Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The resolution of 8K ultra-high-definition imaging technology (7680 × 4320 pixels) is 16-fold higher than the current high-definition technology (1920 × 1080 pixels). 8K/two-dimensional (2D) laparoscopy was clinically available in 2014, but few reports concerning its application have been published. The aim of this study was to evaluate the appropriate methods of usage and problems learned from clinical use of 8K/2D laparoscopy. SUBJECTS AND METHODS: The patients were 100 colorectal surgery patients who underwent 8K/2D laparoscopy at Asahikawa Medical University Hospital between November 2018 and March 2021. We evaluated the effectiveness, operating conditions, methods and issues of 8K/2D laparoscopy. RESULTS: The median age was 68.5 years. The primary disease was malignancy of the left side of the colon and rectum in 92 patients. The right-sided colectomy was performed in five cases, total proctocolectomy of ulcerative colitis was performed in 3 cases. The proper application of 8K/2D laparoscopy can be achieved by adhering to certain tips, such as darkening the operation room and keeping an appropriate distance from the monitor. Regarding intraoperative complications caused by the 8K/2D laparoscope, skin burns due to heat from the tip of the laparoscope were observed in one patient. There were no cases of complications due to the 8K/2D laparoscopy. CONCLUSION: 8K/2D laparoscopy can be used safely in colorectal surgery. There are still some tips for proper use, such as keeping an appropriate distance to the monitor and darkening the room. However, 8K/2D laparoscopy can provide delicate images and can be used without any operational problems.

DOI： 10.4103/jmas.jmas_281_21

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: How does making origami cranes under a dry box affect Fundamentals of Laparoscopic Surgery (FLS) scores in medical students? DESIGN: Four medical students from Asahikawa Medical University (tertiary hospital) participated. They made origami cranes under a dry box (origami crane training) five days per week for four weeks. The time required to make each origami crane (origami crane time) and degree of completion were evaluated. FLS scores were measured before training and on days 5, 10, 15, and 20. We examined the relationship between "origami crane training" and FLS scores. RESULTS: At the beginning of the experiment, none of the participants could complete the origami crane, but they were able to complete it in 31 ± 7 min on day 20. The Total FLS score was 164 ± 48 before the start of training, and 1107 ± 112 on day 20. The average scores of the students closely approached the Proficiency Level for the FLS tasks of peg transfer, loop ligation and extracorporeal ligation (103→228, 61→137, 0→259). The change over time in the average of the increase in Total FLS Score (difference from the first time and each week's score) improved significantly in four weeks (P < 0.01). CONCLUSIONS: Origami crane training improved the medical students' FLS scores. We thought that origami crane training mainly enhanced hand-eye coordination and bi-hand coordination.

DOI： 10.1016/j.heliyon.2022.e11277

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Capecitabine and oxaliplatin (CAPOX) plus bevacizumab (BEV) therapy (CAPOX/BEV) is a standard treatment recommended as the first-line treatment for colorectal cancer recurrence. Recently, sinusoidal obstruction syndrome (SOS) and resulting portal hypertension have been reported as important side effects of oxaliplatin. We herein report a rectal cancer patient who underwent percutaneous transhepatic stoma variceal embolization (PTO) and partial splenic artery embolization (PSE) for stomal variceal bleeding and splenomegaly due to portal hypertension caused by SOS after CAPOX therapy. A 43-year-old man who underwent robot-assisted laparoscopic abdominoperineal resection for advanced lower rectal cancer was started on CAPOX/BEV therapy for early recurrence 1 month after surgery. In the sixth course, splenomegaly rapidly worsened, stomal varices appeared, and the stoma began bleeding. At 5 months after the appearance of stomal varices, the splenomegaly worsened, the frequency of stomal bleeding increased, and PTO was performed. Five months later, PSE was performed for splenomegaly and thrombocytopenia. At 5 months since the PSE, the stoma bleeding has not recurred, and the thrombocytopenia has been corrected. The patient has been able to continue chemotherapy. We suggest that staged treatment by PTO and PSE be considered an important treatment option for stomal varices and splenomegaly associated with SOS.

DOI： 10.1007/s12328-022-01720-7

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

INTRODUCTION: Rectourethral fistula (RUF) after prostatectomy is a rare complication; however, when it occurs it is likely to be intractable and treatment requires surgical closure of the fistula. Several approaches to fistula closure have been reported, but there is no established treatment. CASE PRESENTATION: The patient was a 66-year-old man who had undergone robot-assisted laparoscopic radical prostatectomy for prostate cancer. On the 16th postoperative day, RUF was diagnosed. Cystostomy, laparoscopic ileostomy and transanal fistula closure were performed, and conservative treatment was continued for 5 months; however, the RUF remained, so the patient underwent fistula closure with a gracilis muscle flap using both transperineal and laparoscopic manipulation. Because it was a high fistula, the RUF was difficult to fill with a transperineal approach alone; however, in combination with laparoscopic manipulation, the appropriate filling of the fistula was possible. CLINICAL DISCUSSION: Although few reports have described the use of the laparoscopic transabdominal approach in combination with a transperineal gracilis muscle flap, the advantages of this technique are that the superior part of the fistula can be dissected, the flap can be filled more securely than with a transperineal approach alone, and transabdominal manipulation can be performed in a less invasive manner. In addition, by coordinating perineal and laparoscopic manipulation, we were able to close the fistula without organ damage by safe dissection. CONCLUSION: The laparoscopic approach is useful for RUF closure because it allows the interposition of the flap to reliably fill the space between the bladder and the rectum.

DOI： 10.1016/j.ijscr.2022.106856

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Authorship：Corresponding author   Language：English  

Pembrolizumab is one of the treatment options for treatment-refractory unresectable advanced or metastatic colorectal cancer with microsatellite instability-high (MSI-H) or deficiencies in DNA mismatch repair (dMMR). Herein, we report a case in which a recurrent cecal cancer lesion showed specific imaging findings and local inflammatory findings during treatment with pembrolizumab, followed by marked shrinkage. The patient was an 80-year-old woman. Postoperative peritoneal recurrence of cecal cancer of approximately 7 cm in size was observed. The patient had MSI-H and was treated with pembrolizumab. After five courses of treatment, the patient presented to our hospital with a chief complaint of abdominal pain. A blood test showed a strong inflammatory reaction, and computed tomography (CT) showed diffuse low-density area in the tumor. Under the suspicion of an abscess, conservative treatment was initiated and the patient quickly recovered. A CT at 1 month showed a marked reduction in size at the same site, and a CT at 3 months showed that the recurrent foci had almost disappeared. The inflammatory reaction before shrinkage in this case may have been caused by tumor immune response to pembrolizumab.

DOI： 10.23922/jarc.2021-053

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

This study examined the efficacy of end-ischemic hypothermic oxygenated machine perfusion preservation (HOPE) using an originally developed machine perfusion system for split-liver transplantation. Porcine split-liver grafts were created via 75% liver resection after 10 min of warm ischemia. In Group 1, grafts were preserved by simple cold storage (CS) for 8 h (CS group; n = 4). In Group 2, grafts were preserved by simple CS for 6 h and end-ischemic HOPE for 2 h (HOPE group; n = 5). All grafts were evaluated using an isolated ex vivo reperfusion model with autologous blood for 2 h. Biochemical markers (aspartate aminotransferase and lactate dehydrogenase levels) were significantly better immediately after reperfusion in the HOPE group than in the CS group. Furthermore, the HOPE group had a better histological score. The levels of inflammatory cytokines (tumor necrosis factor-α, interferon-γ, interleukin-1β, and interleukin-10) were significantly lower after reperfusion in the HOPE group. Therefore, we concluded that end-ischemic HOPE for split-liver transplantation can aid in recovering the graft function and reducing ischemia-reperfusion injury. HOPE, using our originally developed machine perfusion system, is safe and can improve graft function while attenuating liver injury due to preservation.

DOI： 10.1038/s41598-021-01467-0

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Language：Japanese   Publisher：日本Acute Care Surgery学会  

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Language：Japanese   Publisher：(一社)日本臨床栄養代謝学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本血液代替物学会  

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

<title>Abstract</title><sec>
<title>Purpose</title>
8K Ultra-high-definition (UHD) imaging has been developed in accordance with the progression of imaging technologies. We evaluated laparoscopic procedures performed by novice medical students using 2K/two-dimensional (2D), 2K/three-dimensional (3D) and 8K/2D monitors, with a particular focus on depth perception.


