記述言語：英語   掲載種別：研究論文（学術雑誌）  

Neuroblastoma (NB) is a primary malignant tumor of the peripheral sympathetic nervous system. High-risk NB is characterized by MYCN amplification and human telomerase reverse transcriptase (hTERT) rearrangement, contributing to hTERT activation and a poor outcome. For targeting hTERT-activated tumors, we developed two oncolytic adenoviruses, OBP-301 and tumor suppressor p53-armed OBP-702, in which the hTERT promoter drives expression of the viral E1 gene for tumor-specific virus replication. In this study, we demonstrate the therapeutic potential of the hTERT-driven oncolytic adenoviruses OBP-301 and OBP-702 using four human MYCN-amplified NB cell lines (IMR-32, CHP-134, NB-1, LA-N-5) exhibiting high hTERT expression. OBP-301 and OBP-702 exhibited a strong antitumor effect in association with autophagy in NB cells. Virus-mediated activation of E2F1 protein suppressed MYCN expression. OBP-301 and OBP-702 significantly suppressed the growth of subcutaneous CHP-134 tumors. Thus, these hTERT-driven oncolytic adenoviruses are promising antitumor agents for eliminating MYCN-amplified NB cells via E2F1-mediated suppression of MYCN protein.

DOI： 10.1016/j.omto.2020.05.015

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児血液・がん学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

症例は13歳女児。先天性心疾患および多脾症候群のため、小児科で加療されていた。12歳時、検査入院中に、血性嘔吐が出現し当科を受診した。胃軸捻転症および遊走脾と診断した。経鼻胃管による減圧で症状が消失し経過観察としたが、その後短期間で複数回の捻転が生じたため、腹腔鏡下胃固定術および脾臓摘出術を行った。術中観察では逆位の胃および複数の脾臓を認めた。後腹膜に固定された一部の脾臓を温存し、残る遊走脾を切除後、胃と腹壁を固定した。また、無回転型腸回転異常症を認めたため、予防的虫垂切除を行った。術後経過は良好で症状再発なく3年が経過している。多脾症候群には多様な心血管奇形や腹腔内臓器奇形を合併することが多い。胆道閉鎖症や腸回転異常症の合併が報告されているが、胃軸捻転症は極めて稀である。個々の症例において臨床像が異なるため、治療方針については十分な検討を要する。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J01113&link_issn=&doc_id=20191105140035&doc_link_id=%2Fes5shoge%2F2019%2F005506%2F008%2F1076-1080%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fes5shoge%2F2019%2F005506%2F008%2F1076-1080%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本小児血液・がん学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本膵・胆管合流異常研究会  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

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記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

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記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

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記述言語：日本語   出版者・発行元：日本小児泌尿器科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児放射線学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：日本小児泌尿器科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Primary adenocarcinoma of the appendix is a rare disease in clinical practice. Moreover, primary adenocarcinoma of the appendix in the pediatric age group is even rarer with very little cases being published. Here, we report a case of primary adenocarcinoma of the appendix with local invasion into adjacent organs in a child who was initially diagnosed as having an acute appendicitis. CASE PRESENTATION: A 13-year-old girl presented with abdominal pain of 3-month duration. Imaging study showed a mass including the fecalith that occupied her pelvic and right lower abdominal cavity. Drainage of the abscess and appendectomy were performed by the preoperative diagnosis of an acute appendicitis with an appendiceal mass. Postoperative histopathological examinations revealed the appendiceal adenocarcinoma. She then received the whole mass resection, ileocecal resection with lymph node dissection. The masses were tightly adherent with infiltration into the sigmoid colon, uterus, and right ovary. These organs were all dissected, and subsequent sigmoid colostomy was performed. We preserved the left ovary for her fertility. The pathological findings demonstrated negative margins and no lymph node invasions, and final pathological stage was pT4(SI)N0M0, stage II. After the operation, she received the chemotherapy with 6 cycles of 5-fluorouracil (5-FU), leucovorin (LV), and oxaliplatin (mFOLFOX6) and subsequent 6 cycles of simplified LV and 5-FU (sLV5FU2). The patient is doing well till today on follow-up without progression of the disease 5 years after the operation. CONCLUSION: Primary adenocarcinoma of the appendix is exceedingly rare in children. In this report, we described one of the youngest primary adenocarcinomas of an appendix case ever reported. When encountering atypical cases of the appendicitis, we should consider the possibility of primary adenocarcinoma of the appendix as it has an extremely poor prognosis and is usually diagnosed in advanced stages.

