Faculty Profiles - MASUYAMA Hisashi

MISC - MASUYAMA Hisashi

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Pretreatment prognostic nutritional index is a significant predictor of prognosis in patients with cervical cancer treated with concurrent chemoradiotherapy. International journal

Junko Haraga, Keiichiro Nakamura, Chiaki Omichi, Takeshi Nishida, Tomoko Haruma, Tomoyuki Kusumoto, Noriko Seki, Hisashi Masuyama, Norihisa Katayama, Susumu Kanazawa, Yuji Hiramatsu

Molecular and clinical oncology 5 ( 5 ) 567 - 574 2016

Language：English Publisher：SPANDIDOS PUBL LTD

This study investigated whether pretreatment neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and prognostic nutritional index (PNI) are prognostic factors in patients with cervical cancer who undergo concurrent chemoradiotherapy (CCRT) and radiotherapy (RT). A total of 131 patients who underwent CCRT and RT for cervical cancer were retrospectively investigated and the correlations of NLR, PLR and PNI with clinical parameters and prognosis were assessed in CCRT and RT. The CCRT and RT groups had a median progression-free survival (PFS) of 41.82 and 24.72 months, respectively, and an overall survival of 49.70 and 29.56 months, respectively. At a cut-off value of NLR≥2.85, the PFS and OS in patients with higher NLR undergoing RT were significantly shorter compared with those in patients with lower NLR (P=0.029 and P=0.017, respectively). At a cut-off value for PNI of ≤48.55 in patients undergoing CCRT and ≤45.80 in patients undergoing RT, the PFS and OS in patients with lower PNI were significantly shorter compared with those in patients with higher PNI (PFS and OS with CCRT, P<0.001 and P<0.001, respectively; PFS and OS with RT, P=0.002 and P=0.008, respectively). Multivariate analyses also identified low PNI as an independent prognostic factor for PFS and OS in patients receiving CCRT. Therefore, low PNI was shown to predict poor prognosis in patients with cervical cancer.

DOI： 10.3892/mco.2016.1028

衛藤英理子, 渋川昇平, 光井崇, 延本悦子, 早田桂, 瀬川友功, 増山寿, 平松祐司, 吉本順子

現代産婦人科 64 ( 2 ) 229 - 233 2016

Language：Japanese Publisher：中国四国産科婦人科学会

【目的】先天性心疾患は新生児の約1%にみられる最も頻度の高い先天奇形の一つであるため、出生後に適切な治療を行う上で胎児診断が重要となっている。当院における胎児心疾患症例の現状と課題を把握することを目的とした。【研究方法】2011年4月から2014年3月までに当院で先天性心疾患疑いのため当院産科胎児超音波精査外来を受診した109例を対象に、診療録より母体背景、胎児診断名および診断週数、新生児診断名、染色体検査の有無、分娩方法、児の予後を抽出し、後方視的に検討した。また1997年から2013年までの胎児心疾患症例数を診療録より集計した。【研究成績】胎児心疾患症例は年々増加し、2000年と比較すると2013年は約9倍となっていた。109例のうち紹介例は102例(県外51例)、当院での胎児診断週数は32.9±3.8週であった。新生児診断では左心低形成症候群が23例と最も多く、心室中隔欠損症18例、両大血管右室起始症13例、肺動脈閉鎖症11例などであった。胎児診断と新生児診断を比較すると、特に完全大血管転位症、両大血管右室起始症、ファロー四徴症、総肺静脈還流異常症の胎児診断に苦慮する傾向がみられた。児の予後不良例は10例(子宮内胎児死亡1例、新生児死亡9例)あり、左心低形成症候群の重症型や18トリソミーの症例が多かった。胎児超音波検査で染色体異常が疑われて出生前に羊水染色体検査が行われた症例と、出生後に児の染色体検査が行われた症例とを合わせると、18トリソミー7例、21トリソミー5例、22q11.2欠失症候群1例という結果であった。【結語】当院は先天性心疾患の紹介例が多く、中でも左心低形成症候群が多いのが特徴であった。羊水染色体検査は適切な症例に施行すれば有用な情報が得られる。円錐動脈幹奇形や総肺静脈還流異常症の胎児診断率の向上が今後の課題である。(著者抄録)

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子宮頸管ポリープ切除を機に発見された子宮頸癌の検討.