</sec><sec>
<title>Methods</title>
Nine medical students were enrolled. They performed two tasks using 2K/2D, 2K/3D and 8K/2D monitors. In Task 1, they were asked to grasp three metal rods with forceps using each hand. In Task 2, they were asked to grasp a metal rod with forceps held in the right hand, pass the metal rod through a metal ring and transfer it to their left hand.


</sec><sec>
<title>Results</title>
In Task 1, when performed with the dominant hand, the procedures performed using 2K/3D took a significantly shorter time than those performed using 8K/2D (<italic>P</italic> = 0.04). However, there was no significant difference among the three groups in the time required for procedures performed by the non-dominant hand. In Task 2, the procedure time with 2K/2D was significantly longer than that with 2K/3D or 8K/2D (<italic>P</italic> = 0.02).


</sec><sec>
<title>Conclusion</title>
2K/3D showed superior utility to 8K/2D for performing forceps procedures using the dominant hand. However, when the movement of both hands was coordinated (“bi-hand coordination”), the laparoscopic procedures were performed almost as deftly with 8K/2D and 2K/3D.


</sec>

DOI： 10.1007/s00595-020-02215-z

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Other Link： https://link.springer.com/article/10.1007/s00595-020-02215-z/fulltext.html

Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：北海道外科学会  

クローン病に対する治療は内科治療が基本であり、内科治療の進歩に伴い、腸管切除の割合が減少している。しかし、クローン病は診断されてから10年以内に50%の患者が腸管切除などの手術を受けており、外科治療は依然として重要である。内科治療が進歩しているにも関わらず、外科的再発(再手術)が改善されていないことも報告されている。再手術の原因は、狭窄形成部や吻合部に多いことが明らかになっている。そのため、腸管病変に対する狭窄形成術の適応、腸管切除術の適応、吻合方法の違いを理解することは重要と思われる。本稿では術式の再確認を行い、腹腔鏡手術の最近のエビデンスについても触れたいと思う。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J01375&link_issn=&doc_id=20210727190002&doc_link_id=%2Fdc7hksrg%2F2021%2F006601%2F003%2F0013-0019%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdc7hksrg%2F2021%2F006601%2F003%2F0013-0019%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本臨床栄養代謝学会  

【目的】旭川医科大学病院(以下,当院と略)では,胃がん術後に細径経鼻栄養チューブを用いて術直後からの経腸栄養付加を採用してきたが,経口摂取のみの管理と比較した報告はなかった.そこで本研究において早期経腸栄養付加の術後栄養における有用性を検討することとした.【対象と方法】2007年1月から2018年7月までに当院で胃がんに対し切除術を施行した503例のうち,術後早期経腸栄養付加336例をEN群,経口摂取のみ167例をON群とし,傾向スコアマッチングで背景因子を調整した.両群において術後2日目から飲水,3日目から食事を開始し,EN群は術直後から4日間成分栄養剤エレンタール投与を付加した.【結果】EN群で術後7日目の体重減少率は有意に少なく(p<0.001),術後7日目のトランスサイレチン値が有意に高値であった(p<0.001).【結論】胃がん術後の早期経腸栄養付加は,術後早期における体重減少の抑制と,栄養維持に有用であることが示唆された.(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Georg Thieme Verlag KG  

<title>Abstract</title>Kasai portoenterostomy (KPE) is currently the first-line treatment for biliary atresia. Many pediatric surgeons have reported that the dissection of the fibrous remnant at the porta hepatis is one of the most important components of this procedure. Furthermore, laparoscopic portoenterostomy is being increasingly used to treat biliary atresia.

An advantage of laparoscopic surgery is that surgeons can more easily identify microbiliary ducts, owing to the magnification. We report the case of a 61-day-old girl on whom we performed an exploratory laparotomy and diagnosed type III biliary atresia using intraoperative cholangiography. For the first time, we performed an open KPE using an 8K ultra-high-definition television system. This allowed us to clearly view the porta hepatis and to successfully perform the portoenterostomy.

DOI： 10.1055/s-0040-1721466

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

5-FUによる高アンモニア血症は,稀であるが重篤な副作用である.大腸癌での報告は散見されるが,食道癌では少ない.食道癌の術前化学療法である5-FU+シスプラチン療法(以下:FP療法)中に高アンモニア血症を伴う意識障害をきたした症例を経験したので報告する.症例は67歳,男性.受診3ヵ月前より嚥下時閉塞感,嘔吐を自覚し,前医で食道扁平上皮癌と診断された.LtAe,70×30mm,3型,SCC,cT3,cN3,cM0,cStageIIIと診断し,術前化学療法(FP療法:5-FU 第1-5病日,CDDP 第1病日)の方針となった.治療開始後,第3病日早朝より傾眠傾向であった.その後,徐々に意識レベルが低下しJCSIII-200まで増悪した.血液検査で血中アンモニア濃度132μg/dlと高値であり,5-FUによる高アンモニア血症を伴う意識障害と診断した.治療として,5-FU投与を中止し,補液,分岐鎖アミノ酸製剤を開始した.結果,速やかに意識レベルは改善した.2コース目は5-FUを50%減量,ラクツロース内服と分岐鎖アミノ酸製剤を併用することで施行可能であった.胸腔鏡下食道亜全摘術および胃管再建術を行うも,転移リンパ節(No.106tbL,106recL)の気管浸潤を認め,R2切除となった.術後1日目より経腸栄養を開始し,術後7日目で食事開始となり,術後19日目に退院した.自験例は,貧血,低アルブミン血症および骨格筋量低下が高アンモニア血症の誘因となった可能性が考えられた.(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J03156&link_issn=&doc_id=20201106060016&doc_link_id=10.3919%2Fjjsa.81.2016&url=https%3A%2F%2Fdoi.org%2F10.3919%2Fjjsa.81.2016&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：北海道外科学会  

炎症性偽腫瘍(inflammatory pseudotumor:以下、IPT)は、形質細胞や炎症細胞浸潤を伴った限局性病変で肺や肝臓、脾臓などの実質臓器に発生することが多い。今回、術前診断が困難であった腸間膜炎症性偽腫瘍の一例を経験したので、文献的考察を含めて報告する。症例は60歳代男性、腹痛のため前医を受診した。左上腹部に腫瘤を触知し腹部CT検査で腹腔内腫瘤を認め、精査を目的に当院を紹介受診した。造影CT検査では空腸近傍に84×63×90mmの境界明瞭で内部の造影効果が不均一な腫瘤を認めた。FDG-PET/CT検査では同病変にSUVmax4.7→5.9の異常集積を認めた。画像所見より小腸腫瘍(GISTまたは悪性リンパ腫疑い)の術前診断で手術の方針となった。開腹しTreitz靱帯から約5cm肛門側の空腸間膜内に約10cm大の腫瘤を認め、約20cmの空腸を合併切除し摘出した。組織学的所見では腫瘍は線維性に肥厚した被膜に包まれたリンパ節に相当しIPTの診断となった。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01375&link_issn=&doc_id=20200703090013&doc_link_id=%2Fdc7hksrg%2F2020%2F006501%2F014%2F0060-0063%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdc7hksrg%2F2020%2F006501%2F014%2F0060-0063%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(公財)日中医学協会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

