記述言語：英語  

DOI： 10.1089/lap.2022.0390

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PubMed

記述言語：英語  

DOI： 10.1016/j.arcped.2022.11.016

PubMed

記述言語：英語  

DOI： 10.1186/s40792-023-01586-y

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PubMed

記述言語：英語  

DOI： 10.3389/fped.2022.1090336

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PubMed

記述言語：英語  

DOI： 10.1111/ases.13116

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PubMed

記述言語：英語  

DOI： 10.1111/ases.13119

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PubMed

記述言語：英語  

DOI： 10.1111/ped.15454

PubMed

記述言語：日本語   出版者・発行元：公益社団法人 日本地理学会  

<p>近年，ドローン空撮とSfM - MVS技術の普及により，高解像度な地形データを短時間で取得できるようになった（内山ほか，2014など）．これに加え，車の自動運転向けにLiDAR装置の需要が高まり，LiDARの小型化・高性能化・低価格化が急速に進んだ．これにより，十数万円のLiDARを用いた計測装置を活用できるようになり，LiDARを用いた地形計測が容易になった．岩佐ほか（2022)は，熊本地震の地震断層について簡易LiDAR計測を行い，数十メートル四方の比較的狭い範囲でその精度と有効性を検証している．本発表では，この装置を利用して比較的広範囲の地形計測を行い，その有効性を検討する．</p>

DOI： 10.14866/ajg.2023s.0_179

CiNii Research

記述言語：英語  

DOI： 10.3389/fped.2022.1053154

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PubMed

記述言語：英語  

DOI： 10.1186/s12894-022-01153-x

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PubMed

記述言語：英語  

DOI： 10.1016/j.jpedsurg.2022.11.018

PubMed

記述言語：英語  

DOI： 10.1007/s00383-022-05235-7

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PubMed

記述言語：英語  

DOI： 10.1007/s00383-022-05243-7

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PubMed

記述言語：英語  

DOI： 10.1007/s00383-022-05230-y

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PubMed

記述言語：英語  

DOI： 10.1186/s12887-022-03755-8

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PubMed

記述言語：英語  

DOI： 10.3389/fped.2022.1030934

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PubMed

記述言語：英語  

DOI： 10.3389/fped.2022.1005879

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PubMed

記述言語：英語  

DOI： 10.18999/nagjms.84.4.716

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PubMed

出版者・発行元：東京医学社  

DOI： 10.24479/ps.0000000254

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記述言語：英語  

DOI： 10.1007/s00595-022-02611-7

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PubMed

出版者・発行元：東京医学社  

DOI： 10.24479/ps.0000000238

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出版者・発行元：東京医学社  

DOI： 10.24479/ps.0000000234

CiNii Research

記述言語：英語  

DOI： 10.1002/jhbp.1235

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PubMed

記述言語：英語  

DOI： 10.1186/s12893-022-01738-1

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PubMed

記述言語：日本語  

DOI： 10.1007/s00383-022-05125-y

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PubMed

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記述言語：日本語  

DOI： 10.1007/s00464-022-09185-y

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PubMed

記述言語：日本語  

DOI： 10.1186/s12887-022-03207-3

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PubMed

記述言語：日本語  

DOI： 10.1007/s00464-022-09132-x

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PubMed

記述言語：日本語  

DOI： 10.18999/nagjms.84.1.148

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PubMed

記述言語：英語  

DOI： 10.4240/wjgs.v14.i1.56

PubMed

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  

DOI： 10.34410/jspbm.45.0_77

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記述言語：英語  

DOI： 10.4103/jmas.JMAS_98_21

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PubMed

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  

DOI： 10.34410/jspbm.45.0_74

CiNii Research

出版者・発行元：(株)東京医学社  

DOI： 10.24479/j00645.2022081278

CiNii Research

記述言語：日本語   出版者・発行元：Pediatric Surgery International  

Purpose: Minimally invasive examinations are particularly important in pediatric patients. Although the significance of urinary N1,N12-diacetylspermine (DiAcSpm) as a tumor marker (TM) has been reported in many types of adult cancers, its usefulness in pediatric cancers has not been reported. This may be due to urinary DiAcSpm level variations with age. This study aims to measure the normal levels of urinary DiAcSpm in healthy individuals and investigate its usefulness as a TM in childhood cancer. Methods: Urinary samples were collected from pediatric patients with and without cancer. The urinary DiAcSpm levels were measured, and the values were compared. Results: A total of 32 patients with cancer and 405 controls were enrolled in the study. Of the 32 patients, 13 had neuroblastoma, 9 had malignant lymphoma (ML), and 10 had leukemia. In the control group, the urinary DiAcSpm values markedly fluctuated among those with young age, especially infants; meanwhile, the values converged among those aged roughly 10 years and above. The sensitivity of DiAcSpm was significantly different among the three types of cancers: neuroblastoma (30.8%), ML (77.8%), and leukemia (40%). Conclusion: The urinary DiAcSpm value is a useful TM for both screening and follow-up of ML.