川井紗耶香, 春間朋子, 原賀順子, 西田傑, 小川千加子, 楠本知行, 中村圭一郎, 関典子, 増山寿, 平松祐司

現代産婦人科 64 ( 2 ) 315 - 319 2016

急性膵炎を契機に発見された胃癌合併妊娠の一例.

岡本和浩, 瀬川友功, 柏原麻子, 牧尉太, 玉田祥子, 江口武志, 光井崇, 衛藤英理子, 平野友美加, 延本悦子, 早田桂, 増山寿, 平松祐司

現代産婦人科 64 ( 2 ) 431 - 434 2016

Language：Japanese Publisher：中国四国産科婦人科学会

胃癌合併妊娠は稀であるが、欧米と比較して日本では比較的高率である。妊娠に合併する胃癌は、症状としては悪心嘔吐、上腹部痛等があるがそれらは正常な妊娠経過でも経験し、特異的でないこと、また妊娠中は放射線検査が躊躇されることもあり発見が遅れることも多く、診断時に進行している症例が多く、予後は不良である。今回我々は急性膵炎を契機に発見された胃癌合併妊娠の一例を経験したので文献的考察を踏まえて報告する。症例は29歳、0経妊0経産。妊娠33週5日に背部痛を認め、翌日に前医救急外来を受診。血液検査で著明なアミラーゼ高値を認め、急性膵炎の診断となった。第3病日に今後の加療目的に当科紹介転院となった。第4病日に施行したMRI検査にて悪性腫瘍合併が疑われ、その他の画像検査と併せて胃癌合併が強く疑われた。既に妊娠34週に入っており、児の娩出は問題ないと判断し、第6病日・妊娠34週4日に帝王切開を行い、妊娠を終了した。帝王切開時、腹腔内に多発する転移巣を認め、胃幽門部に腫瘤性病変を認め、周囲のリンパ節腫大、胃から膵への直接浸潤を認めた。第10病日・帝王切開術後4日目に上部消化管内視鏡を行い、胃体下部に3型・潰瘍浸潤型の胃癌を認めた。第19病日・術後13日目より化学療法(5-FU+PTX)を開始した。第51病日に癌性髄膜症による急性水頭症を認め、V-P shunt術を施行した。その際の脳脊髄液細胞診はclassVであり、癌細胞は既知の胃癌として矛盾しない所見であった。第65病日早朝より除脳硬直が出現し、約1時間後に永眠された。(著者抄録)

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婦人科腫瘍治療既往のある難治性の下肢痛・しびれに疎経活血湯が奏効した8症例.

関典子, 原賀順子, 春間朋子, 西田傑, 小川千加子, 楠本知行, 中村圭一郎, 増山寿, 後藤由佳, 奥田博之, 平松祐司

痛みと漢方 26 85 - 90 2016

Three histologically distinct cancers of the uterine corpus: A case report and review of the literature. International journal

Hisashi Masuyama, Junko Haraga, Takashi Nishida, Chikako Ogawa, Tomoyuki Kusumoto, Keiichiro Nakamura, Noriko Seki, Hiroyuki Yanai, Yuji Hiramatsu

Molecular and clinical oncology 4 ( 4 ) 563 - 566 2016

Language：English Publishing type：Book review, literature introduction, etc. Publisher：SPANDIDOS PUBL LTD

Collision tumors, which are characterized by the coexistence of two or more completely distinct and independent tumors in the uterine corpus, are very rare. A collision tumor is mainly composed of two distinct tumor types, epithelial and mesenchymal. To the best of our knowledge, there has only been a single case in which a choriocarcinoma with an endometrial carcinoma were coexistent but histologically distinct. We herein report the first case of a collision tumor in a 52-year-old woman, with a history of two pregnancies and two deliveries. The collision tumor was composed of three histologically distinct neoplasms in the uterine corpus, namely an endometrioid carcinoma, an undifferentiated carcinoma and a choriocarcinoma. The patient underwent hysterectomy, bilateral adnexectomy and pelvic lymph node dissection, followed by six cycles of adjuvant chemotherapy with paclitaxel/carboplatin due to the high risk of endometrial cancer, and an additional five cycles of chemotherapy with methotrexate, as the β-human chorionic gonadotropin level was beyond the normal range. Following adjuvant chemotherapy, the tumor markers were within normal limits and no relapses of the cancer have been observed during 1 year of follow-up. Diagnosing a collision tumor prior to surgery is difficult if the neoplasms are in close proximity, or if one of the tumors predominates. Careful pathological examination is crucial for accurately diagnosing the neoplasms in a collision tumor and ensuring appropriate management and a favorable prognosis.