Segmental absence of intestinal musculature(以下,SAIM)は腸管の部分的な固有筋層の欠損で成人では非常にまれである。症例は60歳台女性。検診でのバリウムによる上部消化管造影検査の2日後,下痢を主訴に当院救急外来受診。CTでS状結腸内と腸間膜内にバリウム塊と周囲に腸管外ガスと脂肪織濃度の上昇を認めた。消化管穿孔の診断で緊急手術となりS状結腸壁の菲薄化と腸間膜内にバリウムを含む便塊の貯留を認めハルトマン手術を施行した。肉眼所見では腸間膜付着部側に直線的・帯状に固有筋層の欠損と穿孔を認めた。組織学的所見でも同様でSAIMとそれに伴う消化管穿孔の診断となった。バリウム排泄による腸管内圧の上昇によりSAIMによる腸管壁の脆弱部分に穿孔が発生したと考えられた。SAIMの病変に対する手術時には多発病変の検索や腸管内圧が上昇しないように留意するべきである。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Improvement of machine perfusion (MP) technologies is required to enhance organ quality for donor after cardiac death (DCD) grafts. Installing a dialyzer or a filter into the perfusion circuit to maintain the perfusate condition has some advantages. However, the consequences of purification perfusate during subnormothermic machine perfusion (SNMP) remain unexplained. In this study, the effects of initial purification perfusate with simple method of replacing the first 0.5-L perfusate during SNMP were investigated to consider installation effect of the filter or the dialyzer. Porcine liver grafts, which have 60-min warm ischemia time, were procured to imitate the DCD graft condition. Purified SNMP (PSNMP) results were compared with simple cold storage and conventional SNMP. In PSNMP, initial perfusate of 0.5 L was removed to substitute for purification. After preservation process, the preserved grafts were reperfused with diluted autologous blood for 2 h under normothermic machine perfusion condition to evaluate the liver function using an isolated reperfusion model. The vascular pressures, enzyme release rates and the metabolic indexes during reperfusion were analyzed. The pressures in the hepatic artery after reperfusion 60 min were significantly lower in PSNMP group compared with cold storage (CS) and SNMP groups. In addition, lactate dehydrogenase and alkaline phosphatase were significantly lower after PSNMP than after the CS or SNMP. Also, the metabolic indexes of hyaluronic acid and lactate were significantly decreased by purifying the perfusate in MP preservation than in CS or SNMP. The effectiveness of initial purification perfusate during SNMP was investigated.

DOI： 10.1007/s10047-019-01123-5

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Other Link： http://link.springer.com/article/10.1007/s10047-019-01123-5/fulltext.html

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：International Scientific Information, Inc.  

BACKGROUND Split-liver transplantation can be useful in situations of limited donor resources. However, novel preservation methods are required to help the recipient recover from severe ischemic reperfusion injury incurred due to receiving a relatively small liver graft. MATERIAL AND METHODS Our experiment was performed using porcine livers without warm ischemia time, assuming a brain-dead organ. We made porcine split-liver grafts by 75% liver resection at the back table and divided the specimens into 4 groups. Group 1 was preserved with simple cold storage after splitting (CS; n=3), Group 2 was preserved with hypothermic perfusion preservation (HMP) after splitting (SBP; n=3), Group 3 was preserved with HMP after splitting under perfusion preservation (SDP; n=4), and Group 4 had the whole liver perfused as control grafts (Whole Liver; n=3). To assess potential methods of preservation and their effects, all grafts were evaluated by an ex vivo isolated liver reperfusion model using diluted autologous blood. RESULTS Portal vein pressure resistances during reperfusion were low in Group3 (SDP). Hepatic artery pressure resistances during reperfusion were markedly higher in Group 1(CS) than in the other groups. The levels of AST and LDH were high and increased at 2 h after reperfusion in Group 1 (CS). The histological findings show that the liver cell structure was irregular in Group 1 (CS) but remained regular in Groups 2 (SBP) and 3 (SDP). Histological Suzuki scores were also significantly better in Groups 2 (SBP) and 3 (SDP) compared with Group 1 (CS). CONCLUSIONS Splitting the liver under machine perfusion preservation may help restore the function and reduce ischemia-reperfusion injury.

DOI： 10.12659/aot.919920

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japan Surgical Association  

DOI： 10.3919/jjsa.81.2016

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Public Library of Science (PLoS)  

The recent clinical application of perfusion technology for the machine preservation of donation after cardiac death (DCD) grafts has some advantages. Oxygenation has been proposed for the preservation of DCD liver grafts. The aim of this study is to clarify whether the use of HbV-containing preservation solution during the subnormothermic machine perfusion (SNMP) of the liver graft improves the graft function of DCD porcine livers in an ex vivo reperfusion model. Pig livers were excised after 60 minutes of warm ischemic time and were preserved under one of three preservation conditions for 4 hours. The preservation conditions were as follows: 4°C cold storage (CS group; N = 5), Hypothermic machine preservation (HMP) with UW gluconate solution (HMP group; N = 5), SNMP (21°C) with UW gluconate solution (SNMP group; N = 5), SNMP (21°C) with HbVs (Hb; 1.8 mg/dl) perfusate (SNMP+HbV group; N = 5). Autologous blood perfusion was performed for 2 hours in an isolated liver reperfusion model (IRM). The oxygen consumption of the SNMP and SNMP+HbV group was higher than the HMP groups (p < 0.05). During the reperfusion, the AST level in the SNMP+HbV group was lower than that in the CS, HMP and SNMP groups. The changes in pH after reperfusion was significantly lower in SNMP+HbV group than CS and HMP groups. The ultrastructural findings indicated that the mitochondria of the SNMP+HbV group was well maintained in comparison to the CS, HMP and SNMP groups. The SNMP+HbVs preservation solution protected against metabolic acidosis and preserved the liver function after reperfusion injury in the DCD liver.

DOI： 10.1371/journal.pone.0226183

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本臨床栄養代謝学会  

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Language：Japanese   Publisher：(一社)日本臨床栄養代謝学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japanese Society of Internal Medicine  

The patient was a 76-year-old man who was treated with nivolumab due to recurrent gastric cancer. A blood examination revealed grade 3 alkaline phosphatase (ALP) elevation. A histopathological examination revealed marked portal infiltration, including eosinophils and CD4+ and CD8+ T lymphocytes, suggesting nivolumab-related cholangitis accompanied by the features of both an immune-related adverse event (irAE) and drug-induced liver injury (DILI) with allergic reaction. The patient’s ALP level immediately decreased after the administration of prednisolone. Although nivolumab-related cholangitis, a rare irAE, has been reported to be refractory to steroid therapy, patients with features of irAE and allergic DILI might immediately respond to prednisolone.

DOI： 10.2169/internalmedicine.2330-18

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：北海道外科学会  

1999年に販売が開始された手術支援ロボットもテクノロジーの進歩とともに様々な改良が加えられてきました。我が国においても2012年4月に前立腺悪性腫瘍手術に対するロボット支援手術の保険収載が認められて以降、da Vinci Surgical Systemを用いたロボット支援手術の導入がすすんできました。また、本年4月より新たに12の術式にda Vinci Surgical Systemを用いたロボット支援手術の保険収載が決まりました。これにより泌尿器科中心であった我が国のロボット支援手術も心臓外科・呼吸器外科・消化器外科・泌尿器科・婦人科の5領域でのロボット支援手術の保険診療が可能となりました。また、来年以降には我が国をはじめ各国から手術支援ロボットの販売が開始される予定です。いよいよ従来の腹腔鏡下手術からロボット支援手術へと新たな時代の幕開けとなりました。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：International Scientific Information, Inc.  

BACKGROUND Machine perfusion techniques offer a solution to the serious organ shortage. However, to assess the effects of machine perfusion, many detailed studies are required. In this study, an ex vivo reperfusion model using diluted autologous blood was confirmed to evaluate the utility of machine preservation for livers donated after cardiac death (DCD). In particular, beneficial effects of the oxygenated hypothermic machine perfusion (HMP) for DCD porcine livers are evaluated. MATERIAL AND METHODS Porcine livers were procured under warm ischemia time (WIT) of 60 min. The livers were preserved by hypothermic machine perfusion (HMP) or static cold storage (CS) for 4 h. After the preservation, the livers were perfused for 2 h using the ex vivo reperfusion model with diluted blood oxygenated by a membrane oxygenator at 35-38°C. RESULTS At 2 h of ex vivo reperfusion with 60 min of warm ischemic time (WIT), the portal vein pressure for CS was higher than HMP (18.8±15.9 vs. 7.5±3.9 [mmHg] in 60 min). Furthermore, LDH in CS was higher than HMP (528.5±149.8 vs. 194.1±32.2 [IU/L/100 g liver] in 60 min. P<0.05). Lactate after CS (60) was significantly higher than HMP (60) (8.67±0.39 vs. 5.68±0.60 [mmol/L] at 60 min. p<0.01). CONCLUSIONS The ex vivo reperfusion model can be used to evaluate the utility of machine perfusion. Advantages of HMP for DCD livers are evaluated with this model.