DOI： 10.1007/s00383-021-04987-y

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PubMed

記述言語：日本語   出版者・発行元：Pediatric Surgery International  

Purpose: The features of right-sided congenital diaphragmatic hernias (RCDHs) are quite different from those of left-sided CDHs (LCDHs). We have summarized the features of RCDHs experienced in our institution. Methods: This retrospective study analyzed the cases of patients with CDH registered at our institution between 2011 and 2020. Defects on each side were compared based on prenatal diagnosis, medical treatment, type of surgery, and outcomes. Results: A total of 101 patients underwent surgery at our institution during the neonatal period, and 11 had RCDHs. RCDHs and LCDHs were significantly different in terms of extracorporeal membrane oxygenation (36% vs. 6%, p = 0.002), patch repair (81% vs. 28%, p < 0.001), recurrence rate (36% vs. 11%, p = 0.022), and length of hospital stay (117 days vs. 51 days, p = 0.012). The severity of the fetal diagnosis did not reflect postnatal severity. All patients with RCDH survived to discharge, and there was no significant difference in survival rate between the right and left sides. Conclusion: Neonates with RCDH required more intensive treatments; however, the survival rate was comparable between RCDH and LCDH. RCDH was significantly different from LCDH and an optimal treatment strategy for RCDHs should be established.

DOI： 10.1007/s00383-021-04999-8

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PubMed

記述言語：日本語   出版者・発行元：Pediatric Surgery International  

Purpose: Tracheomalacia (TM) is a frequent complication after esophageal atresia (EA) repair. This study aimed to review patients who underwent aortopexy for TM after EA repair and to compare their imaging features. Methods: The patients who underwent thoracoscopic EA repair and contrast-enhanced computed tomography (CECT) at our hospital between 2013 and 2020 were retrospectively reviewed. The ratio of the lateral and anterior–posterior diameter of the trachea (LAR) where the brachiocephalic artery (BCA) crosses the trachea was defined. The LAR of the patients who underwent CECT for asymptomatic pulmonary disease was set as a normal reference. The Z-score of each LAR was calculated and compared between the patients that did or did not undergo aortopexy. Results: A total of 51 patients represented the controls, 5 patients underwent aortopexy, and 12 patients were discharged without surgery. The mean LARs in the patients who underwent aortopexy, did not undergo aortopexy, and controls were 3.54, 1.54, and 1.15, respectively. The mean Z-score of the aortopexy group was 21.2. After successful aortopexy, each patient’s LAR decreased to < 1.5. Conclusion: Aortopexy was preferred if the trachea was compressed by the BCA. The LAR is a useful indicator for predicting the therapeutic effect of aortopexy.

DOI： 10.1007/s00383-021-04985-0

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PubMed

記述言語：日本語  

DOI： 10.18999/nagjms.83.4.765

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PubMed

記述言語：日本語   出版者・発行元：Surgical Endoscopy  

Background: Most studies reporting the outcomes of laparoscopic ovarian prolapsed hernia operations with large sample sizes are based on intracorporeal closure, while studies on extraperitoneal closure have limited sample sizes. We proactively used the single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) technique and obtained favorable outcomes, which we report in this paper. Methods: We retrospectively reviewed patients who had undergone laparoscopic surgery for inguinal hernia at our institution. They were retrospectively classified into two groups based on the pre- or intraoperative diagnosis of hernia with a prolapsed ovary, namely the prolapse group and the non-prolapse group, respectively. The data were statistically analyzed and p < 0.05 was considered statistically significant. Results: A total of 771 subjects underwent SILPEC during the study period, including 400 girls. Among them, 63 girls were diagnosed with an ovarian prolapsed hernia. SILPEC was successfully performed through a single port in all cases, with a single exception, in whom the forceps was inserted directly through the right lower quadrant to pull up the ovary. The duration of surgery in the prolapse group was not higher than that in the non-prolapse group. During the SILPEC surgery, the ovaries were successfully reverted into the abdominal cavity by external compression of the inguinal area alone in 38 of the 63 patients. In the remaining 25 cases, the ovaries were reverted into the abdominal cavity by external compression of the inguinal area and traction of the round ligament with forceps. None of these cases failed to return to the ovaries. Conclusion: Our study results indicate that SILPEC may be performed safely for the treatment of ovarian prolapsed inguinal hernia. Since the ovary and fallopian tube are close to the internal inguinal ring due to the short round ligament, the procedure requires careful suturing with traction of the round ligament.