DOI： 10.3892/mco.2016.770

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A Pregnancy with Severe Hypertrophic Obstructive Cardiomyopathy after Surgery for an Implantable Cardioverter Defibrillator: A Case Report and Literature Review. International journal

Takashi Mitsui, Hisashi Masuyama, Kentaro Ejiri, Kei Hayata, Hiroshi Ito, Yuji Hiramatsu

Case reports in obstetrics and gynecology 2016 4690790 - 4690790 2016

Language：English

Hypertrophic obstructive cardiomyopathy (HOCM) is cardiac hypertrophy of ventricular myocardium with left ventricular outflow tract obstruction. We report a pregnancy with HOCM after defibrillator implantation surgery. The patient was a 33-year-old nulligravida and was categorized as New York Heart Association class II. Her brain natriuretic peptide (BNP) level was 724.6 pg/dL at preconception. She received careful pregnancy management. However, because frequent uterine contractions were observed at 25 weeks and 6 days of pregnancy, she was hospitalized, and magnesium sulfate was started as a tocolytic agent. At 27 weeks and 5 days of pregnancy, she had respiratory discomfort and orthopnea with a sudden decrease in peripheral oxygen saturation. Cardiac ultrasonography showed a worsened condition of HOCM and her BNP level was 1418.0 pg/mL. We performed an emergent cesarean section and she delivered a boy weighing 999 g. The Apgar score was 8 and 9 points at 1 and 5 minutes, respectively. The mother's heart failure quickly improved after birth and she was discharged at 10 days postoperatively. Fluctuations in circulatory dynamics during pregnancy may sometimes exacerbate heart disease. Therefore, the risks should be fully explained and careful assessment of cardiac function should be performed during pregnancy in patients with severe HOCM.

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A case of ovarian endometrioid adenocarcinoma resembling sex-cord stromal tumor with hyperandrogenism, hyperestrogenism and pseudo-Meigs syndrome

34 ( 2 ) 112 - 118 2016

妊娠高血圧症候群を合併した母体の出生児の3歳までの身体発育の性差

光井崇, 増山寿, 江口武志, 玉田祥子, 衛藤英理子, 早田桂, 平松祐司

日本産科婦人科栄養・代謝研究会プログラム・抄録集 40th 2016

糖代謝異常妊婦の安静時代謝量と体組成

衛藤英理子, 岡本和浩, 柏原麻子, 牧尉太, 江口武志, 玉田祥子, 光井崇, 早田桂, 増山寿, 平松祐司

日本産科婦人科栄養・代謝研究会プログラム・抄録集 40th 2016

“Diabetes begets diabetes”-メカニズムの解明に向けて-

増山寿, 江口武志, 玉田祥子, 光井崇, 平野友美加, 衛藤英理子, 延本悦子, 早田桂, 瀬川友功, 平松祐司

日本産科婦人科学会雑誌 68 ( 2 ) 2016

Creation of a cerebellar diameter reference standard and its clinical application to the detection of cerebellar hypoplasia unique to trisomy 18

Kei Hayata, Yuji Hiramatsu, Hisashi Masuyama, Eriko Etou, Etsuko Nobumoto, Takashi Mitsui

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH 41 ( 12 ) 1899 - 1904 2015.12

Language：English Publisher：WILEY-BLACKWELL

Aim: We created a new reference standard focusing on the hemispheric anteroposterior cerebellar diameter (APCD) in addition to the transverse cerebellar diameter (TCD) and discussed whether or not the cerebellar measurement was useful for the detection of trisomy 18 (T18).
Material and Methods: In 150 normal fetuses between 14 and 36 weeks of gestational age (GA), the TCD and APCD were prospectively measured. In 26 cases with T18, the value was compared with the control.
Results: At <22weeks of gestation, the TCD reference standard was calculated as follows: TCD=(1.027xGA)-0.674 (R-2=0.97, P<0.001). The reference standard of the APCD was calculated as follows: APCD=(0.682xGA)-3.925 (R-2=0.73, P<0.001). In eight cases with T18, the TCD was below the 5th percentile value in 7/8 (88%) cases and the APCD was below the 5th percentile value in 8/8 (100%) cases. At >22 weeks of gestation, the reference standard of the TCD was calculated as follows: TCD=(1.603xGA) - 13.216 (R-2=0.92, P<0.001). The reference standard of the APCD was calculated as follows: APCD=(0.859xGA) - 7.30 (R-2=0.84, P<0.001). In 18 cases with T18, the TCD was below the 5th percentile value in 14/18 (78%) cases and the APCD was below the 5th percentile value in 18/18 (100%) cases.
Conclusion: APCD reference standard, divided by the gestational age of more or less than 22 weeks, might be useful to diagnose T18.