DOI： 10.12659/aot.910008

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

Oxygenation is necessary for aerobic metabolism, which maintains adenosine triphosphate within the graft organ. In recent years, some studies have demonstrated that subnormothermic machine perfusion (SNMP) with hemoglobin-based oxygen carriers has the potential to improve oxygen metabolism. OBJECTIVE: The aim of this study was to evaluate the effectiveness of perfusate with human-derived hemoglobin vesicles (HbV) under SNMP in a pig model of donation after cardiac death. MATERIALS AND METHODS: In this study, pig livers were procured with a warm ischemic time of 60 minutes and were preserved in 3 groups for 240 minutes. The preservation conditions were as follows: 4°C cold storage (Group 1); SNMP with University of Wisconsin perfusate alone (Group 2); and SNMP (21°C) with University of Wisconsin solution and HbV (hemoglobin, 0.6 mg/dL) perfusate (Group 3). All livers were perfused for 120 minutes using pig autologous blood machine perfusion (reperfusion phase). We investigated the aspartate transaminase level and hemodynamics (portal vein resistance and oxygen consumption) in the preservation and reperfusion phases. A histologic study (hematoxylin-eosin staining) was performed after 240 minutes of preservation. RESULTS: The portal vein resistance of Group 3 was not increased in comparison with Group 2. During preservation, the oxygen consumption of Group 3 was higher than that of Group 2. However, the level of aspartate transaminase did not differ between Groups 2 and 3. CONCLUSION: The present study revealed that perfusate with HbV increased the oxygen consumption of the donor liver during SNMP.

DOI： 10.1016/j.transproceed.2018.02.184

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

INTRODUCTION: Subnormothermic machine perfusion (SNMP) shows some advantages for the preservation of grafts donated after cardiac death (DCD) and improvements in machine perfusion (MP) technology are important to enhance organ preservation outcomes for liver transplantation. In this study, we focused on purified subnormothermic machine perfusion (PSNMP) and volumes of perfusate removed to substitute for purification and replaced by modified University of Wisconsin-gluconate after the start of perfusion and investigated, in particular, the optimum perfusate purification volume. Several purification volumes under SNMP were compared. In addition, the perfusate purification during MP was indicated as a potential technique to enhance the organ quality of DCD grafts and extended-criteria donors. METHODS: The PSNMP at several volumes (0.5 L, 1.5 L, and 3 L) were compared with regular SNMP without any purification treatment (untreated control). In the PSNMP group, all perfusate was removed to substitute for purification of the perfusate by modified University of Wisconsin-gluconate solution after the start of perfusion. After removing the perfusate, new perfusate with the same components was perfused to preserve the porcine livers obtained under warm ischemia for 60 minutes using SNMP at 22°C porcine liver for 4 hours. RESULTS: The concentrations of aspartate aminotransferase and lactate dehydrogenase in the untreated group were significantly higher during perfusion compared to those of the intervention group. There are no significant differences among the volume conditions of the purification groups. CONCLUSIONS: The optimal volume of perfusate purification was confirmed with a simple experimental comparison between untreated and PSNMP conditions.

DOI： 10.1016/j.transproceed.2018.03.055

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

BACKGROUND: Machine perfusion (MP) techniques are expected to prove useful for preserving the organ viability and recovering organ function for organ transplantation. Furthermore, an accurate assessment of organ viability using MP is important for expanding the donor criteria. In this study, an ex vivo reperfusion model (ERM) simulating transplantation using diluted autologous blood under normothermic conditions was evaluated for its utility of MP under subnormothermic conditions for livers donated after cardiac death (DCD). METHODS: The liver preservation methods for DCD porcine livers were evaluated using the ERM. This investigation was performed using a novel perfusion system developed by our research group. Porcine livers were procured with a warm ischemia time (WIT) of 60 minutes. The organs were then preserved using subnormothemic machine perfusion (SNMP) or static cold storage (CS) for 4 hours. We also compared these tissues with SNMP livers procured under a WIT of 0 minutes. After the preservation, the livers were reperfused for 2 hours using the ERM with diluted autologous blood oxygenated by a membrane oxygenator under NMP conditions. Reperfusion was evaluated based on perfusion flow dynamics and outflow of deviating enzymes. RESULTS: In the early stages of reperfusion, pressure in the blood vessels increased sharply in the CS group. Furthermore, the amount of aspartate aminotransferase accumulation was lower in the SNMP group than in the other groups. These results suggest ischemia-reperfusion injury is suppressed in SNMP conditions. CONCLUSION: An ERM has use in evaluating the utility of MP for the DCD liver.

DOI： 10.1016/j.transproceed.2018.04.020

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Language：Japanese   Publisher：日本血液代替物学会  

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Language：Japanese   Publisher：日本血液代替物学会  

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Language：Japanese   Publisher：日本血液代替物学会  

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：(一社)日本臓器保存生物医学会  

分割肝移植は成人脳死肝移植ドナーグラフトを2つに肝切除して分割し、2人のレシピエントにそれぞれ移植する手技である。分割肝処理は体外で行う限り、その操作や保存温度にむらが生じるので、マージナルドナーともいえるが、分割作業を機械灌流しながら行うことにより、その有効性が示唆された。近年の臓器保存の進歩である機械灌流保存を適用した分割肝移植について、著者らはブタを用いて研究を行っているのでその一端を報告した。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J03926&link_issn=&doc_id=20180723050018&doc_link_id=%2Fca3organ%2F2018%2F002502%2F018%2F0197-0201%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fca3organ%2F2018%2F002502%2F018%2F0197-0201%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本外科学会  

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publisher：北海道外科学会  

移植外科学において臓器組織保存学は移植免疫学とともに欠くことのできない分野である。臓器保存の目的はviabilityを低下させることなく、長時間保存できることに有る。欧米で増加している心停止ドナーを含むマージナルドナーからの移植手術は、臓器提供者不足を補う一つの対策である。このような臓器の温阻血障害に加えた冷保存障害は強い虚血再灌流障害を発生させ、結果、高率に移植後無機能、遷延性機能障害が出現する。近年、欧米ではマージナルドナーに対して灌流型臓器保存装置を用いて持続灌流保存を行う移植施設が増加し、術後の早期機能発現に関する数多くの報告がある。また腎臓以外にも肝臓、肺などで持続灌流保存方法が臨床に登場しており、低温ではなく常温での成功例も報告されている。マージナルドナーの有効活用を背景に、臓器保存の研究は障害臓器の回復のメカニズムを解明し、治療法を探求する、将来性のある分野である。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J01375&link_issn=&doc_id=20180313080001&doc_link_id=%2Fdc7hksrg%2F2017%2F006202%2F002%2F0118-0123%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdc7hksrg%2F2017%2F006202%2F002%2F0118-0123%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：(一社)日本臓器保存生物医学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Public Library of Science (PLoS)  

The effects of warm machine perfusion preservation of liver grafts donated after cardiac death on the intracellular three-dimensional ultrastructure of the organelles in hepatocytes remain unclear. Here we analyzed comparatively the ultrastructure of the endomembrane systems in porcine hepatocytes under warm ischemia and successive hypothermic and midthermic machine perfusion preservation, a type of the warm machine perfusion. Porcine liver grafts which had a warm ischemia time of 60 minutes were perfused for 4 hours with modified University of Wisconsin gluconate solution. Group A grafts were preserved with hypothermic machine perfusion preservation at 8°C constantly for 4 hours. Group B grafts were preserved with rewarming up to 22°C by warm machine perfusion preservation for 4 hours. An analysis of hepatocytes after 60 minutes of warm ischemia by scanning electron microscope revealed the appearance of abnormal vacuoles and invagination of mitochondria. In the hepatocytes preserved by subsequent hypothermic machine perfusion preservation, strongly swollen mitochondria were observed. In contrast, the warm machine perfusion preservation could preserve the functional appearance of mitochondria in hepatocytes. Furthermore, abundant vacuoles and membranous structures sequestrating cellular organelles like autophagic vacuoles were frequently observed in hepatocytes after warm machine perfusion preservation. In conclusion, the ultrastructure of the endomembrane systems in the hepatocytes of liver grafts changed in accordance with the temperature conditions of machine perfusion preservation. In addition, temperature condition of the machine perfusion preservation may also affect the condition of the hepatic graft attributed to autophagy systems, and consequently alleviate the damage of the hepatocytes.