DOI： 10.1007/s00464-021-08777-4

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記述言語：日本語   出版者・発行元：Pediatrics International  

Background: Endoscopic variceal ligation (EVL) is a widely accepted treatment for esophagogastric varices in patients with portal hypertension (PHT). It is used for urgent treatment and prophylactic treatment of esophagogastric varices in pediatric as well as adult patients. However, major life-threatening adverse events such as early rebleeding can occur. Although early rebleeding after EVL among children and adolescents has been reported, the risk factors remain obscure. This study evaluated the risk factors for early rebleeding after EVL in children and adolescents. Methods: The subjects were children and adolescents (<18 years) with PHT who underwent EVL for esophagogastric varices. Early rebleeding was defined as hematemesis, active bleeding, or blood retention in the stomach, confirmed by esophagogastroduodenoscopy from 2 h to 5 days after EVL. Results: A total of 50 EVL sessions on 22 patients were eligible for this study. There were four episodes of early rebleeding. No other major adverse event has occurred. Multivariate analysis showed that EVL implemented at cardiac varices just below the esophagogastric junction (EGJ), within 5 mm from the EGJ, is the independent factor for a higher risk of early rebleeding: odds ratio 18.2 (95% confidence interval: 1.40–237.0), P = 0.02. Conclusions: Children and adolescents who undergo EVL for cardiac varices just below the EGJ have a higher risk of early rebleeding than those who do not.

DOI： 10.1111/ped.14614

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PubMed

記述言語：日本語   出版者・発行元：Surgery Today  

Purpose: To investigate late complications after surgery for congenital biliary dilatation (CBD). Methods: We retrospectively reviewed the patients treated for late postoperative complications of extrahepatic bile duct resection with bilioenteric anastomosis for CBD at our hospital between 1999 and 2019. Results: Twenty-seven complications, including bile duct stenosis with (n = 19) or without (n = 3) hepatolithiasis, remnant intrapancreatic bile duct (n = 2), intestinal obstruction (n = 2), and refractory cholangitis (n = 1) were treated in 26 patients. The median age at radical surgery and the initial treatment of complications was 3 years, 2 months and 14 years, 5 months, respectively. The median period from radical surgery to initial treatment of complications was 7 years, 1 month. Before 2013, bile duct stenosis was initially treated with bile duct plasty (n = 11) or hepatectomy (n = 3), and 71.4% (n = 10) of patients needed further treatment; after 2013, double-balloon endoscopic retrograde cholangiography (DBERC) was used (n = 8), and 25% (n = 2) of patients needed further treatment. Patients with remnant intrapancreatic bile duct, intestinal obstruction, and refractory cholangitis required surgery. Conclusion: Long-term follow-up is necessary after surgery for congenital biliary dilatation. DBERC is thus considered to be useful for bile duct stenosis management.

DOI： 10.1007/s00595-021-02238-0

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本小児外科学会  

<p>症例は13歳女児で，左下腹部痛を主訴に受診した．腹部CTで骨盤内に130 mm大の腫瘍を認め，左尿管および左腸骨動静脈を巻き込んでいた．腹腔鏡補助下生検で横紋筋肉腫と診断した．化学放射線療法後に腫瘍縮小を認めたため根治切除の方針とした．左総腸骨動静脈および左尿管の合併切除を伴う腫瘍摘出術を施行し，左総腸骨動脈は人工血管を用いて再建し，左尿管は右尿管に吻合する交叉性尿管尿管吻合を施行した．術後経過は良好で術後化学療法を施行し，現在術後3年3か月経過したが無再発生存中である．左尿管および左腸骨動静脈浸潤を伴う後腹膜原発横紋筋肉腫に対して，集学的治療により良好な予後が得られている症例を経験した．主要血管や尿管の合併切除を要するような横紋筋肉腫においても，各領域の専門家と連携して治療することで安全にかつ有用な治療を施行できると考える．</p>