DOI： 10.1186/s40792-018-0514-4

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：日本小児泌尿器科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: We compared laparoscopic Toupet fundoplication (LTF) and laparoscopic Nissen fundoplication (LNF) in neurologically normal children. METHODS: Forty neurologically normal children who were followed up for more than 3 years after LTF (n = 22) or LNF (n = 18) were reviewed retrospectively. LTF and LNF were performed between 2006 and 2012. RESULTS: There were no significant differences in gender (LTF, 15 male and 7 female patients; LNF:, 12 male and 6 female patients), mean age at surgery (LTF vs LNF: 2.5 vs 2.3 years), mean weight at surgery (LTF vs LNF: 9.6 vs 8.9 kg), preoperative symptoms, preoperative pH monitoring (pH <4) (LTF vs LNF: 26.7% vs 21.8%), mean operative time (LTF vs LNF: 117 vs 126 min), postoperative recommencement of enteral feeding (LTF vs LNF: 3.7 vs 3.8 days), or duration of hospitalization (LTF vs LNF: 5.5 vs 6.3 days). Intraoperative complications were esophageal trauma (LTF; n = 1; 4.5%) and liver trauma (LNF; n = 1; 5.6%) (P = 0.70). Post-LTF complications were wrap stenosis (n = 1; 4.5%), and post-LNF complications were wrap stenosis (n = 1; 5.5%) and gastric outlet obstruction (n = 1; 5.5%) (P = 0.43); all were managed conservatively. No case required conversion to open repair. There was no recurrence after LTF, but there were three cases (16.7%) after LNF (P = 0.08). Reoperation was performed at 4, 11, and 13 months, respectively. CONCLUSION: Despite LTF and LNF appearing to be equally effective, three LNF cases required reoperation.

DOI： 10.1111/ases.12430

PubMed

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記述言語：日本語   出版者・発行元：(株)東京医学社  

4歳7ヵ月女児。食道通過障害を主訴とした。出生時に食道閉鎖症と診断され、気管食道瘻切除術、食道端々吻合、胃瘻造設術が施行されていた。生後9ヵ月頃に食道吻合部狭窄を指摘されていたが、成長により改善すると考えられ無処置であった。食事ごとに食物が詰まるため、4歳7ヵ月時に当科紹介となった。上部消化管像にて、食道中部に狭窄を認めたため、食道バルーン拡張術を施行したが、バルーンが破裂し、極めて硬い狭窄と考えられた。胸部CTにて狭窄部に比較的厚い組織を認め、RIC法にて切除可能な瘢痕組織と判断した。まず狭窄部を十字に切開し、切開した間の瘢痕組織を、スコープを回転し進めながら徐々に切除した。術後は、直後に縦隔気腫を認めたが、翌日に軽快し、術後7日目には、穿孔部は閉鎖していた。軽度の狭窄が残存していた箇所は、バルーンにて12mmまで拡張可能となった。流動食と経鼻胃管による経管栄養を併用しつつ、術後23日目に退院した。退院後は瘢痕化が完了するまでに週に1回、バルーン拡張術を行い、手押しの加圧のみで容易に拡張可能となった。食事は術後7ヵ月にはパン、ご飯、糸こんにゃくなどを摂取可能となり、狭窄は解除され瘢痕組織切除部は食道粘膜に覆われていた。術後11ヵ月には、唐揚げを通常の大きさで摂取可能となり、狭窄は認めず口側の拡張も改善した。術後約6年経過したが再狭窄は認めなかった。

