静脈の走行を確認する.抗生物質とステロイドを注入後,2mm角のゼルフォームまたはジェルパート2mm粒にて選択的に塞栓する.塞栓範囲は40〜80%とし,脾静脈が描出される程度とする.塞栓後に抗生物質とステロイドを2日間,全身投与する.合併症は左側腹部痛,発熱で,まれに腹水・左胸水貯留,脾膿瘍,門脈血栓を認める.汎血球減少症,食道胃静脈瘤,肝性脳症に対し有効である.PSEは安全性も確立され,とくに脾の一部を温存しながら,門脈圧亢進症に伴うさまざまな合併症に対して効果がある.(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）  

Bleeding from esophageal varices (EVs) or gastric varices (GVs) is a catastrophic complication of chronic liver disease. In this paper, we review the management of bleeding EVs and GVs. DIAGNOSIS OF EVS AND GVS: The grading system for esophagogastric varices proposed by the Japan Society for Portal Hypertension classifies GVs into those involving the cardia (Lg-c), the fundus (Lg-f), and both the cardia and the fundus (Lg-cf). In this review, we divide GVs into 2 categories: Lg-c (cardiac varices: CVs) and Lg-cf or Lg-f (fundal varices: FVs). TREATMENT MODALITIES FOR EVS AND GVS: Treatment modalities for EVs and GVs include placement of a Sengstaken-Blakemore tube, pharmacologic therapy, surgery, interventional radiology, and endoscopic treatment. MANAGEMENT OF BLEEDING EVS AND GVS: In Japan, endoscopic treatment has recently become the therapy of choice for bleeding EVs or GVs. In other countries, especially the United States, vasoactive drugs and endoscopic treatment are routinely used to manage variceal hemorrhage. BLEEDING EVS: Endoscopic variceal ligation is useful for controlling bleeding from EVs. However, confirmation of ligation precisely at the site of bleeding is usually difficult in patients with massive variceal bleeding. The site of acute bleeding can generally be identified by means of water instillation and suction. Ligation is then performed at the bleeding point. If endoscopic hemostasis is unsuccessful, a Sengstaken-Blakemore tube is used as a temporary bridge to other treatments. Transportal obliteration is useful for blocking variceal blood flow. BLEEDING GVS: Endoscopic injection sclerotherapy with a tissue adhesive, such as N-butyl-cyanoacrylate or isobutyl-2-cyanoacrylate, is effective for acute bleeding from GVs. However, bleeding from the GV injection site and rebleeding from the rupture point have been reported in patients receiving endoscopic injection sclerotherapy. If endoscopic hemostasis is unsuccessful, a Sengstaken-Blakemore tube is used as a temporary bridge to other treatments. Balloon-occluded retrograde transvenous obliteration and transportal obliteration are useful for the treatment of uncontrolled bleeding from GVs. PREVENTION OF RECURRENT VARICEAL HEMORRHAGE: Given the high recurrence rate, survivors of an acute variceal hemorrhage should receive treatment to prevent recurrence. Complete eradication of EVs or GVs and maintenance of low portal venous pressure are essential for preventing recurrence of variceal hemorrhage.

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）  

We describe a 35-year-old man with hepatocellular carcinoma (HCC) that recurred in the diaphragm after right hepatic lobectomy. The patient had undergone right hepatic lobectomy for HCC with chronic hepatitis B virus infection 1 year previously. On pathological examination, the tumor measured 15 × 14.4 × 11 cm and was moderately well differentiated. The surgical margins were negative. After 1 year, computed tomography of the abdomen revealed a mass extending from the right side of the diaphragm to the retroperitoneal space. The mass was enhanced in the early phase and washed out in the late phase. Extrahepatic recurrence of HCC in the diaphragm was diagnosed. We performed tumor resection with partial resection of the right side of the diaphragm and wedge resection of the right lower lobe of the lung. The diaphragm was reconstructed with a sheet of artificial pericardium. The histopathological diagnosis was recurrence of HCC in the diaphragm with invasion of the right lung. The postoperative course was uneventful, and the patient was discharged on postoperative day 8. He underwent chemotherapy with cisplatin and 5-fluorouracil. After 9 months, the patient died of unresectable recurrence of HCC in the brain. No recurrence was detected in the right subphrenic area.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We describe a patient with intracystic hemorrhage from one of multiple hepatic cysts. A 66-year-old woman was admitted to Nippon Medical School Hospital because of pain in the right upper quadrant of the abdomen. The medical history included multiple hepatic cysts and angina pectoris, which had been treated with aspirin. Three weeks before presentation, pain occurred in the right upper quadrant of the abdomen but resolved spontaneously. Ultrasonography revealed multiple hepatic cysts. One of the cysts in segment 8 had a hypoechoic structure and contained fluid. Computed tomography showed an area of homogenous density (diameter, 6 cm) which was slightly greater than that of the other hepatic cysts in segment 8. There was calcification of the cyst wall. On magnetic resonance imaging, this cyst showed heterogeneous hyperintensity on T1- and T2- weighted sequences which was greater than that of the other hepatic cysts. Intracystic hemorrhage of one of the multiple hepatic cysts was diagnosed. The pain gradually resolved without drainage, embolization, or operation, and the patient was discharged. After discharge, the upper abdominal pain did not recur. On magnetic resonance imaging 14 months later, the cyst showed heterogeneous hyperintensity on T1- and T2- weighted sequences which was less than that on the previous scan.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Hepatic epithelioid hemangioendothelioma (HEH) is a rare tumor. We report on a patient who underwent hepatectomy for malignant HEH associated with abdominal pain due to rapid progression. An 83-year-old man was admitted to Nippon Medical School Hospital because of acute, severe upper abdominal pain. Seven months before admission, a hepatic tumor, 3 cm in diameter, had been detected in the left lateral sector. The diagnosis was hepatic cavernous hemangioma. Abdominal ultrasonography revealed a heterogeneous hyperechoic tumor with a smooth border, 6 cm in diameter, in the left lateral sector (segment 3). Contrast-enhanced computed tomography of the abdomen showed that the tumor was enhanced from the early to the late phase. Abdominal angiography revealed a cotton wool-like appearance of the tumor. The diagnosis was hepatic cavernous hemangioma. A malignancy could not be ruled out because of the tumor's rapid growth, which had caused abdominal pain. Left hepatectomy was performed. Histopathological examination showed necrosis throughout the tumor. Slightly pleomorphic neoplastic cells with rounded, spindle-like nuclei and scant cytoplasm were sporadically found in vascular channels. Intracytoplasmic lumina occasionally contained red cells. Neoplastic cells were positive for factor VIII-related antigen, CD31, and CD34. The Mib-1 index was high. The tumor was diagnosed as malignant HEH. The postsurgical course was uneventful, and the patient was discharged on postoperative day 11. After 3 months, multiple metastatic tumors appeared in right hepatic lobe. Transcatheter arterial chemoembolization was performed.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Hepatic angiomyolipoma is a rare hepatic mesenchymal tumor. We report a case of hepatic angiomyolipoma that was successfully resected along with a giant hemangioma. A 53-year-old Japanese woman was admitted to our hospital for further evaluation of a liver tumor in segment 4. The tumor was detected on positron emission tomography during a health check-up. Abdominal ultrasonography revealed a well-defined mass of mixed echogenicity, 1.5 cm in diameter, in segment 4, and a giant hemangioma of mixed echogenicity, 7 cm in diameter, in segment 7. On enhanced computed tomography, the tumor in segment 4 showed hyperattenuation in the early phase and hypoattenuation in the delayed phase. On magnetic resonance imaging, the tumor in segment 4 showed hypointensity on T1-weighted images, hyperintensity on T2-weighted images, and hyperintensity on diffusion-weighted images. On angiography, the tumor in segment 4 appeared as a circumscribed hypervascular mass in the early phase and a slightly hypovascular mass in the delayed phase. The imaging findings suggested a primary hepatocellular carcinoma. The patient consented to resection of the tumor in segment 4 along with the giant hemangioma in segment 7. These tumors were resected with tumor-free surgical margins by partial resection of segments 4 and 7 of the liver. The cut surface of the resected specimen of segment 4 showed a yellowish tumor consisting of mature adipose tissue. The histopathological diagnoses of the resected specimens were angiomyolipoma in segment 4 and cavernous hemangioma in segment 7. The tumor in segment 4 consisted of mature lipocytes with angiomatous and small lymphocytic components, but no mitotic figures. The tumor showed immunoreactivity to smooth muscle antigen and homatropine methylbromide 45 and no immunoreactivity to AE/E3. The postoperative course was uneventful, and the patient remains well 1 year after the operation.