DOI： 10.11164/jjsps.57.5_878

CiNii Research

記述言語：日本語   出版者・発行元：特定非営利活動法人 日本小児外科学会  

<p>症例は1歳9か月女児，嘔吐と発熱を主訴に前医受診，先天性胆道拡張症の診断で入院となった．入院6日目に胆道穿孔が明らかになり当科に転院し，緊急手術を行った．手術では総胆管と胆囊管合流部に約2 cm大の穿孔部を認めた．胆道ドレナージや穿孔部の修復は極めて困難であり，腹腔鏡下に一期的根治術を施行した．また，肝門部の左右胆管に強い膜様狭窄を認め胆管形成も施行した．合併症なく経過し，術後10日目に軽快退院となった．胆道穿孔をきたした先天性胆道拡張症に対する治療は二期的手術が推奨されている．一方，近年は一期的根治術が有用であるという報告が散見されるが，ほとんどは開腹手術である．今回，我々は腹腔鏡下に一期的根治術を施行した1例を経験した．胆道穿孔症例でも，腹腔鏡下胆道拡張症手術に習熟した施設において，全身状態が良好な症例であれば腹腔鏡下での一期的手術は有用であると考える．</p>

DOI： 10.11164/jjsps.57.5_855

CiNii Research

記述言語：日本語  

Web of Science

記述言語：日本語   出版者・発行元：Pediatric Surgery International  

A correction to this paper has been published: https://doi.org/10.1007/s00383-021-04873-7.

DOI： 10.1007/s00383-021-04873-7

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記述言語：日本語  

Web of Science

記述言語：日本語   出版者・発行元：Scientific Reports  

Bile duct and anastomotic strictures and intrahepatic stones are common postoperative complications of congenital biliary dilatation (CBD). We performed double-balloon endoscopic retrograde cholangiography (DBERC) for diagnostic and therapeutic purposes after radical surgery. We focused on the effectiveness of DBERC for the treatment of postoperative complications of CBD patients. Bile duct and anastomotic strictures and intrahepatic stones are common postoperative complications of congenital biliary dilatation (CBD). We performed double-balloon endoscopic retrograde cholangiography (DBERC) for diagnostic and therapeutic purposes after radical surgery. We focused on the effectiveness of DBERC for the treatment of postoperative complications of CBD patients. This retrospective study included 28 patients who underwent DBERC (44 procedures) after radical surgery for CBD between January 2011 and December 2019. Strictures were diagnosed as “bile duct strictures” if endoscopy confirmed the presence of bile duct mucosa between the stenotic and anastomotic regions, and as “anastomotic strictures” if the mucosa was absent. The median patient age was 4 (range 0–67) years at the time of primary surgery for CBD and 27.5 (range 8–76) years at the time of DBERC. All anastomotic strictures could be treated with only by 1–2 courses of balloon dilatation of DBERC, while many bile duct strictures (41.2%) needed ≥ 3 treatments, especially those who underwent operative bile duct plasty as the first treatment (83.3%). Although the study was limited by the short follow-up period after DBERC treatment, DBERC is recommended as the first-line treatment for hepatolithiasis associated with biliary and anastomotic strictures in CBD patients, and it can be safely performed multiple times.

DOI： 10.1038/s41598-021-90550-7

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出版者・発行元：(株)東京医学社  

DOI： 10.24479/j00645.2021229976

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記述言語：日本語  

DOI： 10.1200/JCO.2021.39.15_suppl.e22008

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本小児外科学会  

<p>【目的】腹腔鏡下胆道閉鎖症手術（腹腔鏡下肝門部空腸吻合術）の執刀を熟練した術者に限定する必要性の有無を明らかにすることを目的として，自施設での治療成績を後方視的に検討した．</p><p>【方法】2014年4月から2018年8月の期間中，胆道閉鎖症に対して当院で腹腔鏡下肝門部空腸吻合術を施行した35例を対象とした．腹腔鏡下肝門部空腸吻合術を5例以上経験した術者が執刀した患者（A群：12例）と執刀経験4例以下の術者が執刀した患者（B群：23例）とに分類し，手術，術後経過と術後6か月，1年，2年の各時点における無黄疸自己肝生存についてそれぞれ統計学的解析を行い比較，検討した．</p><p>【結果】A群とB群で手術日齢，体重，出血量，ドレーン抜去時期，経口開始時期に有意差は認められなかったが，手術時間はA群が有意に短かった（<i>p</i>＝0.0049）．無黄疸自己肝生存率は術後6か月（A群58.3％，B群60.9％，<i>p</i>＝0.506），術後1年（A群66.7％，B群65.2％，<i>p</i>＝0.932），術後2年（A群58.3％，B群56.5％，<i>p</i>＝0.918）でいずれの時点でも有意差は認められなかった．</p><p>【結論】今回の検討では，腹腔鏡下胆道閉鎖症手術に熟練した術者の指導の下では，執刀経験量による減黄率の有意な差は認められなかった．</p>