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：英語  

Blue rubber bleb nevus syndrome (BRBNS) is a rare disease in which venous malformations (VMs) involve any body organ, most commonly the skin and the gastrointestinal (GI) tract. Treatment of BRBNS aims at preserving the GI tract as much as possible. Although there are several dozen case reports about BRBNS that describe short-term clinical courses, a few provide an account of long-term clinical course. Here, we report a case of BRBNS in a girl that required multiple abdominal surgeries due to the GI VMs and a recurrence at an interval of 14 years. The preferred approach for gastrointestinal VMs involves the complete resection of all lesions without residual VMs. It is important to bear in mind the possibility of delayed recurrence of GI VMs after surgical or endoscopic treatment.

DOI： 10.1155/2018/8087659

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本小児血液・がん学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児血液・がん学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児血液・がん学会  

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記述言語：英語   出版者・発行元：(一社)日本癌学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: The aim of this study was to compare laparoscopic hepaticojejunostomy (LHJ) and open hepaticojejunostomy (OHJ) for choledochal cyst associated with hilar hepatic duct stenosis (HHDS). METHODS: Data collection was prospective for LHJ cases from 2009 and retrospective for OHJ cases from 2003 to 2008. Data were compared with respect to HHDS. HHDS was incised longitudinally as required during hilar hepatic ductoplasty. RESULTS: Fifty-eight subjects were studied (LHJ: n = 27, 4 boys, 23 girls; OHJ: n = 31; 6 boys, 25 girls). HHDS was present in 10 LHJ cases and 10 OHJ cases. Todani classification of choledochal cyst in LHJ patients was type 1A (n = 16) and type 4A (n = 11), and in OHJ patients, it was type 1A (n = 19) and type 4A (n = 12). There were significant differences between LHJ and OHJ with regard to mean operative time (386 vs 341 min), mean blood loss (5.9 vs 18.4 mL), recommencement of enteral feeding (3.9 vs 6.4 days), and hospital stay (11.7 vs 15.5 days) (all P < 0.05). Hepatic ductoplasty was performed in 23 LHJ patients and in 21 OHJ patients. There were no intraoperative complications and no conversions to OHJ. There were no significant differences between LHJ and OHJ, regardless of the presence of HHDS, for postoperative complications, which included minor bile leakage, anastomotic stricture, and intestinal obstruction. CONCLUSION: LHJ is as effective as OHJ for the treatment of choledochal cysts irrespective of the presence of HHDS and the need for hepatic ductoplasty.

DOI： 10.1111/ases.12358

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

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記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Purpose Patients with asplenia syndrome (AS) are likely to have upper gastrointestinal tract malformations such as hiatal hernia. This report discusses the treatment of such conditions. Methods Seventy-five patients with AS underwent initial palliation in our institution between 1997 and 2013. Of these, 10 patients had hiatal hernia. Of the patients with hiatal hernia, 6 had brachyesophagus and 7 had microgastria. Results Of the 10 patients with hiatal hernia, 9 underwent surgery in infancy (7 before Glenn operation, 2 after Glenn operation). Two underwent typical Toupet fundoplication, and the other 7 underwent atypical repair including reduction of the stomach. Two patients with atypical repair showed recurrence of hernia and required reoperation. Three patients required reoperation due to duodenal obstruction. Duodenal obstruction occurred due to preduodenal portal vein or abnormal vessels compressing the duodenum. Obstructive symptoms were not seen in any cases preoperatively. Conclusions In patients with hiatal hernia, typical fundoplication is often difficult because most have concomitant brachyesophagus, microgastria, and hypoplasia of the esophageal hiatus. However, we should at least reduce the stomach to the abdominal cavity as early as possible to increase thoracic cavity volume and allow good feeding. Increasing the volume of the thoracic cavity thus makes Glenn and Fontan circulations more stable. Duodenal obstruction secondary to vascular anomalies is also common, so the anatomy in the area near the duodenum should be evaluated pre- and intraoperatively.