DOI： 10.1371/journal.pone.0186352

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：(一社)日本臓器保存生物医学会  

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Language：Japanese   Publisher：(一社)日本移植学会  

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Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

© 2016 Elsevier Inc. All rights reserved. Background The use of grafts from donors after cardiac death (DCD) would greatly contribute to the expansion of the donor organ pool. The objective of this study is to determine the benefits of extracorporeal membrane oxygenation (ECMO) and subnormothermic machine perfusion (MP) with rewarming in a large animal model of DCD liver. Methods After cardiac arrest, the abdominal aorta and the inferior vena cava were cannulated and connected to an ECMO circuit. Porcine livers were perfused in situ with ECMO at 22°C for 60 minutes after 60 minutes of cardiac death. Then the livers were perfused for 4 hours by MP as a graft viability test. In group 1, non-in situ ECMO and grafts were preserved hypothermic MP. In group 2, non-in situ ECMO and grafts were preserved subnormothermic rewarming MP. In group 3, we used ECMO and subnormothermic rewarming MP. To assess potential methods and effect, effluent enzymes were measured. Portal vein and hepatic artery pressure during MP were evaluated. Results Effluent enzyme of AST, alanine aminotransferase and LDH as viability markers were significantly low (aspartate aminotransferase, 2899, 2292, and 972 IU/L; alanine aminotransferase, 134, 140, and 72 IU/L; and lactate dehydrogenase, 4354, 4455, and 1855 IU/L in each group, respectively). Portal vein and hepatic artery pressure during preservation came down smoothly in group 3 compared with group 1. Conclusions The combined use of in situ subnormothermic ECMO and machine preservation with rewarming is more essential for the recovery and resuscitating function of DCD liver grafts.

DOI： 10.1016/j.transproceed.2015.12.087

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Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.transproceed.2015.12.076

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本移植学会  

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Authorship：Lead author   Language：Japanese   Publisher：The Japanese Journal of Gastroenterological Surgery  

DOI： 10.5833/jjgs.2014.0118

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Baishideng Publishing Group Inc.  

In October 2009, a 71-year-old female was diagnosed with a cystic tumor in the tail of the pancreas with an irregular dilatation of the main pancreatic duct in the body and tail of the pancreas. A distal pancreatectomy with splenectomy, and partial resection of the duodenum, jejunum and transverse colon was performed. In March 2011, a follow-up computed tomography scan showed a low density mass at the head of the remnant pancreas. We diagnosed it as a recurrence of the tumor and performed a total pancreatectomy for the remnant pancreas. In the histological evaluation of the resected specimen of the distal pancreas, the neoplastic cells formed an acinar and papillary structure that extended into the main pancreatic duct. Mucin5AC, α1-antitrypsin (α-AT) and carcinoembryonic antigen (CEA) were detected in the tumor cells by immunohistochemistry. In the resected head of the pancreas, the tumor was composed of both acinar and ductal elements with a mottled pattern. The proportions of each element were approximately 40% and 60%, respectively. Strongly positive α-AT cells were detected in the acinar element. Some tumor cells were also CEA positive. However, the staining for synaptophysin and chromogranin A was negative in the tumor cells. Ultimately, we diagnosed the tumor as a recurrence of mixed acinar-ductal carcinoma in the remnant pancreas. In conclusion, we report here a rare case of repeated pancreatic resection for multicentric lesions of mixed acinar-ductal carcinoma of the pancreas.

DOI： 10.3748/wjg.v20.i33.11904

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Hindawi Limited  

Many cases of surgical resection of metastatic pancreatic tumors originating from renal cell carcinoma have been reported; however, cases of reresection of recurrent pancreatic metastasis of renal cell carcinoma in the remnant pancreas are rare. We performed a second resection for recurrent pancreatic metastasis of renal cell carcinoma six years after pancreatoduodenectomy with pancreaticogastrostomy reconstruction. By performing middle segment-preserving pancreatectomy, we were able to successfully spare the exocrine and endocrine pancreatic function compared to that observed after total pancreatectomy, with no signs of recurrence for two years after the surgery.

DOI： 10.1155/2014/648678

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Other Link： http://downloads.hindawi.com/journals/cris/2014/648678.xml

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

We report a rare case of clear cell sarcoma of the esophagus and review the literature regarding clear cell sarcomas of the gastrointestinal tract. A 57-year-old male was admitted with dysphagia during swallowing. Preoperative imaging studies, including upper gastrointestinal endoscopy and endoscopic ultrasonography, showed that the tumor was located between the mucosa and the muscularis propria of the lower esophagus. We performed subtotal esophagectomy with gastric tube reconstruction. Pathological findings of the tumor showed mixed spindle cells and oval cells. Immunohistochemical staining showed that the tumor cells were positive for S-100, vimentin and neuron-specific enolase and negative for α-smooth muscle actin, myoglobin and c-kit. Fluorescence in situ hybridization using a Ewing sarcoma breakpoint region 1 probe showed split signals in a small percentage of cells. We finally diagnosed the patient with clear cell sarcoma of the esophagus.

DOI： 10.1007/s12328-014-0479-1

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Other Link： http://link.springer.com/article/10.1007/s12328-014-0479-1/fulltext.html

Language：Japanese   Publishing type：Research paper (scientific journal)  

For aging, people having malignant disease are increasing. And surgical resection is an important part in the treatment of pulmonary metastasis from colorectal cancer. We analyzed the treatment outcome and prognostic factors affecting survival in our subset of patients. We have experienced 64 operations of metastatic lung tumors from colorectal cancer for 23 years since January 1988. Various factors affecting prognosis are studied based on 5-year survival in this report. Overall 5-year survival rate was 38.7%. The disease-free intervals more than 2 years, a solitary metastatic pulmonary lesion and the serum level of prethoracotomy carcinoembryonic antigen (CEA) were significantly affecting factors on the prognosis. Furthermore, sequential study for 23 years couldn't demonstrate the prognostic improvement by the advance of the thoracoscopic technology or the development of the new anti-cancer drugs, though the treatment of patients with pulmonary metastases from colorectal cancer continues to evolve. The role of pulmonary metastasectomy is very important to reduce the volume of metastatic lesions for the better prognosis.

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Language：Japanese   Publisher：Japan Surgical Association  

A 76-year-old man, who had undergone a total gastrectomy 21 years prior, had a sudden onset of abdominal pain. Abdominal CT scan revealed a tumor with a layered structure in the upper abdomen. Jejunography revealed a crab-claw appearance. Intestinal obstruction caused by intussusceptions was diagnosed, and a laparotomy was performed. An invaginated bowel progressing in an antiperistaltic direction was present on the anal side of the Y-anastomosis. After manual replacement, a partial resection of jejunum was performed. No abnormalities were found at the resected jejunum. A year later, the patient again developed abdominal pain. CT scan revealed of an intussusception, and a laparotomy was performed. Retrograde invagination at the anal side of the Y-anastomosis was again found. The patient required a jejunum resection which included the Y-anastomosis. No subsequent relapses have been documented.<BR>Intussusception after gastrectomy occurs rarely. Nevertheless, it must be kept in mind as a probable occurrence after gastrectomy.

DOI： 10.3919/jjsa.74.391

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Circumportal pancreas (CP) is an extremely rare pancreatic fusion anomaly which is usually asymptomatic. This report presents the case of a patient with a tumor in the head of a CP and the retroportal accessory pancreatic duct in the pancreatic tissue behind the portal vein. A 53-year-old male was diagnosed with a nonfunctioning neuroendocrine tumor of the pancreas and resection of the tumor was scheduled. The patient was revealed to have CP on preoperative computed tomography and endoscopic retrograde cholangiopancreatography, which showed the pancreatic tissue encircling the portal vein and the retroportal accessory pancreatic duct. The patient safely underwent pylorus-preserving pancreatoduodenectomy reconstructed with pancreaticogastrostomy.

DOI： 10.1007/s12328-012-0326-1

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Other Link： http://link.springer.com/article/10.1007/s12328-012-0326-1/fulltext.html

Language：Japanese   Publisher：Japanese Society for Abdominal Emergency Medicine  

A 53-year-old woman complained of abdominal pain a week after her first treatment with leuprolide acetate for the bleeding caused by a uterine leiomyoma. CT showed portal and superior mesenteric vein (SMV) thrombosis. She was treated with thrombolytic therapy, but femoral vein thrombosis occurred around the central vein catheter. We undertook inferior vena cava filter placement and operated for bowel obstruction. Pathological examination revealed the obstruction had been caused by SMV thrombosis. It was considered that luprolide acetate might have been associated with the thrombosis because none of the other thrombotic factors was detected.