DOI： 10.11164/jjsps.57.3_596

CiNii Research

記述言語：日本語   出版者・発行元：特定非営利活動法人 日本小児外科学会  

<p>症例は36週4日，2,370 gで出生した腹壁破裂の女児．出生後，脱出した腸管を確認すると結腸閉鎖を合併していた．その口側盲端にはpinholeがあいていたが腹腔内の汚染はなく，一旦サイロ造設し翌日結腸閉鎖に対する手術を施行した．腸管を洗浄しながら癒着剥離を行い結腸閉鎖部の口側・肛門側を確認し，血流の十分ある部分で自動縫合器による機能的端々吻合を行った．腸管は浮腫が強く腹腔内に還納できなかったため，再度サイロを造設して手術を終了した．その後1週間かけて腸管を腹腔内に還納し，第9生日にsutureless法で腹壁閉鎖を行った．術後経過は良好で，第19生日にfull feedingとなり，第32生日に退院した．結腸閉鎖合併腹壁破裂症例では人工肛門造設が一般的であるが，自動縫合器を用いることで口径差を気にせず吻合を行うことができるため，有効な方法と考えられた．</p>

DOI： 10.11164/jjsps.57.1_22

CiNii Research

記述言語：日本語   出版者・発行元：Scientific Reports  

Urine is a complex liquid containing numerous small molecular metabolites. The ability to non-invasively test for cancer biomarkers in urine is especially beneficial for screening child patients. This study attempted to identify neuroblastoma biomarkers by comprehensively analysing urinary metabolite samples from children. A total of 87 urine samples were collected from 54 participants (15 children with neuroblastoma and 39 without cancer) and used to perform a comprehensive analysis. Urine metabolites were extracted using liquid chromatography/mass spectrometry and analysed by Metabolon, Inc. Biomarker candidates were extracted using the Wilcoxon rank sum test, random forest method (RF), and orthogonal partial least squares discriminant analysis (OPLS-DA). RF identified three important metabolic pathways in 15 samples from children with neuroblastoma. One metabolite was selected from each of the three identified pathways and combined to create a biomarker candidate (3-MTS, CTN, and COR) that represented each of the three pathways; using this candidate, all 15 cases were accurately distinguishable from the control group. Two cases in which known biomarkers were negative tested positive using this new biomarker. Furthermore, the predictive value did not decrease in cases with a low therapeutic effect. This approach could be effectively applied to identify biomarkers for other cancer types.

DOI： 10.1038/s41598-021-83619-w

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記述言語：日本語   出版者・発行元：Pediatric Surgery International  

Purpose: This study aimed to investigate the negative effects of intestinal obstruction for jaundice-free native liver survival after Kasai portoenterostomy (PE) for biliary atresia (BA). Methods: We retrospectively reviewed the records of patients who underwent PE for BA between 2006 and 2019. We evaluated the postoperative morbidity of intestinal obstruction for up to 2 years after PE and the effects of intestinal obstruction on jaundice-free native liver survival. On the basis of their initial operation, patients were divided into open portoenterostomy (Open-PE) and laparoscopic portoenterostomy (Lap-PE) groups, and morbidity was compared. Results: Of the 87 patients reviewed, 6 (6.9%) patients developed postoperative intestinal obstruction and underwent surgery to relieve the obstruction. The morbidity of early postoperative intestinal obstruction was 1.68 per 10,000 person days. The jaundice-free native liver survival rate among patients who once achieved jaundice-free status after PE was significantly lower in the patients with intestinal obstruction compared to in those without intestinal obstruction (0% vs. 73.8%; RR = 3.81, p = 0.007). No significant differences were seen in postoperative intestinal obstructions between the Open-PE and Lap-PE groups (p = 0.242). Conclusions: Intestinal obstruction negatively impact jaundice-free native liver survival, even in patients who once achieved jaundice-free status after PE for BA.