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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 xanthogranulomatous cholecystitis (XGC) that was diagnosed preoperatively by means of ultrasonography (US) with the contrast-enhancement agent Sonazoid after a false-positive result had been obtained with fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET). A 69-year-old woman was admitted because of right upper quadrant pain. Blood tests revealed a serum CA19-9 level of 749.8 IU/L. Computed tomography (CT), US, and magnetic resonance imaging of the abdomen showed abnormal thickening of the gallbladder wall but no stones. The border between the gallbladder and the liver was unclear. FDG-PET revealed a lesion with increased uptake of tracer in the gallbladder wall. The thickness of the lesion was similar to that on CT. We suspected gallbladder carcinoma with hepatic invasion. To confirm the tentative diagnosis, we performed US with the contrast-enhancement agent Sonazoid. The gallbladder wall was homogeneously enhanced in the early vascular phase and remained enhanced for 90 seconds. Enhancement of the gallbladder wall was smooth and regular. The border between the gallbladder and liver was clear and smooth. On the basis of these examinations, we diagnosed chronic cholecystitis (XGC suspected), not gallbladder carcinoma. At surgery, the gallbladder wall was observed to be extremely thick because of severe inflammation, and cholecystectomy was performed. XGC was diagnosed on intraoperative pathological examination. Histopathological examination showed XGC, severe proliferative fibrosis with formation of multiple yellow-brown intramural nodules, and foamy histiocytes without malignant cells. In conclusion, the present case of XGC was diagnosed preoperatively with contrast-enhanced US after a false-positive result had been obtained with FDG-PET. Contrast-enhanced US can thus play important roles in diagnosing gallbladder disease and selecting treatment.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Budd-Chiari syndrome is characterized by hepatic venous outflow obstruction. We describe a patient with a huge caudate lobe of the liver due to Budd-Chiari syndrome. A 49-year-old woman was referred to Nippon Medical School Hospital to receive treatment for enlarged gastric varices. She had been followed up for idiopathic portal hypertension with deformity of the liver for 7 years and had undergone surgery for pharyngeal carcinoma 5 years earlier. Upper gastrointestinal endoscopy revealed solitary gastric varices without esophageal varices. Abdominal computed tomography revealed obstructions and scars of the right, middle, and left hepatic veins. The caudate lobe was enlarged, and the portal vein was displaced ventrally, without thrombus. The drainage vein of the caudate lobe, the short hepatic vein on the left side of the inferior vena cava, was dilated. The portal vein and drainage vein of segment 6 were visualized and showed no atrophy. Venography revealed no obstruction of the inferior vena cava. Budd-Chiari syndrome with solitary gastric varices was diagnosed on the basis of these findings. We performed balloon-occluded retrograde transvenous obliteration and partial splenic embolization to treat the gastric varices. The posttreatment course was uneventful, and the patient was discharged 8 days after embolization. The gastric varices shrank.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We describe a patient with extrahepatic portal venous obstruction due to a giant hepatic hemangioma associated with Kasabach-Merritt syndrome. A 67-year-old woman presented with upper abdominal distension and appetite loss. The medical history was not relevant to the current disorder. Initial laboratory tests revealed the following: serum platelet count, 9.9 × 10⁴/µL; serum fibrinogen degradation products, 12 µg/mL; prothrombin time, 1.26; and serum fibrinogen, 111 mg/dL. Computed tomography demonstrated homogenous low-density areas, 15 cm in diameter, in the left lobe of the liver. Common hepatic arteriography revealed a hypervascular tumor with pooling of contrast medium in the delayed phase. The portal venous phase of supramesenteric arteriography revealed obstruction and cavernous transformation of the portal vein. We diagnosed extrahepatic portal venous obstruction due to a giant hepatic hemangioma associated with Kasabach-Merritt syndrome. Laparotomy was performed, and the liver was found to be markedly enlarged. After mobilization of the left lobe, left hepatectomy was performed with intermittent clamping. After resection, Doppler ultrasonography revealed recovery of the portal venous flow. The cavernous transformation shrank. Pathologic examination of the surgical specimen confirmed the presence of a giant benign hepatic cavernous hemangioma. The patient was discharged 16 days after operation. Laboratory data and complications improved after 2 months.