DOI： 10.1055/s-0036-1592135

PubMed

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記述言語：日本語   出版者・発行元：日本小児泌尿器科学会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：日本小児泌尿器科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：英語   出版者・発行元：(一社)日本小児血液・がん学会  

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記述言語：英語   出版者・発行元：(一社)日本小児血液・がん学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

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記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

This study presents a modified surgical approach to laparoscopic myotomy for achalasia using stepped dilation with a Rigiflex balloon and contrast medium under image guidance. A 10-year-old boy with persistent dysphagia and vomiting had ingested only liquids for 3 months, losing >10 kg in body weight. Barium swallow and esophageal manometry diagnosed esophageal achalasia with mild esophageal dilatation. After failed pneumatic dilatation, laparoscopic Heller myotomy with Dor fundoplication was performed. Prior to surgery, a Rigiflex balloon dilator was placed within the esophagus near the diaphragmatic hiatus. A four-port technique was used, and mobilization of the esophagus was limited to the anterior aspect. A 5-cm Heller myotomy was performed, extending another 2 cm onto the anterior gastric wall. During myotomy, the Rigiflex balloon was serially dilated from 30 to 50 mL, and filled with contrast medium under fluoroscopic image guidance in order to maintain appropriate tension on the esophagus to facilitate myotomy, and to confirm adequate myotomy with sufficient release of lower esophageal sphincter by resecting residual circular muscle fibers. Residual circular muscle fibers can be simultaneously visualized under both fluoroscopic image guidance and direct observation through the laparoscope, and they were cut precisely until the residual notch fully disappeared. Dor fundoplication was completed. The operative time was 180 minutes, and oral intake was started after esophagography on postoperative day 1. As of the 12-month follow-up, the patient has not shown any symptoms, and his postoperative course appeared satisfactory.

DOI： 10.1089/lap.2015.0217

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Recently, laparoscopic percutaneous extraperitoneal closure (LPEC) for pediatric inguinal hernia has become more popular. The aim of this study was to compare LPEC with open repair (OR) performed in one institution. METHODS: In total, 1050 patients underwent OR from July 2003 to June 2008, and 1017 patients underwent LPEC from July 2008 to June 2013. The mean follow-up period was 100 months in OR and 40 months in LPEC (p < 0.01). Given the difference in the follow-up periods, the log-rank test was used for the analysis of the long-term results. The mean age at operation in OR and LPEC was 3.72 and 3.75 years, respectively (p = 0.81). The mean body weight was 14.73 and 14.72 kg, respectively (p = 0.98). The male/female ratio was 617/433 and 561/456, respectively (p = 0.10). In the LPEC procedure, the asymptomatic contralateral internal ring was routinely observed, and when a patent processus vaginalis (PPV) was confirmed, prophylactic surgery was performed. RESULTS: The mean operative time for unilateral surgery in OR and LPEC was 28.5 and 21.2 min, respectively (p < 0.01). The mean operative time for bilateral surgery was 52.3 and 25.4 min, respectively (p < 0.01). Recurrence was confirmed in 0.52% in OR and in 0.27% in LPEC (p = 0.53). In the LPEC group, 41.7% of patients with clinically unilateral inguinal hernia were confirmed to have a contralateral PPV and underwent prophylactic LPEC. Contralateral metachronous inguinal hernia (CMIH) was seen in 6.48% in OR and in 0.33% in LPEC (p < 0.01). Two patients showed postoperative testicular atrophy, and two had iatrogenic postoperative cryptorchism after OR, while no postoperative testicular complications were seen after LPEC. CONCLUSION: Both OR and LPEC obtained satisfactory results from the perspective of recurrence rate and complications. Prophylactic contralateral LPEC is useful for preventing CMIH without prolonging operative time compared with OR. The midterm safety and efficacy of LPEC are proven.