DOI： 10.1007/s00383-020-04807-9

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PubMed

記述言語：日本語   出版者・発行元：Pediatric Surgery International  

Purpose: Although we generally perform thoracoscopic lobectomy for congenital lung cysts (CLCs), we recently began performing thoracoscopic-limited pulmonary resection (segmentectomy or small partial lung resection) on relatively small lesions and on lesions involving multiple lobes. Our study aimed to determine the therapeutic outcomes of thoracoscopic CLC surgery. Methods: We retrospectively reviewed patients aged ≤ 18 years who underwent their first CLC surgery at our facility between 2013 and 2020. Results: A comparison between patients < 4 months old and those ≥ 4 months old showed no significant difference in operating time or incidence of complications. Blood loss volume (mL/kg) was significantly greater in patients < 4 months old and in patients who had undergone semi-urgent or urgent surgery. Operating time and postoperative complications were not increased in semi-urgent or urgent surgeries. There was no significant difference in operating time, blood loss volume, or postoperative complications between patients with a preoperative history of pneumonia and patients with no such history. Conclusion: In most patients, thoracoscopic surgery for CLC was safely performed. Limited pulmonary resection is considered difficult to perform thoracoscopically in children, but can be safely performed using new devices and navigation methods. Level of evidence: III.

DOI： 10.1007/s00383-020-04793-y

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Scopus

PubMed

記述言語：日本語   出版者・発行元：Pediatric Surgery International  

Purpose: One of the main causes of stricture at hepaticojejunostomy site after surgery for congenital biliary dilatation is inflammation or infection associated with bile leak. The aim of this study was to determine the risk factors and outcomes of bile leak after laparoscopic surgery. Methods: We retrospectively reviewed the demographics and outcomes of patients who underwent laparoscopic surgery for congenital biliary dilatation between September 2013 and December 2019. Data from patients with bile leak were compared to data from patients without bile leak. Results: Fourteen of 78 patients had bile leak. Hepatic duct diameter at anastomosis was the only risk factor of bile leak. Patients with the diameter ≤ 10 mm had higher incidence of bile leak than in patients with the diameter > 10 mm (P = 0.0023). Among them, bile leak occurred more frequently in patients operated on by non-qualified surgeons based on the Japan Society for Endoscopic Surgery endoscopic surgical skill qualification system than by qualified surgeons (P = 0.027). However, none of the patients with bile leak developed anastomotic stricture afterwards. Conclusion: Although good technical skill is necessary to avoid bile leak in narrow hepatic duct cases (≤ 10 mm), slight bile leak may not result in anastomotic stricture.

DOI： 10.1007/s00383-020-04791-0

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Scopus

PubMed

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  

DOI： 10.34410/jspbm.44.0_50

CiNii Research

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  

DOI： 10.34410/jspbm.44.0_72

CiNii Research

出版者・発行元：(株)東京医学社  

DOI： 10.24479/j00645.2021085587

CiNii Research

記述言語：日本語   出版者・発行元：BMC Surgery  

Background: In cases of Hirschsprung disease, complete and reproducible resection of the aganglionic bowel is ideal to achieve good postoperative bowel function. Reliable identification of the upper margin of the surgical anal canal, which is the squamous-columnar junction, is necessary during transanal pull-through. Here, we describe a novel staining technique using Lugol’s iodine stain to visualize the upper margin of the surgical anal canal. Methods: Lugol’s iodine staining was performed in five patients with Hirschsprung disease treated using a single-stage laparoscopic transanal pull-through modified Swenson procedure. In two of these patients, endocytoscopic observation with ultra-high magnification was performed using methylene blue and crystal violet to mark the border of the squamous epithelium at 1 week before surgery. The alignment between the incisional line, which was revealed using Lugol’s iodine staining and endocytoscopic marking, was evaluated. Complications, including postoperative bowel dysfunction, were evaluated. Results: In all cases, Lugol’s iodine staining produced a well-demarcated line. The endocytoscopic marking of the upper margin of the surgical anal canal was aligned with the line revealed by Lugol’s iodine staining. There were no complications associated with the transanal pull-through procedure, including postoperative bowel dysfunction. Conclusions: Lugol’s iodine staining could be a safe and practical method to visualize the upper margin of the surgical anal canal intraoperatively. This finding may be useful for surgeons to make a consistent removal of the aganglionic bowel during surgery for Hirschsprung disease.