DOI： 10.11231/jaem.32.981

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Other Link： http://search.jamas.or.jp/link/ui/2012322307

Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

We report two cases of neuroendocrine carcinoma of the rectum. CASE 1: A 50s woman was diagnosed as rectal cancer and underwent anterior resection of the rectum and lymphnode dissection. The histological diagnosis was neuroendocrine carcinoma with peritoneal dissemination. She was treated with chemotherapy as an outpatient. One year later from the operation, multiple liver metastases were revealed and she died eight months later. CASE 2: A 50s man underwent endoscopic mucosal resection (EMR) of the rectum as rectal tumor and histological diagnosis was an early well-moderate deferenciated carcinoma and its cut-tend was unclear. He received a careful follow-up. One year later, a follow-up colonoscopy revealed a submucosal tumor in the lower rectum. He was diagnosised with local reccurence of rectal cancer, and then underwent an abdominoperineal resection of the rectum and lymphnode dissection. The histological diagnosis was poorly differenciated neuroendocrine carcinoma with lymphnode metastasis. Two months later from the operation, a local reccurence was revealed and he was treated with octreotide and irradiation.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 60s male was admitted to our hospital for a diagnosis of gastric tumor sized 20 mm in diameter at the fornix of the stomach. Endoscopic mucosal resection (EMR) was performed, and the resected tumor was pap, m, ly0, v0, HMX, VM0, pathologically. One month after the EMR, the local recurrence was confirmed and a partial gastrectomy was performed. Pathological findings were tub1, sm2, ly1, v1, HM0, VM0. Total gastrectomy was added because of the possibility of the lymph node metastasis. Pathological findings revealed no residual cancers. The final pathological diagnosis was T1b(sm2) N0H0P0M0, Stage IA, based on the Japanese classification of gastric cancer. Three months thereafter, CT showed multiple liver metastases. Immunohistochemical study of the operated tumor revealed AFP-producing gastric cancer. Chemotherapy was performed, but he died of the gastric cancer. Endoscopic treatment is a minimally invasive therapeutic strategy, but it requires a considerable care in application.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Society of Gastroenterology  

In a 72 years old woman, abdominal computed tomography (CT) disclosed multicentric hypervascular tumor in S4 of the liver, and it was T1·T2 by the MRI, and a high signal was presented together. Stenosis was shown by ERCP at the same site. Cholangiocellular carcinoma was suspected before operation, but malignant change was not recognized by frozen section, so the operation was finished. Later, a diagnosis of solitary necrotic nodule of the liver was established by pathological diagnosis. Solitary necrotic nodule of the liver is a benign tumor.<br>

DOI： 10.11405/nisshoshi.104.47

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Other Link： http://search.jamas.or.jp/link/ui/2007111757

Language：Japanese   Publisher：(一社)日本肝臓学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：日本消化器病学会-北海道支部  

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Language：Japanese   Publisher：日本消化器病学会-北海道支部  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本小児外科学会  

症例は21歳女性.低位鎖肛に対して生後3ヵ月にPotts法による鎖肛根治術を施行したが,8歳以降は当科への通院歴はなく,その後は自己管理となっていた.当院搬送1ヵ月前から便秘があり,1日前に前医入院,入院後に糞便性腸閉塞・腹部コンパートメント症候群・下肢虚血を発症し,当院に救急搬送された.緊急全身麻酔下摘便を施行し,9kgの糞便を排出した.長期間の集中治療を要したが,後遺症なく軽快し,現在は小児外科と成人診療科で連携し内服および浣腸による排便コントロールを継続している.直腸肛門奇形術後には排便機能障害,尿路系の異常,脊髄の異常,性機能異常などが起こりえるため,長期フォローアップが必要である.時に低位鎖肛であっても,本症例のように致死的状態に陥る危険性もあり,患者・家族への疾患理解や療養方針を考えるべく患者教育を行い,小児外科医療だけでなく,成人医療へのトランジションも不可欠であると思われた.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01113&link_issn=&doc_id=20231229080008&doc_link_id=%2Fes5shoge%2F2023%2F005907%2F008%2F1088-1094%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fes5shoge%2F2023%2F005907%2F008%2F1088-1094%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：(一社)日本Acute Care Surgery学会  

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Language：Japanese   Publisher：(一社)日本臓器保存生物医学会  

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Language：Japanese   Publisher：(一社)日本人工臓器学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：English   Publisher：(一社)日本癌学会  

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Language：Japanese   Publisher：日本消化器病学会-北海道支部  

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Language：Japanese   Publisher：日本消化器病学会-北海道支部  

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Language：Japanese   Publisher：日本女性骨盤底医学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：日本ストーマ・排泄リハビリテーション学会  

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Language：Japanese   Publisher：(NPO)日本食道学会  

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Language：Japanese   Publisher：(NPO)日本食道学会  

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Language：Japanese   Publisher：日本ストーマ・排泄リハビリテーション学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：日本臨床皮膚外科学会・瘢痕・ケロイド治療研究会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：日本消化器病学会-北海道支部  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：日本外科代謝栄養学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：日本消化器病学会-北海道支部  

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Language：Japanese   Publisher：(NPO)日本食道学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：日本ストーマ・排泄リハビリテーション学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：金原出版(株)  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00620&link_issn=&doc_id=20220114040011&doc_link_id=10.18888%2Fop.0000002580&url=https%3A%2F%2Fdoi.org%2F10.18888%2Fop.0000002580&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(NPO)日本食道学会  

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Language：Japanese   Publisher：(NPO)日本食道学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：日本消化器病学会-北海道支部  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本外傷学会  

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Language：Japanese   Publisher：(一社)日本臨床栄養代謝学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(株)南江堂  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：北海道外科学会  

本邦においてはStage II、IIIの進行胃癌に対するD2郭清を伴う胃切除術後の補助化学療法として、S-1単剤療法(1年間)とXELOX療法(6ヵ月間)が確立されているが、そのいずれを選択すべきかについての明確な基準はなく、また最近SOX療法の安全性、有効性も報告されている。治癒切除可能だが予後不良な4型/大型3型、高度リンパ節転移およびStage III症例に対する術前補助化学療法による予後改善効果が期待されているが、いまだ標準治療としては確立されていない。Stage IV胃癌に対する減量手術の意義は否定されたが、化学療法が奏効しR0切除が可能となった症例では、conversion therapyによる予後の改善が期待されており、今後の検討が期待される。(著者抄録)

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本Acute Care Surgery学会  

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本臓器保存生物医学会  

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(NPO)日本食道学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本臓器保存生物医学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：English   Publisher：(一社)日本胃癌学会  

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Language：English   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本臓器保存生物医学会  

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Language：Japanese   Publisher：(一社)日本臓器保存生物医学会  

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Language：Japanese   Publisher：(一社)日本肝臓学会  

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese  

CiNii Books

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(株)へるす出版  

87歳女。狭心症、頸動脈狭窄症があり、アスピリン、イコサペント酸エチル、シロスタゾールを内服中であった。嘔吐後に胸痛が出現し、改善しないため救急外来を受診した。軽度の白血球上昇を認めた。胸部造影CT検査所見では、肺塞栓や大動脈解離は指摘できず、後縦隔に胸部中部食道から下部食道にかけて大きさ40×25×155mmで造影効果のない、上下方向に連続する腫瘤性病変を認めた。上部消化管内視鏡検査では、門歯より約25cmから食道胃接合部まで片側性に存在する連続した食道粘膜下血腫を認めた。臨床経過および画像所見より特発性食道粘膜下血腫と診断した。抗血小板薬療法を中断し、絶食、中心静脈栄養の投与を行った。第16病日の上部消化管内視鏡で、巨大潰瘍は明らかな改善傾向を示し、再生上皮を認める状態であったため、食事を開始した。第30病日には3時から6時方向に再生した食道粘膜が存在し、第35病日に退院した。

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Language：Japanese   Publisher：(一社)日本臓器保存生物医学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本臓器保存生物医学会  

J-GLOBAL

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2015&ichushi_jid=J03926&link_issn=&doc_id=20151204120003&doc_link_id=%2Fca3organ%2F2015%2F002202%2F004%2F0019-0025%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fca3organ%2F2015%2F002202%2F004%2F0019-0025%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：北海道農村医学会  