DOI： 10.1007/s00464-015-4354-z

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：岡山医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 15-year-old girl was found to be hypertensive (230-270/140-170 mm Hg) without any subjective symptoms. Magnetic resonance imaging confirmed the presence of a well-defined 22 mm hypodense lesion in the lower pole of the left kidney, located close to the renal hilum. Plasma rennin activity was elevated (75 ng/mL/h), and reninoma was diagnosed. Retroperitoneoscopy-assisted nephron-sparing surgery was planned. The retroperitoneum was accessed through a 4 cm left pararectal upper abdominal incision. Following blunt dissection, the abdominal wall was elevated with a lifting bar and lifting retractor, inserted below the 12th rib in the anterior axillary line to create sufficient working space in the retroperitoneal cavity without the need for pneumoperitoneum. Three 5 mm trocars were introduced above the superior iliac crest for the camera and the assistant. Gerota's fascia was opened and the kidney exposed. The surgeon dissected the left kidney through the minilaparotomy incision under both direct vision and using the magnified view on the monitor, which was particularly effective for the lateral and posterior sides of the kidney. The posterior peritoneum was incised intentionally next to the diaphragm to allow further mobilization of the kidney. Diathermy was used to remove the tumor and a layer of surrounding normal parenchymal tissue at least 0.5 cm thick. The histopathologic diagnosis was reninoma. Ischemia time was 14 minutes. Postoperatively, both plasma rennin activity and blood pressure were normal (1.9 ng/mL/h and 90-110/70-80 mm Hg, respectively). After follow-up of 12 months, there is no evidence of recurrence.

DOI： 10.1089/lap.2015.0397

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/PURPOSE: In Japan, surgical repair of a laryngotracheoesophageal cleft (LTEC) typically consists of the anterior approach, with the lateral approach as an alternative. Endoscopic surgery to repair the tracheoesophageal septum has been reported, and this study reviewed our experience treating several cases of LTEC endoscopically. METHODS: Endoscopic repair of LTEC was performed in 7 patients (3 boys, 4 girls; age range 4 months to 2 years 10 months; mean age 11 months; mean weight at surgery 7.23 kg; weight range 3.85-12.24 kg) between 2009 and 2014. LTEC was type I in 5 patients and types II and IV in 1 patient each. The patient with type IV was first operated on by the lateral approach, and the remaining cleft, which level was type III, was repaired endoscopically. Postoperative outcomes were retrospectively studied. RESULTS: Endoscopic surgery was successful in all patients. All 6 patients with types I and II LTEC were extubated easily, while in the patient with type IV LTEC, it was difficult to remove the tracheostomy cannula because of tracheomalacia. Postoperatively, tracheostomy cannulation became more stable, and the patient is gradually being weaned off the ventilator. All patients could be fed orally without difficulty postoperatively. CONCLUSIONS: Endoscopic surgery provides a view from the cephalic aspect permitting the surgeon to form a normal larynx with only minimal risk of complications.

DOI： 10.1016/j.jpedsurg.2015.07.018

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To present the medium to long-term outcome of the largest pediatric series of laparoscopic Toupet fundoplications (LTF) performed at a single institution. PATIENTS AND METHODS: Subjects were 131 neurologically impaired children (81 M, 50 F) who underwent LTF between 2003 and 2013. Our LTF involves full dissection of the crus of the diaphragm to allow the intraabdominal esophagus to be mobilized at least 3-4 cm. RESULTS: Preoperative mean fraction time for pH <4 was 14.6 %. Mean age at LTF was 6.7 years (3 months-18 years). Mean duration of follow-up was 5.7 years (range 1.2-12.1 years). One case required conversion to open surgery. Intra-operative complications were all injuries to the esophagus/gastric wall (n = 4; 3.0 %) including full-thickness perforation (n = 1; 0.8 %). Postoperative complications included pyloric stenosis (n = 4; 3.0 %), dysphagia (n = 1; 0.8 %), incisional hernia (n = 1; 0.8 %), hemorrhage requiring transfusion (n = 1; 0.8 %), recurrence (n = 3; 2.3 % at 11, 13, and 48 months, respectively), and gastrostomy site infection (n = 7; 5.3 %). Mean operative time decreased significantly with experience from 180.8 min for the first quarter of subjects to 150.6 (2nd quarter), 128.6 (3rd) and 109.2 min (4th). CONCLUSIONS: Our LTF would appear to be safe for treating GERD in children because of reliable outcome and low recurrence.