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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：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: We evaluated the results of shunting and nonshunting procedures for the treatment of esophagogastric varices in patients with idiopathic portal hypertension (IPH).
Methodology: Between 1981 and 2008, surgery was performed in 9 patients with IPH. Three patients were bleeding before operation, and the other 6 were treated prophylactically. Patients were divided into 2 groups, a shunting group (4 underwent distal splenorenal shunt) and a nonshunting group (3 underwent esophageal transection and 2 underwent Hassab&apos;s procedure).
Results: Esophagogastric varices were completely eradicated in 3 (75.0%) patients in the shunting group and 4 patients (80.0%) in the nonshunting group. Additional endoscopic treatment (one session) was performed in 2 patients with incompletely eradicated varices. There was no recurrence in the shunting group. In the nonshunting group, esophagogastric varices recurred in all 4 patients with completely eradicated varices. All recurrent esophageal varices were completely eradicated. Postoperative platelet counts (x10(4)/mu L) were significantly lower in the shunting group (10.0+/-2.6) than in the nonshunting group (42.0+/-14.0) (p=0.0029). The increase in the platelet count after operation was significantly lower in the shunting group (1.7+/-0.2 times) than in the nonshunting group (5.8+/-2.9 times) (p=0.0267). No patient received anticoagulants postoperatively. Portal venous thrombus did not develop in the shunting group, but appeared in 4 patients (80.0%) in the nonshunting group. No patient had loss of shunt selectivity or portal-systemic encephalopathy. One patient in the nonshunting group died of cerebral hemorrhage; all others are alive.
Conclusions: Shunting procedure, distal splenorenal shunt, was suggested to be useful for the management of esophagogastric varices in patients with IPH.

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記述言語：日本語   出版者・発行元：(株)南江堂  

難治性腹水に対する腹腔-静脈シャント、特にDenver Shunt(Cardinal Health社)について述べる。難治性腹水例であれば、癌性腹水であっても生活の質(QOL)改善目的で適応としている。また腹水の細菌培養陽性または白血球数500/μl以上の場合や、高度の出血傾向を認めた場合は適応外としている。手技は左鎖骨下静脈アプローチが挿入が容易であり、カテーテルの屈曲に注意を払うことが重要である。合併症としては凝固異常、敗血症、消化管出血、肝細胞癌破裂、カテーテル閉塞、心不全などがある。全身状態不良例では合併症も多くなるため、全身状態が良好な状況下で早期に決断し施行すると治療成績が改善すると考える。Denver Shuntは合併症を念頭におき、術前にその対策を練っておけば安全に施行できQOLも著明に改善し有用である。(著者抄録)

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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：(一社)日本門脈圧亢進症学会  

DOI： 10.11423/jsph.16.69

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

肝移植前後における部分的脾動脈塞栓術(PSE)の意義、位置づけを検討した。生体肝移植を施行した15例中、PSEを術前に施行した術前PSE群2例、術後に施行した術後PSE(術前PSE未施行)群2例を対象とした。脾容量は術前PSE群では移植後44.6%、術後PSE群では42.3%とほぼ向様に縮小した。PSEと肝移植を一連の治療と考え、全治療と定義した。血小板数の変化率を全治療1年後において比較すると、術前PSE群は3.21倍、術後PSE群は1.58倍に増加した。シャントを有する症例では術前PSEにて術中術後のグラフト門脈血流量低下を予防した。移植のみでは十分に回復されない脾機能亢進症に対してPSEを追加施行することで更に改善が得られた。また、術前PSE施行はシャントを有するsmall-for-size graft対策になりうる可能性があると思われた。

DOI： 10.11423/jsph.16.7

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J03767&link_issn=&doc_id=20100726460002&doc_link_id=10.11423%2Fjsph.16.7&url=https%3A%2F%2Fdoi.org%2F10.11423%2Fjsph.16.7&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）  

We describe the spontaneous rupture of a simple hepatic cyst associated with a benign course. A 64-year-old woman was admitted for right upper quadrant pain. The patient denied a history of abdominal trauma. Abdominal computed tomography (CT) showed a huge solitary hepatic cyst (diameter, 10 cm) in the right lobe. Part of the cyst surface was irregular, and the interior was heterogeneous on ultrasonography. Fluid retention was detected under the liver capsule. Spontaneous rupture of a nonparasitic hepatic cyst was suspected. The patient was admitted to our hospital for further evaluation and treatment. Examination of the abdomen revealed right upper quadrant pain but no signs or symptoms of peritonitis. One week after admission, CT revealed that the volume of fluid retained under the liver capsule had decreased. Percutaneous puncture was performed with a needle and an 8-French pigtail catheter under ultrasonographic guidance. Serous, brown fluid was aspirated. After percutaneous aspiration, the patient's symptoms resolved. Minocycline hydrochloride was given daily by intravenous injection for 7 days. The catheter was then removed. There has been no evidence of recurrence after 1 year.