当院の栄養サポートチームが2011年4月～2012年3月に介入を行った76例を栄養投与法別に3群に分け、介入開始時と終了時の血清アルブミン値の変化や介入終了時の転帰について比較検討した。3群の内訳は、経腸栄養法継続群(30例;以下A群)、経腸栄養+静脈栄養法から経腸栄養法への移行群(20例;以下B群)、静脈栄養法継続群(26例;以下C群)である。検討の結果、血清アルブミン値は介入前に比べて介入終了時にA群で有意に上昇し、B群も上昇していたのに対し、C群では有意に低下していた。転帰はA群とB群のほとんどが「退院」または「アウトカム達成による介入終了」であったのに対し、C群では「介入中に死亡」または「状態悪化による介入中止」が61%を占めていた。

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Language：Japanese   Publisher：北海道農村医学会  

当院では2012年4月から院内でのZn測定を開始し、これにあわせNSTの栄養評価指標として採用した。今回、栄養指標としてエビデンスのある血清アルブミン(ALB)とZnとの関連性を調べることで、NST活動におけるZn値の有用性について検討した。対象は、2012年7月～2013年6月に当院NSTで介入を2週間以上行った61例とした。検討の結果、ALBの平均値は介入前に比べて介入終了時に有意に上昇していたのに対し、Znの平均値は軽微な上昇にとどまった。また、ALBとZnとの間には有意な正の相関が認められたものの、種々の既報告と比べると相関は弱かった。これらの結果から、NST介入によるALBとZnの変動には差があり、Znは予想よりも改善されていないことが明らかになった。

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Language：Japanese   Publisher：北海道農村医学会  

近年、重症心身障害者(重症者)施設において入所者の高齢化が顕著となっており、それに伴い、以前は僅少とされていた悪性腫瘍罹患重症者が増加傾向にある。このような背景の中、当院では比較的短期間に2例の重症者乳癌を経験したので提示し、重症者の乳癌診療における問題点について考察した。また、当院と北海道療育園が平成24年10月から開始した診療連携としての乳腺検診について、1年目の結果を報告した。北海道療育園には約150名の女性重症者が6病棟に分かれて入院もしくは入所していることから、乳腺検診は2ヵ月ごとに1病棟ずつ視触診を基本としたスクリーニングを行い、何らかの所見や既往のある症例には同時に乳腺超音波検査を施行した。1年間で154名のスクリーニングを実施し、何らかの既往・所見があったのは7名(4.5%)で、内訳は、乳癌術後3名(うち2名は提示症例)、乳腺線維腺腫2名、乳腺症1名、乳腺炎術後1名であった。

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本農村医学会  

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Language：Japanese   Publisher：(一社)日本老年医学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

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Language：Japanese   Publisher：旭川厚生病院  

当院栄養サポートチームが平成23年4月から平成24年3月の間に介入を行った76症例について,栄養投与法別に血清アルブミン値の変化と転帰の検討を行った。経腸栄養法継続群,経腸栄養法と静脈栄養法の併用から経腸栄養法への移行群では,介入終了時の血清アルブミン値に改善を認め,転帰も良好であった。対して,静脈栄養法の継続群では血清アルブミン値は有意に低下,転帰においても不良であった。以上の結果から,可能な限り経腸栄養法を選択することは栄養状態の改善に有用である可能性が示唆された。(著者抄録)

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(株)南江堂  

著者らが大腸原発転移性肺腫瘍に対し切除術を行った64例の治療成績と予後因子について検討した。術式は部分切除が40例、肺葉切除が24例で、肺転移巣切除術後の累積5年生存率は38.7%であった。予後因子の検討ではDFIが2年以上の5年生存率が55.9%で、2年未満の26.3%より有意に予後が良好であった。肺の術前血清CEA値については5ng/ml未満の5年生存率が84.0%と、5ng/ml以上の21.7%に比べ有意に良好であった。また、転移個数は増えるに従い予後不良となり、転移分布も両側に転移巣がわたるものは予後が不良であった。尚、開腹手術からVATSの移行期と新規抗癌薬の使用の移行期を3群に分けて生存率を比較したが、各期間において成績向上の傾向はあるものの有意差はみられなかった。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2013&ichushi_jid=J00349&link_issn=&doc_id=20130321020005&doc_link_id=1390564238033271936&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390564238033271936&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_2.gif

Language：Japanese   Publisher：北海道農村医学会  

2005～2012年に大腸癌の初回手術を行った患者で、EGFRの有無とk-ras遺伝子変異の有無を検査した症例のうち、肝転移に対する初回治療に分子標的治療薬を使用した80例の成績を報告した。使用した分子標的治療薬の内訳は、bevacizumabが45例、cetuximabが19例、panitumumabが16例であった。bevacizumabを使用した群の奏効率は49%、肝切除移行率は22%であり、2nd line治療はFOLFOXからFOLFIRIへ、またはその逆への移行例が31%、分子標的治療薬を加えない化学療法への移行が16%などであった。cetuximabを使用した群の奏効率は16%、肝切除移行率は0%であり、2nd lineはpanitumumabを用いた治療への移行が32%、分子標的治療薬を加えない化学療法への移行が21%などであった。初回治療にpanitumumabを使用した群の奏効率は0%で、継続投与を9例(56%)に行っているが、皮膚障害の副作用に難渋ことも多く、4例(25%)がbest supportive careへ移行し、肝切除移行率は0%である。

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：旭川厚生病院  

比較的稀な胆石性イレウスを経験したため,若干の文献的考察を加え報告する。症例は70歳代女性で,高度肥満と術前コントロール不良の糖尿病があり,歩行器が必要なADLであったことから,胆嚢摘出術および内胆汁瘻閉鎖術は行わずイレウス解除術のみを施行した。(著者抄録)

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(NPO)日本医療マネジメント学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

患者は40歳台の未婚女性.主訴は左上腹部痛で,左腎のやや尾側に超音波,CTで35×50mm大の腫瘤性病変が指摘された.FDG-PETでは異常集積を認めず,良性腫瘍,血腫などが鑑別診断に挙がったが,サイズから悪性疾患が完全に否定できなかった.ラッププロテクターに8号の手術用手袋を被覆したGlove法による単孔式腹腔鏡下手術で腫瘤摘出を行った.白色で卵円形の腫瘤は大網に存在していたため,超音波凝固切開装置で周囲の組織から切離し,約35mmの臍部創から腹腔外に摘出した.病理組織学的診断は異所性子宮内膜症であった.未婚女性の大網に単発の腫瘤を形成した良性疾患に対して整容性,秘匿性に優れる本術式はきわめて有用であった.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2012&ichushi_jid=J03270&link_issn=&doc_id=20120828180007&doc_link_id=10.11477%2Fmf.4426100816&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.4426100816&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

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Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

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Language：Japanese   Publisher：北海道農村医学会  

血清学的検査で肝エキノコックス症と確定診断され切除術を受けた64歳女性例について、エキノコックス抗体価とCT像の経時的変化を術後5年間観察した。その結果、抗体は術後6ヵ月までに陰転化し、以後まったく検出されなかった。術前のCTで認めていた嚢胞性病変は術後5年時には認めなかった。

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：旭川厚生病院  

当院での腹腔鏡下胃切除・大腸切除症例の年次別推移・手術手技・術後合併症について検討した。対象は当院で腹腔鏡により胃切除または大腸切除を施行された症例で,I:腹腔鏡下胃切除は2007年5月10日より2011年9月30日までに施行された136例,II:腹腔鏡下大腸切除は1998年3月30日より2011年9月30日までに施行された219例である。結果として,I:腹腔鏡下胃切除は病理診断で病期Ia,b(胃癌取り扱い規約第14版)の症例が125/136(91.9%)例であった。縫合不全は1例であった。II:2008年以降,腹腔鏡下大腸切除は進行癌にも適応を拡大し手術症例は増加した。2007年以降の症例の郭清リンパ節個数は平均16.6個と適正であった。まとめとして,I:胃癌は胃癌治療のガイドラインを遵守し手術が施行されている。II:進行大腸癌にも腹腔鏡手術が施行されているが,リンパ節郭清は不足なく行われている。(著者抄録)

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese  

CiNii Books

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Language：Japanese   Publisher：(株)癌と化学療法社  