DOI： 10.1007/s00383-015-3770-4

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We describe a novel technique for laparoscopic hepatic ductoplasty and hepaticojejunostomy in choledochal cyst with a narrow common hepatic duct. After complete cyst excision, a longitudinal incision was made in the anterior wall of the narrow common hepatic duct to enlarge the anastomotic opening. Next, the anterior wall was everted, then anchored to the hepatic hilum by suturing. Anchoring of the anterior wall provided a good field of view for creating the anastomosis, and the lumen of the anastomotic region was also secured. We believe that our technique is feasible and useful when the duct size is small.

DOI： 10.1007/s00383-015-3779-8

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：英語   出版者・発行元：(一社)日本小児血液・がん学会  

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記述言語：英語   出版者・発行元：(一社)日本小児血液・がん学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児血液・がん学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児血液・がん学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児血液・がん学会  

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記述言語：日本語   出版者・発行元：日本膵・胆管合流異常研究会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: We report a case of a 1.8-kg infant who had laparoscopic Toupet fundoplication (LTF) using the AirSeal Intelligent Flow System and Anchor Port (AP). MATERIALS AND SURGICAL TECHNIQUE: Our case had severe gastroesophageal reflux in association with genetic and cardiac anomalies. Despite the patient being continuously fed, persistent vomiting caused failure to thrive, and LTF was performed at 4 months of age when he weighed 1.8 kg. The AirSeal Intelligent Flow System is a novel laparoscopic CO2 insufflation system that improves the visual field by constantly evacuating smoke and providing a more stable pneumoperitoneum. The AP is a recently developed, stretchable, elastomeric, low-profile cannula. Three 5-mm AP were inserted: one subumbilically for the scope and one in both the right and left upper abdomen for the surgeon. A 5-mm AirSeal trocar was inserted in the left lower abdomen for the assistant. The gastrosplenic ligament was dissected free, and the intra-abdominal esophagus was prepared. A posterior hiatoplasty was performed, followed by the 270° fundoplication. During the fundoplication, the esophagus was fixed to the crus and then the right and left wraps were fixed to the esophagus. Pneumoperitoneum was maintained stably throughout the LTF procedure, with optimal operative field. Total operating time for LTF was 90 min. Body temperature dropped from 37.4°C to 35.7°C during pneumoperitoneum but resolved once pneumoperitoneum was ceased. Postoperative progress was uneventful, and an upper gastrointestinal study on postoperative day 2 showed no residual gastroesophageal reflux. DISCUSSION: We believe the AirSeal Intelligent Flow System and AP contributed to the successful completion of LTF in a 1.8-kg infant.

DOI： 10.1111/ases.12182

PubMed

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記述言語：日本語   出版者・発行元：日本小児泌尿器科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: In children with choledochal cysts (CC), obstruction of the discharge of bile or pancreatic juice is frequently observed, and biliary perforation and severe pancreatitis may occur. In such cases, temporary drainage is necessary to stabilize these patients. We employed laparoscopic cholecystostomy followed by laparoscopic cyst excision in cases with complicated CC. METHODS: Between 2009 and 2013, emergency laparoscopic cholecystostomy for bile drainage was performed in seven girls with complicated CC in whom conservative treatment failed to ameliorate abdominal pain, vomiting, and jaundice; among these seven patients included two with biliary perforation, one with a huge cyst, and four with peribiliary edema suggestive of impending biliary rupture. Protein plugs in the common channel or the terminal portion of the cyst were present in six patients. RESULTS: Amelioration of symptoms, such as abdominal pain and jaundice, was achieved in all patients after laparoscopic cholecystostomy. Saline irrigation of the bile duct via cholecystostomy was commenced 2 days postoperatively. All patients underwent laparoscopic cyst resection after improvement of their general condition and detailed evaluation of the intrahepatic and extrahepatic bile ducts and pancreaticobiliary maljunction. Impacted protein plugs or gallstones were eliminated in all patients by the time of laparoscopic cyst excision. CONCLUSION: Laparoscopic cholecystostomy followed by laparoscopic cyst excision is a useful and safe procedure for the treatment of complicated CC. This technique is also favorable from a cosmetic viewpoint because the resultant wound can be reused as the trocar insertion site at the time of laparoscopic cyst excision.