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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：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: Early prospective randomized clinical trials demonstrated that perioperative parenteral nutrition (PN) with branched chain amino acids (BCAA) is beneficial in cirrhotic patients with hepatocellular carcinoma who undergo hepatectomy. However, PN support is expensive and requires a long hospital stay. Moreover, PN support has not been evaluated in patients with a normal liver who undergo hepatectomy. It was studied the benefits of perioperative oral nutrition (ON) with BCAA in patients who underwent hepatectomy, including those with a non-hepatitis liver.
Methodology: In this prospective, randomized, controlled trial, 38 patients were assessed for eligibility. Fourteen patients were excluded because they had received intraoperative blood transfusions or incomplete resections. The 24 eligible patients (20 with malignant liver tumors and 4 with benign liver tumors) were randomly assigned to receive perioperative ON with BCAA (11 patients, BCAA group) or a usual diet (13 patients, control group). The BCAA group received a BCAA supplement twice daily plus a usual diet for 14 days before operation and on days 1 to 7 after operation. The control group received a usual diet alone. The primary end point was the improvement in postoperative biochemical measurements.
Results: Two of the 11 patients in the BCAA group developed postoperative complications, as compared with 3 of the 13 patients in the control group (18.2% vs. 23.1%, p=0.7686). Serum levels of alanine aminotransferase, aspartate aminotransferase, and ammonia did not differ significantly between the BCAA group and control group; however, peak values were lower in the BCAA group. There was no difference between the groups in serum hemoglobin levels after operation. Among patients with hepatitis, serum erythropoietin (EPO) levels on POD 3, 5, and 7 were slightly but not significantly higher in the BCAA group than in the control group. Among patients with non-hepatitis, serum EPO levels on POD 3, 5, and 7 were significantly higher in the BCAA group than in the control group (p=0.0174, p=0.0141, and p=0.0328, respectively).
Conclusion: Short-term ON support with BCAA was associated with higher serum EPO levels than was a normal diet in patients with non-hepatitis who underwent curative hepatic resection. Higher EPO levels might be beneficial in protecting liver cells from ischemic injury and preventing intraoperative hemorrhage associated with lower perioperative levels of alanine aminotransferase and aspartate aminotransferase in serum. This is the first study to demonstrate an effect of EN support with BCAA in patients with non-hepatitis, as well as those with hepatitis.

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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：(株)南江堂  

部分脾動脈塞栓術(PSE)と脾摘の功罪について述べる。PSEでは血管造影剤過敏症例とChild-Pugh Score 13点以上、脾摘ではChild-Pugh Score 10点以上(Child-Pugh Class C)を原則適応外としている。合併症は、PSEでは左側腹部痛77.6%、発熱94.8%、腹水貯留5.2%、左胸水貯留3.4%、脾膿瘍1.7%であった。脾摘では重症感染症がまれに起こるため術後にPneumococcal vaccine投与が必要である。時に門脈血栓が出現するが、近年は術後抗凝固療法により減少しつつある。両方法とも汎血球減少症、食道・胃静脈瘤、肝性脳症に対し有効であるが、脾摘のほうが効果は確実である。しかしPSEは低侵襲で、全身状態に合わせて梗塞範囲を加減でき、しかも後日追加治療が可能である。また脾の一部を温存できる。門脈圧亢進症に対する脾温存の是非が解明されていない現在、治療成績も両者遜色ないことから患者の希望や各施設の特色から判断して治療法を選択すべきである。(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）  

We describe a symptomatic splenic artery aneurysm (SAA) with occasional left-sided abdominal pain which was successfully treated with transcatheter embolization. A 65-year-old man was referred to a nearby clinic because of left shoulder and abdominal pain developing the day after blunt trauma to the shoulder and abdomen. Radiography revealed no fracture, and the patient went home. He stopped working for 7 months. Left-sided abdominal pain then developed several times after strenuous physical labor, and the patient was referred to a nearby hospital. The patient had a history of asthma and untreated hypertension; the use of iodinated contrast material was therefore avoided. Unenhanced computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen revealed a hematoma in the splenic hilum. The patient was referred to Nippon Medical School Hospital. His neurologic status was stable. Unenhanced CT of the abdomen at a nearby hospital revealed a low-density area in the splenic hilum. Fat-suppressed, T1-weighted images showed a hyperintense lesion adjacent to the splenic hilum. Fat-suppressed, T2-weighted images showed a dark hemosiderin rim, a bright ring, and an intermediate central core, which indicated a recurrent chronic hematoma in the abdomen. Dynamic contrast-enhanced MRI revealed a small hyperenhanced lesion adjacent to the hematoma, which appeared to be an SAA. After an injection of corticosteroids, selective splenic arteriography was performed. The splenic artery was catheterized via a right femoral approach. Arteriography showed an SAA, 1 cm in diameter with extravasation of contrast material. The neck of the SAA was catheterized with a microcatheter, and coils were placed successfully into the SAA to prevent recurrent bleeding. Postembolization angiography showed total occlusion of the SAA. The patient was discharged 7 days after embolization and has since resumed normal activities, with no residual symptoms.

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

DOI： 10.11423/jsph.15.348

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A number of surgical procedures have been developed to manage esophageal varices. Broadly, these can be classified as shunting and non-shunting procedures. While total shunt effectively reduces the incidence of variceal bleeding, it is associated with a high risk of hepatic encephalopathy. The distal splenorenal shunt (DSRS), a selective shunt, was developed by Warren in 1967 to preserve portal blood flow through the liver while lowering variceal pressure. The hope was that both bleeding and hyperammonemia would be prevented. The DSRS effectively prevents rebleeding, but still carries a risk of hyperammonemia. We improved the DSRS procedure by additionally performing splenopancreatic disconnection (SPD, i.e. skeletonization of the splenic vein from the pancreas to its bifurcation at the splenic hilum) and gastric transection (GT, i.e. transection and anastomosis of the upper stomach with an autosuture instrument). An alternative to shunting was developed by Sugiura and Futagawa in 1973. Esophageal transection (ET) divides and reanastomoses the distal esophagus and devascularizes the distal esophagus and proximal stomach; splenectomy, selective vagotomy, and pyloroplasty are performed concomitantly. DSRS was more effective than ET in preventing recurrence of esophageal varices, but was associated with a higher incidence of hyperammonemia. The incidence of hyperammonemia in patients who underwent DSRS with SPD plus GT was significantly lower than that in patients who underwent DSRS alone or those who underwent DSRS with SPD. In conclusion, there are various surgical treatments for esophagogastric varices. Distal splenorenal shunt with SPD plus GT is considered an adequate treatment for patients with esophagogastric varices.