まれな大腸原発内分泌細胞癌の2手術例を経験したので報告する。症例1は50歳台、女性。排便時の出血を主訴に受診し、直腸S状部に2型腫瘍を認め、生検で低分化腺癌であった。直腸S状部癌、SS、N1、H0、P0、M0、Stage IIIaの診断で直腸高位前方切除術を行った。病理診断で内分泌細胞癌、n1、p1であった。術後FOLFIRI療法を行ったが、術後1年で多発肝転移が出現しmFOLFOX6へ変更したが、肺転移も出現し術後1年8ヵ月で原病死した。症例2は50歳台、男性。早期直腸癌に対し前医で内視鏡的粘膜切除(EMR)を施行。病理検査では高分化～中分化腺癌で断端不明であったため経過観察中であった。EMRより1年後に下部直腸右後壁の隆起性病変が出現し、直腸癌EMR後局所再発の診断で腹会陰式直腸切断術を施行した。病理診断は、低分化型神経内分泌細胞癌、pA、pN0であった。術後2ヵ月で局所再発を来し、octreotide投与および放射線照射中である。大腸原発内分泌細胞癌は予後が極めて不良であり、化学療法を含めた集学的治療が展開されるべき疾患の一つであると考えられた。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2011&ichushi_jid=J00296&link_issn=&doc_id=20111208600118&doc_link_id=%2Fab8gtkrc%2F2011%2F003812%2F118%2F2265-2267%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2011%2F003812%2F118%2F2265-2267%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)癌と化学療法社  

症例は60歳台、男性。検診で胃の異常を指摘され、当院消化器科を紹介受診した。上部消化管内視鏡検査で胃穹窿部前壁に20mmの0-I型腫瘍を認め、生検で腺癌でありendoscopic mucosal resection(EMR)を施行した。病理組織診断ではpap、m、ly0、v0、HMX、VM0であった。EMR施行時に断端部をAPC焼灼しており経過観察とされたが、1ヵ月後の上部消化管内視鏡検査で20mmの局所再発を認め当科紹介となった。EMR時の結果がm癌であることから胃局所切除を施行した。病理組織診断でtub1、sm2、ly1、v1、HM0、VM0であり、胃全摘D1+No.8a、9、11pを追加施行した。病理組織診断では癌の遺残を認めず、最終病理組織診断はU、ant、Type 0-I、50×30mm、tub1、pT1b(sm2)、ly1、v1、pN0(0/38)、pPM0、pDM0、cH0、cP0、CYX、cM0、pStage IAであった。術後経過良好で外来で経過観察とされたが、3ヵ月後にCTで肝S8、S6に再発を認めた。原発巣の免疫染色ではAFP陽性であった。化学療法を施行したが、奏効せず原病死した。内視鏡治療の治療方針については個々の症例につき慎重に判断する必要がある。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2011&ichushi_jid=J00296&link_issn=&doc_id=20111208600139&doc_link_id=%2Fab8gtkrc%2F2011%2F003812%2F139%2F2328-2330%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2011%2F003812%2F139%2F2328-2330%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：日本ストーマ・排泄リハビリテーション学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本ストーマ・排泄リハビリテーション学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：The Japanese Society of Gastroenterological Surgery  

We report a case of a fairly rare mesenchymal gastrointestinal mesenchymal tumor (GIMT) of the colon. A 46 year-old man with a history of sudden epigastric pain was found in Computed Tomography (CT) to have 6-cm diameter mass in the transverse colon complicated by peritoneal free air and massive fluid accumulation. Emergency surgery showed the mass to be a perforated submucosal tumor leading to peritonitis. Histologically, the resected tumor showed increased spindle cells with neutrophilic proliferation at the perforation. Immunofluorescence microscopy showed positive findings for vimentin but negative for c-kit, CD34, S-100, and SMA all compatible with GIMT.

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2008089475

Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：市立札幌病院  

79歳男性。患者は心窩部痛を主訴に、胆石・総胆管結石症の診断にてEST下総胆管結石摘出術後、胆嚢摘出術を予定した。術前、肺気腫による著明な閉塞性障害と低酸素血症を認めたため、硬膜外麻酔と鎮静による自発換気下で、腹壁吊り上げ式腹腔鏡下胆嚢摘出術を施行した。その結果、術翌日に右気胸を併発したものの、保存的加療にて軽減し、術後7日に退院となった。尚、術後11日目の胸部レントゲンでは肺の完全拡張が確認されたが、経過は良好であった。

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Language：Japanese   Publisher：日本臨床外科学会  

症例は69歳,女性.腸管Behcet病による回盲部潰瘍の増悪にてステロイドパルス療法を施行中であった.経過中消化管穿孔を認め緊急開腹術施行.回腸末端の穿孔があり回盲部切除・洗浄ドレナージ術を行った.病理診断にてサイトメガロウイルス感染による回腸穿孔と判明した.術後下血によりプレショック状態に陥ったが,ガンマグロブリン・ガンシクロビル投与後,下血が改善した.ステロイド加療中の膠原病患者における消化管穿孔・消化管出血症例においては,サイトメガロウイルス感染も念頭に置く必要がある.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2006&ichushi_jid=J03156&link_issn=&doc_id=20060904210044&doc_link_id=10.3919%2Fjjsa.67.1933&url=https%3A%2F%2Fdoi.org%2F10.3919%2Fjjsa.67.1933&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：市立札幌病院  

75歳男.悪寒と発熱を認め近医を受診した.腹部CTにて胆嚢腫大,胆泥を認めたため胆嚢炎を疑い精査・加療目的で紹介入院となった.DIC-CTや血管造影などの術前画像診断では良性疾患との鑑別が困難であったが,胆嚢管原発腫瘍を疑い手術を行った.術中迅速病理診断にて胆嚢管腫瘍は悪性であり,切除断端陽性であったため肝床部切除,肝外胆管切除および胆管空腸吻合術を追加した.病理組織検査所見より,扁平上皮癌が約1/3を占める胆嚢管原発腺扁平上皮癌と診断した

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Language：Japanese   Publisher：市立札幌病院  

47歳女.8年前に左後腹膜腫瘍に対して腫瘍,左腎および副腎の摘出術を受けた.その後,肝臓,膵臓,肺などに転移を認め,その都度切除術を行った.PET/CTにて残肝,右腎に転移を認め,腎部分切除の後,3度目の肝転移に対して肝部分切除術を行った.病理組織学的所見より,平滑筋肉腫と診断した.病理組織像では,原発巣と同様の所見を認めた.術後経過は良好で,第12病日に退院となり,現在再発の兆候を認めていない.転移巣の発見には,US・CTに加えFDG-PETが有効であり,今後もこれらの画像検査による経過観察が重要であると考えられた

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：市立札幌病院  

72歳男.嚥下困難と吃逆を主訴に受診し,上部消化管内視鏡にて腫瘍を認めたため精査目的で入院となった.20年ほど前から胸やけを自覚し,健診にて食道裂孔ヘルニアを指摘されていた.画像診断および生検では確定診断には至らなかったが,肉眼上胃噴門部の悪性腫瘍と考え,胃全摘術を行った.病理組織学的所見より,c-kit陰性の消化管間葉系腫瘍と診断した

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Language：Japanese   Publisher：市立札幌病院  

75歳男.下腹部不快感を主訴に受診し,右下腹部に可動性良好な腫瘤を触知した.腹部超音波,CT,MRIにて確定診断できなかったが,悪性腫瘍が否定できず開腹術を行った.術中所見は回盲部に腫瘤を触れ,虫垂原発の悪性腫瘍が強く疑われた.回盲部切除およびD3郭清を行った.摘出標本は充実性腫瘍で回腸間膜に局在し,病理学的には,陳旧変性した出血層の周辺に膠原繊維の発達した結合織に覆われており,器質化した血腫の所見であった

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Language：Japanese   Publisher：市立札幌病院  

50歳女.左乳房腫瘤を自覚し,受診した.本症例は,46歳時に腎不全合併糖尿病を発症し,49歳時より人工透析導入となっていた.マンモグラフィにて境界不明瞭な高濃度陰影を認めた.MRIでは,T1,T2にて腫瘍は認めず,造影にても増強する腫瘍陰影は描出されなかった.乳腺は岩状に固く,穿刺吸引細胞診では診断不能であった.既往歴,臨床症状,画像所見より糖尿病性乳腺症を疑い,摘出生検を行った.病理組織学的検査より糖尿病性乳腺症と診断した.現在まで再発の所見なく,経過観察中である

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会