DOI： 10.1111/jog.12814

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Pregnancy complications and glucose intolerance in women with polycystic ovary syndrome

Mari Sawada, Hisashi Masuyama, Kei Hayata, Yasuhiko Kamada, Keiichiro Nakamura, Yuji Hiramatsu

ENDOCRINE JOURNAL 62 ( 11 ) 1017 - 1023 2015.11

Language：English Publisher：JAPAN ENDOCRINE SOC

Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by insulin resistance and hyperandrogenism. The interaction of these factors might result in increased risks of miscarriage and pregnancy complications such as gestational diabetes mellitus (GDM). To examine the pregnancy risks in women with PCOS, we compared obstetrical outcomes between patients with and without PCOS. We also studied the differences in maternal characteristics, glucose intolerance and pregnancy complications between PCOS patients with and without GDM, with and without obesity, and between successful pregnancies and miscarriages. We observed a high incidence of GDM and prevalence of GDM diagnosis in the first trimester in PCOS. Patients with GDM had higher body mass index (BMI) and lower homeostasis model assessment of beta-cell function (HOMA-beta) at preconception than those without GDM. Obese pregnant women with PCOS demonstrated a high incidence of GDM with severe insulin resistance, including high fasting insulin, HOMA of insulin resistance (HOMA-IR), and HOMA-beta at preconception compared with normal-weight patients. BMI was significantly correlated with HOMA-IR or HOMA-beta, and both indices were lower in PCOS patients with than without GDM for the same BMI. There were no significant differences in maternal characteristics (excluding maternal age) between PCOS patients with successful pregnancy and PCOS patients with miscarriages. Our data suggest that pregnant women with PCOS have an increased risk of GDM, especially if they have obesity and/or poorer insulin secretion. Measure of beta-cell function, such as HOMA-beta, at preconception might be a useful predictor of the risk of GDM in pregnant PCOS patients.

DOI： 10.1507/endocrj.EJ15-0364

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TWO CASES OF CONGENITAL CYTOMEGALOVIRUS INFECTION

Shoko Tamada, Jota Maki, Takeshi Eguchi, Takashi Mitsui, Yumika Hirano, Eriko Eto, Etsuko Nobumoto, Kei Hayata, Hisashi Masuyama, Yuji Hiramatsu

PLACENTA 36 ( 10 ) A3 - A4 2015.10

Effect of the new diagnostic criteria for gestational diabetes mellitus among Japanese women

Etsuko Nobumoto, Hisashi Masuyama, Yuji Hiramatsu, Takashi Sugiyama, Hideto Kusaka, Nagayasu Toyoda

Diabetology International 6 ( 3 ) 226 - 231 2015.9

Language：English Publisher：Springer-Verlag Tokyo

Background: The new diagnostic criteria for gestational diabetes mellitus (GDM), proposed by the International Association of Diabetes and Pregnancy Study Groups in 2010, were recently accepted in Japan. Therefore, the frequency of GDM is four times higher than previously recorded. This means that GDM has become a more clinically important disease. This study aimed to assess how the number of patients with GDM as well as its complications have changed after adoption of the new criteria. Methods: A total of 3,610 pregnant women in the Japan Assessment of GDM Screening Trial and Okayama University Hospital were included. We analyzed the prevalence of GDM and its complications using the old and new criteria. Results: The prevalence of perinatal outcomes was increased by adopting the new criteria. There were many important perinatal complications in the additional new GDM criteria
therefore, patients with mild GDM, such as one-point disorder patients, should have careful interventions. Admission to the neonatal intensive care unit was significantly increased (p = 0.01) according to the new GDM criteria because the old criteria were stricter than the new ones. GDM patients with obesity (BMI ≥ 25 kg/m&lt
sup&gt
2&lt
/sup&gt
) had a high frequency of perinatal complications that could require active intervention and strict follow-up. Conclusions: Because the new GDM criteria greatly affect perinatal complications, intervention for GDM starting at an early stage and strict follow-up (especially GDM with obesity) are important for reducing complications as well as the incidence of diabetes and metabolic syndrome in the mother and child.