DOI： 10.1111/ases.12170

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: To determine the best way to perform diaphragmatic plication for diaphragmatic eventration (DE) using minimally invasive surgery. MATERIALS AND METHODS: We conducted a retrospective review of pediatric cases of DE treated between 2007 and 2012. Thoracoscopic plication (TP) is performed using single-lung ventilation with three 5-mm ports; laparoscopic plication (LP) is performed using three or four 5-mm ports. The choice of technique was determined preferentially by the treating surgeon. RESULTS: There were 20 subjects (13 treated by LP and 7 treated by TP). Etiology of DE was phrenic nerve injury (LP, n=11; TP, n=1) and muscular deficiency (LP, n=2; TP, n=6). Mean age (LP, 18 months; TP, 25 months) and weight (LP, 8.0 kg; TP, 9.7 kg) at surgery were not significantly different. Mean operating time was 155.6 minutes in LP and 167.0 minutes in TP (P=not significant). Mean intraoperative end-tidal CO2 was 41.9 mm Hg (range, 35-52 mm Hg) in LP and 36.9 mm Hg (range, 33-41 mm Hg) in TP (P=.01). Mean duration of postoperative ventilation was 1.2 days in LP and 1.3 days in TP (P=not significant). Mean time taken to recommence feeding postoperatively was 1.6 days in both groups (P=not significant). Complications were one conversion to thoracotomy in TP, 1 case of atelectasis in each group (P=not significant), and 6 cases of recurrence in LP versus none in TP (P=.04). CONCLUSIONS: Both TP and LP are beneficial for treating small children with DE. However, there is a higher incidence of recurrence after LP, and the role of TP in cardiac patients requiring subsequent surgery is debatable.

DOI： 10.1089/lap.2014.0237

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: To define the role of laparoscopy for treating malrotation in children. MATERIALS AND METHODS: The Ladd procedure (9 laparoscopic [lap-Ladd], 17 open [open-Ladd]; n=26) was performed in children up to and including 30 days of age (neonatal [Group N]) and older (Group C). These groups were compared retrospectively. RESULTS: Group N (n=14) comprised 3 lap-Ladd and 11 open-Ladd patients. Group C (n=12) comprised 6 lap-Ladd and 6 open-Ladd patients. No case had ischemic bowel preoperatively. Intestinal volvulus was confirmed in 3 of 3 lap-Ladd and 9 of 11 open-Ladd patients in Group N, compared with 5 of 6 lap-Ladd and 6 of 6 open-Ladd patients in Group C (P=not significant). Mean operating times were significantly longer for lap-Ladd patients (130.7 minutes versus 81.1 minutes in Group N and 119.2 minutes versus 74.2 minutes in Group C). Conversion to an open-Ladd procedure was necessary in 1 of 3 patients in Group N and 1 of 6 patients in Group C (P=not significant). Complications arose in open-Ladd patients, bowel obstruction in Group N (1 of 11), and mesenteric chylorrhea in Group C (1 of 6). There was recurrence in 1 of 3 lap-Ladd patients in Group N. Mean time to recommence feeding was earlier for lap-Ladd patients (P=not significant). Length of hospitalization was similar in Group N but was shorter for lap-Ladd patients in Group C (P=not significant). CONCLUSIONS: Although lap-Ladd appears to be a safe procedure, it cannot be recommended for the treatment of malrotation in neonates.