DOI： 10.1111/j.1872-034X.2009.00549.x

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記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

X線不透過性マーカー(radiopaque marker)を用いて,腹部単純X線撮影により簡便に消化管内容の移動状況が判断できる.単純性イレウス,術後癒着,難治性便秘症などの診断,治療方針の決定にきわめて有用である.さらに,各種術後の消化管運動の変化を経時的に評価可能で,術後経口摂取開始時期の決定や術後イレウスの早期診断にも有用である.X線不透過性マーカーは腸管に負荷をかけることなく,客観的に消化管運動を評価可能である.しかし,保険適応ではなく,日本での販売がないため米国よりの個人輸入に頼るしかない.また,やや高価であるため,症例を選択し補助検査として使用すべきと考える.(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）  

This report describes a method for percutaneous transhepatic biliary stenting with a BLAKE Silicone Drain, and discusses the usefulness of placement of the drain connected to a J-VAC Suction Reservoir for the treatment of stenotic hepaticojejunostomy. Percutaneous transhepatic biliary drainage was performed under ultrasonographic guidance in a patient with stenotic hepaticojejunostomy after hepatectomy for hepatic hilum malignancy. The technique used was as follows. After dilatation of the drainage root, an 11-Fr tube with several side holes was passed through the stenosis of the hepaticojejunostomy. A 10-Fr BLAKE Silicone Drain is flexible, which precludes one-step insertion. One week after insertion of the 11-Fr tube, a 0.035-inch guidewire was inserted into the tube. After removal of the 11-Fr tube, the guidewire was put into the channel of a 10-Fr BLAKE Silicone Drain. The drain was inserted into the jejunal limb through the intrahepatic bile duct and was connected to a J-VAC Suction Reservoir. Low-pressure continued suction was applied. Patients can be discharged after insertion of the 10-Fr BLAKE Silicone Drain connected to the J-VAC Suction Reservoir. Placement of a percutaneous transhepatic biliary stent using a 10-Fr BLAKE Silicone Drain connected to a J-VAC Suction Reservoir is useful for the treatment of stenotic hepaticojejunostomy.