DOI： 10.1007/s13340-014-0193-8

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The Glasgow Prognostic Score Determined During Concurrent Chemoradiotherapy Is an Independent Predictor of Survival for Cervical Cancer

Takeshi Nishida, Keiichiro Nakamura, Junko Haraga, Chikako Ogawa, Tomoyuki Kusumoto, Noriko Seki, Hisashi Masuyama, Norihisa Katayama, Susumu Kanazawa, Yuji Hiramatsu

INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER 25 ( 7 ) 1306 - 1314 2015.9

Language：English Publisher：LIPPINCOTT WILLIAMS & WILKINS

Objective The Glasgow prognostic score (GPS) determined at pretreatment is important in the prediction of prognosis in various cancers. We investigated if the GPS used both at pretreatment and during concurrent chemoradiotherapy (CCRT) could predict the prognosis of patients with cervical cancer.
Methods We collected GPS and clinicopathological data from the medical records of 91 patients who underwent CCRT for cervical cancer; their GPSs at pretreatment and during CCRT were retrospectively analyzed for correlations with recurrence and survival. Statistical analyses were performed using the Mann-Whitney U test. Disease-free survival (DFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. Cox's proportional hazard regression was used for univariate and multivariate analyses.
Results The median follow-up for all patients who were alive at the time of last follow-up was 38.0 months (range, 1-108 months). The DFS and OS rates of patients with a high GPS during CCRT (GPS 1 + 2; 55 patients; 60.4%) were significantly shorter than those for patients with a low GPS (GPS 0; 36 patients; 39.6%) (DFS, P < 0.001; OS, P < 0.001). Furthermore, multivariate analyses showed that high GPS during CCRT was an independent prognostic factor of survival for OS (P = 0.008).
Conclusions During CCRT, a high GPS was revealed to be an important predictor of survival for cervical cancer.

DOI： 10.1097/IGC.0000000000000485

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The Effects of High-Fat Diet Exposure In Utero on the Obesogenic and Diabetogenic Traits Through Epigenetic Changes in Adiponectin and Leptin Gene Expression for Multiple Generations in Female Mice

Hisashi Masuyama, Takashi Mitsui, Etsuko Nobumoto, Yuji Hiramatsu

ENDOCRINOLOGY 156 ( 7 ) 2482 - 2491 2015.7

Language：English Publisher：ENDOCRINE SOC

Recent studies demonstrate that epigenetic changes under malnutrition in utero might play important roles in transgenerational links with metabolic diseases. We have previously shown that exposure to a high-fat diet (HFD) in utero may cause a metabolic syndrome-like phenomenon through epigenetic modifications of Adiponectin and Leptin genes. Because an association of obesity between mother and offspring endured in multiple generations, we examined whether HFD exposure in utero might affect the metabolic status of female offspring through multigenerational epigenetic changes of Adiponectin and Leptin genes and whether a normal diet in utero for multiple generations might abolish such epigenetic changes after exposure to a HFD in utero using ICR mice. We observed that the effect of maternal HFD on offspring over multiple generations in metabolic syndrome-like phenomenon such as weight and fat mass gain, glucose intolerance, hypertriglyceridemia, abnormal adiponectin and leptin levels, and hypertension, were accumulated with expression and epigenetic changes in Adiponectin and Leptin genes. A normal diet in utero in the subsequent generations after HFD exposure in utero diminished, and a normal diet in utero for 3 generations completely abolished, the effect of HFD in utero on weight and fat mass gain, insulin resistance, serum triglyceride, adiponectin, and leptin levels, with epigenetic changes of Adiponectin and Leptin genes. Exposure to a HFD in utero might affect glucose and lipid metabolism of female offspring through epigenetic modifications to Adiponectin and Leptin genes for multiple generations. Obesogenic and diabetogenic traits were abolished after a maternal normal diet for 3 generations.