DOI： 10.1089/lap.2014.0236

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The potential benefits of thoracoscopic repair (TR) of esophageal atresia and tracheoesophageal fistula (EA/TEF) in newborns are still unclear. Our aim was to define the criteria, perioperative outcome after undergoing TR versus open repair (OR) for EA/TEF. PATIENTS AND METHODS: A retrospective chart review was conducted of 36 consecutive neonates who underwent EA/TEF repair between 2001 and 2012 in Shizuoka Children's Hospital. Patients in this study were birth weight >2,000 g, and did not have severe cardiac malformations or chromosomal aberrations. Of the 26 newborns who met the selection criteria, 11 patients underwent attempts at TR compared to 15 patients who underwent OR. All cases were followed 1 year after operation at least. RESULTS: All 11 TR were successfully completed. There were no significant differences between intra- and perioperative complications in the two groups. Intraoperative EtCO2 and arterial blood gases were not significantly different between the two groups. We did not found eating disorder, respiratory disorder, and failure of growth in all cases. CONCLUSION: In our study, the thoracoscopic approach appeared to be favorable and safe for EA/TEF repair in carefully selected patients.

DOI： 10.1007/s00383-014-3554-2

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The appropriate surgical intervention strategies for solid pseudopapillary tumor (SPT) of the pancreas in children are still controversial. The aim of this study was to establish surgical intervention strategies based on the pathological findings. METHODS: We retrospectively reviewed the medical records of patients who underwent surgery for SPT between January 1994 and April 2013. RESULTS: Five patients with SPT were identified. Tumors were located in the pancreatic head (n = 1), body (n = 2) and tail (n = 2). One patient showed spleen, liver and lung metastases. All five patients underwent pancreatectomy. Enucleation was not performed. One patient with metastases underwent partial hepatectomy. Four tumors had infiltration into the adjacent pancreatic parenchyma. The main pancreatic duct was incorporated into the tumor capsule wall in two patients. Surgical margins were negative in all patients without metastases. The median follow-up period was 37.8 months (range 7-74 months). One patient with metastases died at 60 months after surgery. All other patients were alive and showed no evidence of recurrence. CONCLUSION: Radical resection with negative margins should be performed for SPT. From the perspective of curability, we suggest that pancreatectomy is the first choice for SPT in children.

DOI： 10.1007/s00383-014-3462-5

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児血液・がん学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児血液・がん学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

症例は女児。在胎28週時に前縦隔に径14mmの嚢胞性病変を指摘された。その後、大きさや性状に変化は認めなかった。在胎38週1日、体重3,036gで出生した。CTやMRIにて胸腺右葉下極に嚢胞を含む内部不均一な腫瘤を認めたが、この腫瘤は胸腺左葉下極の内部均一な嚢胞状腫瘤と正中で接していた。胸腺右葉の奇形腫と、奇形腫が胸腺左葉内に穿破して嚢胞を形成したと考えられた。出生直後は無症状であったが、日齢18頃に啼泣時の経皮動脈血酸素飽和度の低下を認めるようになったため、日齢22に手術を行った。胸骨正中切開にて開胸し、胸腺を温存して腫瘤を切除した。病理検査にて右葉の病変は成熟奇形腫であったが、左葉の病変は単房性胸腺嚢胞と診断され、奇形腫の穿破ではなかった。術後経過は良好である。前縦隔には様々な嚢胞状腫瘤が発生するが、両者ともに出生前に指摘されることはほとんどなく、さらに両者を合併した報告はなかった。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01113&link_issn=&doc_id=20201026200047&doc_link_id=%2Fes5shoge%2F2020%2Fs05606%2F016%2F0992-0997%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fes5shoge%2F2020%2Fs05606%2F016%2F0992-0997%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児放射線学会  

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記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

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記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：AMER ASSOC CANCER RESEARCH  

DOI： 10.1158/1538-7445.AM2018-3831

Web of Science

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記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

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