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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：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: Bleeding from esophagogastric varices is a life-threatening complication of chronic liver disease. As compared with esophageal varices (EV), the risk factors for bleeding from gastric varices remain unclear. This study examined interactions between anti-ulcer drugs and non-steroidal anti-inflammatory drugs (NSAIDs) as related to bleeding esophagogastric varices in cirrhotic patients.
Methodology: Eighty-eight cirrhotic patients with an initial episode of bleeding esophagogastric varices who had not received prior treatment studied. The patients were divided 3 groups: 58 with bleeding from EV, 13 with bleeding from cardiac varices (CV), and 17 with bleeding from cardiofundic or fundic varices (FV). The use of "standard" NSAIDs on 4 or more of the last 7 days before the initial episode of bleeding was defined as "regular" use; all other use was considered "occasional".
Results: The number of anti-ulcer drug users was 16 (27.6%) in the EV group, 4 (30.8%) in the CV group, and 5 (29.4%) in the FV group. The number of NSAID users was 9 (15.5%) in the EV group, 4 (30.8%) in the CV group, and 11 (64.7%) in the FV group. The proportion of NSAID users was significantly higher in the FV group than in the EV group (p&lt;0.0001). All 16 users of anti-ulcer drugs who were nonusers of NSAIDs had varices with red color signs. All NSAID users had used NSAIDs orally within a day before the initial episode of bleeding. All "regular" NSAID users were nonusers of anti-ulcer drugs. All anti-ulcer drug users without red color signs were "occasional" NSAID users.
Conclusions: "Occasional" oral NSAID use is an important step leading to variceal hemorrhage, especially in FV, even if the mucosa is protected by anti-ulcer drugs. The ability to use NSAIDs for several days without variceal bleeding in some patients with esophagogastric varices who are concurrently receiving anti-ulcer drugs suggests that such drugs might protect the esophagogastric mucosa.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We describe a 71-year-old man with an inflammatory tumor arising in segment 5 of the liver. The patient was admitted because of acute pain in the right upper quadrant of the abdomen and fever. Initial laboratory tests revealed the following: serum alkaline phosphatase concentration, 634 IU/L; serum gamma glutamic transpeptidase concentration, 1,378 IU/L; serum C-reactive protein concentration, 0.89 mg/dL; and total bilirubin concentration, 8.9 mg/dL. Abdominal ultrasonography, computed tomography (CT), and magnetic resonance imaging showed a mass, 3 cm in diameter, in segment 5 of the liver. Magnetic resonance cholangiopancreatography showed a lesion of moderate-to-high signal intensity on T2-weighted images of segment 5. Endoscopic retrograde cholangiopancreatography revealed a common bile duct stone. The intrahepatic bile ducts of segment 5 could not be visualized after the use of contrast material. Endoscopic sphincterotomy was performed to remove the common bile duct stone. Antibiotics were administered soon after stone removal, and fever gradually resolved. Positron emission tomography revealed hot spots in segment 5 of the liver. Three weeks after discharge, the patient was readmitted with an acute pain in the right upper quadrant of the abdomen. Abdominal ultrasonography, CT, and magnetic resonance imaging showed enlargement of this area. Inflammatory changes of segment 5 due to cholangitis with intrahepatic bile duct stones was diagnosed. Because malignant disease could not be completely ruled out, segment 5 of the liver was resected. Macroscopic examination of the resected specimen revealed a gray, fibrotic, solid tumor associated with intrahepatic bile duct stones. Microscopic examination of the tumor showed proliferation of spindle-shaped myofibroblastic cells in a mixed myxoedematous, dense fibrotic stroma, associated with infiltration by various acute and chronic inflammatory cells. The postoperative course was uneventful, and the patient was discharged on postoperative day 16.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Balloon-occluded retrograde transvenous obliteration (B-RTO) has been used successfully to treat gastric varices in adults. However, only a few case reports of B-RTO in children have been published. We describe a child who had gastric varices with extrahepatic portal venous obstruction (EHO). A 12-year-old boy presented to the pediatric clinic with anemia and tarry stools. He was referred to our department to receive additional treatment for gastric varices. Endoscopy revealed spurting bleeding from gastric varices, and emergent endoscopic injection sclerotherapy was performed. Angiography showed cavernous transformation of the portal vein, hepatofugal flow of the left gastric vein, gastric varices, and gastrorenal shunt. The gastric varices were not eradicated adequately with endoscopic sclerotherapy because of excessive regurgitant blood flow against the portal venous pressure. B-RTO combined with partial splenic embolization (PSE) was therefore performed. The gastric varices were completely eradicated with no complications. This is, to our knowledge, the first report describing the use of B-RTO combined with PSE in a child with EHO who had gastric fundal varices. B-RTO combined with PSE is not excessively invasive and is effective and safe for children. This procedure is therefore recommended for the treatment of gastric varices in children.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Simple hepatic cysts are common benign lesions that are usually asymptomatic and require no treatment. However, complications can occur. This report describes a patient with an infected hepatic cyst treated with percutaneous transhepatic drainage. A 64-year-old woman presented at a nearby hospital because of acute right-upper-quadrant pain, mild left-lower-quadrant pain, diarrhea, and fever. She was admitted and received intravenous antibiotics for 1 week, but symptoms persisted. She was, therefore, referred to our hospital. On admission, ultrasonography demonstrated multiple hepatic cysts. One 13-cm lesion was hypoechoic, unlike the other simple cysts, which were anechoic. Computed tomography showed that the density of the hypoechoic cyst was slightly higher than that of the other cysts. The wall of the cyst was thickened and showed contrast enhancement. On initial laboratory tests the serum C-reactive protein concentration was 18.49 mg/dL, and the white-cell count was 13,300/microL. An infected hepatic cyst was suspected, and percutaneous transhepatic drainage of the cyst was performed. A catheter was inserted into the cyst, and dark red fluid was obtained. The right-upper-quadrant pain gradually resolved after drainage. An infected hepatic cyst was diagnosed, and system antibiotics were administered. However, the mild left-lower-quadrant pain persisted. No pathogens were isolated from the drainage fluid. Minocycline hydrochloride (200 mg) was injected, and the catheter was clamped for 30 minutes, once daily for 3 days. The serum C-reactive protein concentration was 1.78 mg/dL, and the white-cell count was 5,700/microL. The left-lower-quadrant pain resolved, and colonoscopic examination revealed multiple diverticula of the sigmoid colon. Infection has not recurred, and the hepatic cyst has not become larger.

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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  

当院にて劇症肝不全症例に対して,生体肝移植を考慮した集中治療を行った28例を対象に治療開始時期,移植適応の有無,転帰を,移植症例の移植時期,移植後合併症,転帰を検討した。症例の年齢は平均42.4歳(0〜82歳),男女比13:15であった。原疾患はB型肝炎9例,薬剤性7例,不明12例,また亜急性19例,急性9例で,治療開始時脳症はI度2例,II度17例,III度以上が9例であった。7例には生体肝移植を行ったが,13例は移植できずに失った。8例が内科的治療で回復した。全症例の救命率は42.9%であり,内科的治療のみでは38.1%,移植症例は57.1%であった。劇症肝不全の治療は,適切な肝補助療法の選択と施行,さらに肝移植へのタイミングを逸しないことが重要である。そのために治療早期より肝臓内科医,移植外科医,臨床工学士などのチームで治療に当たる必要があると思われる。(著者抄録)

DOI： 10.11231/jaem.29.623

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2009&ichushi_jid=J02824&link_issn=&doc_id=20090703440030&doc_link_id=10.11231%2Fjaem.29.623&url=https%3A%2F%2Fdoi.org%2F10.11231%2Fjaem.29.623&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）  

BACKGROUND: We compared two types of stents in patients who underwent surgery for hepatic hilar malignancies. METHODS: Twenty-one patients with hepatic hilar malignancies who underwent hepatectomy were randomly assigned to one of two groups. A 5-Fr silicon drain with an internal lumen and side holes was used for the hepaticojejunostomy in one group (intraluminal stent group), and a 10-Fr silicon drain with channels along the sides was used in the other (channel stent group). RESULTS: Leakage developed in four patients (36.4%) in the intraluminal stent group versus two (20.0%) in the channel stent group. Cholangitis developed in three patients with leakage (27.3%) in the intraluminal stent group versus no patient in the channel stent group. After operation, the times required for the serum alkaline phosphatase and total bilirubin levels to return to the normal range were significantly shorter in the channel stent group (5.3 +/- 2.9, 3.8 +/- 2.2 days) than in the intraluminal stent group (17.0 +/- 5.8, 9.4 +/- 5.7 days) (P < 0.0001, P = 0.0093). CONCLUSION: A 10-Fr silicon drain with channels is superior to a 5-Fr silicon drain with an internal lumen for internal biliary stenting of hepaticojejunostomy in patients with hepatic hilar malignancies.