DOI： 10.1210/en.2014-2020

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Nationwide demonstration project of next-generation sequencing of cell-free DNA in maternal plasma in Japan: 1-year experience

Haruhiko Sago, Japan NIPT consortium, Akihiko Sekizawa, Takahiro Yamada, Toshiaki Endo, Akimune Hukushima, Jun Murotsuki, Kamei Yoshimasa, Satoshi Nanba, Junko Yotsumoto, Hisao Osada, Yasuyo Kasai, Atsushi Watanabe, Yukiko Katagiri, Naoki Takesita, Masaki Ogawa, Tomohiro Tanemoto, Osamu Samura, Michihiro Kitagawa, Takashi Okai, Shun-Ichiro Izumi, Haruka Hamanoue, Fumiki Hirahara, Kazufumi Haino, Nobuhiro Suzumori, Naoki Hamajima, Yoko Okamoto, Hiroaki Nakamura, Takeshi Kanekawa, Jun Yoshimatsu, Hideaki Sawai, Shinya Tairaku, Katsuhiko Naruse, Hisashi Masuyama, Maki Hyodo, Takashi Kaji, Kazutoshi Maeda, Keiichi Matsubara, Masanobu Ogawa, Toshiyuki Yoshizato, Kiyonori Miura, Hideaki Masuzaki, Takashi Ohba, Yukie Kawano, Miyuki Nishiyama

Prenatal Diagnosis 35 ( 4 ) 331 - 336 2015.4

Language：English Publisher：John Wiley and Sons Ltd

Objective: To report the 1-year experience of a nationwide demonstration project to introduce noninvasive prenatal testing of aneuploidy from maternal plasma and discuss how to implement this program in Japan. Methods: The test was conducted to detect aneuploidy in high-risk pregnant women with adequate genetic counseling. The clinical data, test results, and pregnancy outcomes were recorded. Results: Of the 7740 women tested, 142 (1.8%) had positive results, 7594 (98.1%) had negative results, and four (0.1%) had results that were not reportable. Of the 142 women who tested positive, 13 cases resulted in intrauterine fetal death, and three cases refused to undergo the invasive procedure. Of the 126 positive cases confirmed on karyotyping, a normal karyotype was observed for trisomy 21 in three cases, trisomy 18 in eight cases, and trisomy 13 in two cases. In the follow-up study of the negative cases (n=1638), only one false-negative case of trisomy 18 was detected. Conclusions: We described our nationwide 1-year experience with noninvasive prenatal genetic testing. It is expected that the present data will stimulate a debate regarding prenatal genetic testing and hopefully lead to improvements in the perinatal care system with respect to genetic counseling in Japan.

DOI： 10.1002/pd.4539

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先天性第Ⅴ因子欠乏症を合併した妊婦の一例.

安藤まり, 瀬川友功, 佐藤麻夕子, 衛藤英理子, 延本悦子, 早田桂, 増山寿, 平松祐司, 木村吉宏

現代産婦人科 64 ( 1 ) 131 - 134 2015

Language：Japanese Publisher：中国四国産科婦人科学会

先天性第V因子欠乏症は、発症頻度100万人に1人といわれる稀な疾患である。今回、術前検査の凝固能異常から本疾患が判明した症例を経験したので報告する。38歳女性、1経妊1経産。出血傾向の既往や家族歴はなかった。自然妊娠後、経過順調であったが、骨盤位のため選択的帝王切開術とした。術前検査で凝固能異常を認め、妊娠36週、精査加療目的で血液内科に紹介となった。初診時、プロトロンビン時間(PT)48%(正常値:80〜120%)、活性化部分トロンボプラスチン時間(APTT)47秒(正常値:25〜36秒)と延長していた。凝固因子検査で第V因子活性が3%未満と低値で、先天性第V因子欠乏症と診断された。妊娠39週2日、入院管理のもと新鮮凍結血漿(FFP)15単位を輸血した。妊娠39週3日、手術開始前にFFP5単位投与を追加した。術直前の血液検査でPT77%、APTT31.9秒に改善していることを確認し、全身麻酔下での予定帝王切開術を施行した。術中出血量は、羊水込みで約2020mlと多かったが、子宮収縮不良による弛緩出血が主な原因であり、創部の止血や悪露の排出量に異常はなかった。FFPは、術終了後から術後3日目までは5単位、術後4日目から術後5日目までは2単位を12時間毎に輸血をした。期間中に出血傾向を認めず、術後6日目以降はFFPの追加補充を行うことはなかった。経過良好で術後7日目に退院となった。先天性第V因子欠乏症は、臨床症状が軽微なことから未診断の症例があるとされており、術前スクリーニングで凝固機能異常を認めた場合には本疾患を念頭において精査する必要があると考える。(著者抄録)

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特殊型子宮体癌(Mixed type、Pure type、類内膜腺癌Grade3)の臨床・予後因子に関する検討.

甲斐憲治, 中村圭一郎, 西田傑, 春間朋子, 小川千加子, 楠本知行, 関典子, 増山寿, 平松祐司

現代産婦人科 63 ( 2 ) 255 - 258 2015

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