DOI： 10.1111/j.1440-1746.2009.05827.x

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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：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: The aim of this study was to simultaneously evaluate portal hemodynamics and liver function by scintiphotosplenoportography (SSP) using technetium-99m-diethylenetriamine-pentaacetic asid-galactosyl-human serum albumin ((99m)-Tc-GSA) in recipients of living-donor liver transplants (LDLT).
Methodology: Three LDLT recipients with biliary atresia who underwent SSP using (99m)Tc-GSA were studied. The clearance index of (99m)Tc-GSA (HH15) was calculated by dividing the radioactivity of the heart region of interest (ROI) 15 minutes after injection (H15) by that of the heart ROI 3 minutes after injection (H3), (HH15=H15/H3). The hepatic uptake ratio of (99m)-Tc-GSA (LHL15) was calculated by dividing the radioactivity of the liver ROI at 15 minutes (L15) by H15 plus L15, (LHL15=L15/(H15+L15)). H/L15 (HH15/LHL15).
Results: Patient 1: On SSP before transplantation, digital images showed hepatofugal flow, but not the portal vein in early phase (HH15:0.647, LHL15:0.861, H/L15:0.751). On SSP after transplantation, digital images showed the portal vein clearly, and the hepatofugal flow had disappeared (HH15:0.633, LHL15:0.971, H/L15:0.652). Patient 2: On SSP before transplantation, digital images showed hepatofugal flow, and the liver was slightly visible in early phase (HH15:0.673, LHL15:0.869, H/L15: 0.774). Patient 3: On SSP before transplantation, digital images showed splenorenal shunt, but not the liver in early phase (HH15:0.697, LHL15:0.838, H/L15:0.832).
Conclusions: SSP using (99m)Tc-GSA is useful for the simultaneous evaluation of portal hemodynamics and liver function in pediatric recipients of LDLT.

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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  

81歳女。右季肋部痛が出現し、腹部CTで胆嚢の著明な腫大と、頸部に胆嚢壁の肥厚と思われるhigh densityを認めた。経皮経肝胆嚢ドレナージ(PTGBD)造影で胆嚢は頸部で先細り、胆嚢管は描出されず、造影剤の肝床部への漏出を認めた。胆嚢穿刺で凝血塊を伴う血性胆汁を60cc吸引した。全身状態改善後、内視鏡的逆行性胆道造影を行ったところ、胆嚢管は一部描出されたが胆嚢は描出されず、PTGBD造影では胆嚢頸部の先細りと胆嚢管の狭窄を認めた。胆嚢捻転症と診断し、腹腔鏡下胆嚢摘出術を施行した。胆嚢は腸管と強固に癒着しており、癒着剥離後に胆嚢管の時計回り270度の捻転を解除し、胆嚢を摘出した。胆嚢は肝下面とわずかに付着するのみで、ほとんど遊離した状態であった。摘出標本で胆嚢壁全体は壊死に陥り、組織学的には一部膿瘍形成を伴っていたが炎症細胞浸潤は目立たず、全般に虚血性変化が著明であった。術後経過は良好で、術後10日目に軽快退院した。

DOI： 10.1272/manms.5.57

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2009&ichushi_jid=J04260&link_issn=&doc_id=20090406400011&doc_link_id=%2Fcw1nimed%2F2009%2F000501%2F014%2F0057-0060%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcw1nimed%2F2009%2F000501%2F014%2F0057-0060%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Abdominal hernias are not rare in women, but incisional bladder hernias are rare. The incisional hernia is a condition caused by protrusion of the abdominal viscera through the abdominal fascia. The presenting symptoms in the cases reported included suprapubic discomfort, irritative voiding symptoms, and urinary incontinence. We present a case of bladder herniation with temporary bowel incarceration through a lower midline incision, which followed operative intervention. The temporary bowel herniation was managed conservatively because the impairment of the blood supply was not severe.

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

77歳男。患者はふらつき、見当識障害を主訴とした。70歳時に高アンモニア血症が認められ、経回結腸静脈的シャント塞栓術(TIO)と50%部分脾動脈塞栓術(PSE)が施行された。しかし、この手術から5年経過で再度、血中アンモニア値が上昇し、次第にコントロール不良となった。入院時の血清アンモニア値は262μg/dlで、画像所見等により右胃静脈と後胃静脈を供血路、傍食道静脈および半奇静脈を排血路とした門脈奇静脈シャントに伴う高アンモニア血症と診断された。経皮経肝的シャント塞栓術はChilaiditi症候群のため、またTIOや開腹下血行郭清は頻回の開腹歴から困難と判断し、奇静脈内に挿入したバルーンカテーテルで閉塞下に造影が行われたが、細い側副血行路により造影剤の停滞が不良であった。そこで、側副血行路をcoiling後、50%ブドウ糖を先行注入し、5%EOIを使用してBalloon-occluded retrograde transvenous obliterationが行われた。更に70%PSEを併施した。その結果、術後から高アンモニア血症の著明な改善が認められ、目下、約1年が経過で再発は認められていない。

DOI： 10.11423/jsph1999.14.2_148

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

DOI： 10.11423/jsph1999.14.2_175

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

DOI： 10.11423/jsph1999.14.2_161

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2008&ichushi_jid=J03767&link_issn=&doc_id=20090306380006&doc_link_id=10.11423%2Fjsph1999.14.2_161&url=https%3A%2F%2Fdoi.org%2F10.11423%2Fjsph1999.14.2_161&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：H G E UPDATE MEDICAL PUBLISHING S A  

Primary hepatic gastrinoma is very rare, with fewer than 20 cases reported. We describe a 44-year-old woman in whom primary hepatic gastrinoma was strongly suspected clinically. The patient was referred to our hospital because of intractable diarrhea. She had elevated serum levels of alanine aminotransferase, aspartate aminotransferase, and fasting gastrin. A calcium provocative test showed a marked elevated serum gastrin level (17,000 pg/ml). Abdominal ultrasonography, computed tomography, and magnetic resonance imaging revealed a tumor in the right lobe of the liver, measuring 38x33 mm. No other tumor was detected in the pancreas, duodenum, or local lymph nodes on preoperative radiological imaging or endoscopic ultrasonography. The hepatic tumor was resected. Total intraoperative ultra-sonography and intraoperative exploratory palpation of the duodenum, pancreas, and lymph nodes showed no evidence of an extrahepatic tumor. Pathological findings and immunohistochemical studies revealed a neuroendocrine tumor with increased production of gastrin. Postoperatively, the serum gastrin level returned to normal.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Bile duct invasion is rare in patients with hepatocellular carcinoma (HCC). We show the usefulness of selective transcatheter hepatic arterial embolization (TAE) followed by microwave coagulation therapy (MCT) in a case of HCC with portal and biliary tumor thrombi that ruptured into the biliary system. A 70-year-old man with HCC was admitted because of melena and postprandial abdominal pain. Four years earlier, he had undergone posterior segmentectomy of the liver for HCC. Portal venous thrombus was detected on computed tomography (CT) 3 months earlier. On admission laboratory tests revealed the following values: serum alkaline phosphatase, 760 IU/L; total serum bilirubin, 11.9 mg/dL; direct bilirubin, 9.8 mg/dL; serum hemoglobin, 7.7 g/dL; alpha-fetoprotein 103.9 ng/mL; and PIVKA-2, 52,655 mAU/mL. Serum examinations were positive for anti-hepatitis C virus antibody but negative for hepatitis B surface antigens. Ultrasonography revealed a hypoechoic mass in the right branch of the bile duct at the hepatic hilum. Doppler ultrasonography showed blood flow in the mass. CT showed diffuse tumor involvement throughout the liver parenchyma and the presence of a high-density substance in the right intrahepatic bile duct. The diagnosis was hemobilia secondary to HCC in the right hepatic lobe. The symptoms recurred, and emergency TAE was performed 5 days after the onset of hemobilia. The symptoms subsided, and liver function improved. Endoscopic retrograde cholangiography revealed obstruction of the right intrahepatic bile duct. Surgery was performed 15 days after TAE, and MCT of the right hepatic hilum was performed. After MCT, CT revealed necrosis of the right hepatic hilum. Seven months after TAE, the patient died of liver failure with no recurrence of hemobilia.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Spontaneous intracystic hemorrhage rarely occurs in nonparasitic hepatic cysts. We describe a patient with spontaneous intracystic hemorrhage of a large simple hepatic cyst that mimicked a malignancy. A 59-year-old man presented with right abdominal discomfort. The patient's medical history included a simple hepatic cyst that had been detected 7 years earlier but was left untreated. Three weeks before presentation, right upper abdominal pain occurred but resolved spontaneously. The serum CA19-9 concentration was 48.3 U/mL (normal<37 U/mL). Ultrasonography revealed a large cystic mass, containing many hyperechoic structures and occupying nearly the entire right hepatic lobe. Computed tomography demonstrated a homogenous low-density area, 20 cm in diameter, in the right hepatic lobe. Magnetic resonance imaging revealed a heterogeneous hypointense lesion measuring 20 cm in diameter. The lesions showed linear hyperintense areas on T1-weighted sequences and mosaic heterogeneous hyperintensity on T2-weighted sequences. We suspected a hemorrhagic simple hepatic cyst, hydatid cyst, or hemorrhagic cystadenocarcinoma. Right hepatectomy was performed, and the enlarged right lobe was removed. The mass was soft, sponge-like, and contained fluid, but was not elevated. Pathologic examination of the surgical specimen confirmed the presence of a hemorrhagic benign hepatic cyst.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Biliary cystadenocarcinomas are rare cystic tumors arising from the biliary epithelium. Symptoms vary and are sometimes absent. Most lesions are found incidentally during diagnostic radiologic procedures or surgical exploration for unrelated conditions. We describe an 80-year-old man with anemia due to intracystic bleeding. A computed tomographic scan showed a low-density hepatic lesion with thick, irregular walls and septa. Left lobectomy with cholecystectomy was performed. Histological examination revealed that the surgical specimen was a biliary cystadenocarcinoma. The concentrations of both carcinoembryonic antigen and CA19-9 were high in the cyst contents. The patient died of pneumonia 1 year 4 months after the operation, without the recurrence of cystadenocarcinoma.

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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：H G E UPDATE MEDICAL PUBLISHING S A  

The use of expandable metallic stents (EMSs) for the management of gastrointestinal obstruction is increasing. Traditionally, EMSs have been used for the treatment of malignant esophageal and biliary strictures: however. several groups are examining their use in different organs, including the stomach, duodenum, and colon. We describe a new method for the transhepatic insertion of an EMS together with a double-pigtail catheter, placed from the bile duct to the EMS to prevent migration, in a patient with afferent loop obstruction caused by recurrent gastric carcinoma.

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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：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: The aim of this study was to evaluate the efficacy of the Blake drain for the management of pancreatic fistula (PF) in comparison with the Duple drain.
Methodology: Our study consisted of two parts: a retrospective review of 33 patients with PF after pancreaticoduodenectomy, and a basic experiment to investigate the effects of the Blake drain on the management of PF in an animal model.
Results: In the clinical study, 19 patients received Blake drains (B-group) and 14 received Duple drains (D-group). Grade C fistulas with abdominal bleeding developed in only 2 patients in the B-group. All the patients in the B-group healed with conservative treatment (P &lt; 0.01), and none of them required percutaneous drainage or reoperation (P &lt; 0.05). In the basic experiment, no collections of fluid were detected around the Blake drains. When leakage occurred, it did not lead to abdominal abscess, and a "drain canal" formation linking the anastomosis with the extracorporeal orifice was demonstrated all along the drainage route.
Conclusions: Blake drains may be efficient therapeutic tools in patients with grade B fistulas. The basic experiment affirms that Blake drains provide excellent drainage and contribute to the formation of "drain canals" effective in localizing and controlling PF.

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