DOI： 10.1186/s12893-020-00986-3

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Scopus

PubMed

記述言語：日本語   出版者・発行元：Surgical Endoscopy  

Background: Native liver survival after laparoscopic Kasai portoenterostomy (Lap-PE) for biliary atresia (BA) is controversial. We examined whether a jaundice-free native liver survival rate is comparable between conventional Kasai portoenterostomy (Open-PE) and Lap-PE. Then, the impact of the two types of PE on subsequent living-donor liver transplantation (LTx) was addressed in this study. Methods: The jaundice-free rate in 1- and 2-year-old patients who underwent Open-PE and Lap-PE from January 2006 to December 2017 was investigated. Additionally, perioperative data (duration from the start of surgery to the completion of hepatectomy and others) of patients aged 2 years or younger who underwent LTx after either Open-PE or Lap-PE from 2006 to 2017 were evaluated. Results: Thirty-one (67%) out of 46 Open-PE patients and 23 (77%) out of 30 Lap-PE patients showed native liver survival with jaundice-free status at 1 year of age (p = 0.384); 29 (63%) out of 46 Open-PE patients and 19 (70%) out of 27 Lap-PE patients showed native liver survival with jaundice-free status at 2 years of age (p = 0.524); there were no significant differences. Additionally, there were 37 LTx cases after PE within 2 years of birth, including 29 Open-PE and 8 Lap-PE cases. The patients in the Lap-PE group had fewer adhesions and significantly shorter durations of surgery up to the completion of the recipient’s hepatectomy and durations of post-LTx hospital stay compared to the Open-PE group. There were no differences in blood loss or duration of stay in intensive care unit between the Lap-PE and Open-PE groups. Conclusions: Jaundice-free native liver survival rate has been comparable between Open-PE and Lap-PE. Lap-PE resulted in fewer adhesions, contributing to better outcomes of subsequent LTx compared to Open-PE.

DOI： 10.1007/s00464-019-07108-y

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Scopus

PubMed

記述言語：日本語   出版者・発行元：特定非営利活動法人 日本小児外科学会  

<p>症例は6歳男児．腹痛を主訴に受診．腹部CTで腹腔内遊離ガス像を認めたが穿孔部位を同定することはできなかった．穿孔性腹膜炎の診断で緊急手術を施行した．臍に逆Y字切開（以下，Benz切開）をおき，multi-channel port（5 mm port 2本）を装着して腹腔鏡で腹腔内を観察した．回腸に炎症所見を認め創外へ引き出すと，回腸末端から40 cm口側に3 cm大の囊胞状構造を認め，基部で穿孔していた．回腸重複腸管穿孔と診断して，小腸部分切除を施行した．今回，術前診断が困難であった重複腸管穿孔というまれな疾患に対して，創を延長することなく単孔式腹腔鏡補助下手術を完遂した．Benz切開を用いた単孔式腹腔鏡補助下手術は，小児における急性腹症の診断，治療を行う上で有用であった．</p>

DOI： 10.11164/jjsps.56.3_330

CiNii Research

記述言語：日本語   出版者・発行元：BMC Pediatrics  

Background: The fundamental treatment for patients with pediatric malignant mediastinal tumors is chemotherapy. Therefore, accurate diagnosis is essential for selecting the appropriate chemotherapeutic regimen. However, malignant mediastinal tumors occasionally cause respiratory distress, and biopsies under general anesthesia are dangerous for such patients as invasive mechanical ventilation can aggravate airway obstruction caused by mass effect. In this study, we reviewed our 10-year diagnostic experience to evaluate the efficacy of our practices and confirm a safe diagnostic protocol for future patients. Methods: We retrospectively reviewed medical records of children with malignant mediastinal tumors diagnosed at Nagoya University Hospital from 2007 to 2018 who demonstrated respiratory distress. Respiratory distress included dyspnea, massive pleural effusion, wheezing, and hypoxemia owing to tumors. Data on sex, age at onset, primary symptoms, location of tumor, management strategy (especially the method of diagnosis and definitive diagnosis), clinical course, prognosis during the acute phase (within 3 months from the onset of respiratory symptoms), and long-term outcome were collected. Results: Twelve pediatric patients met the review criteria. There were seven anterior mediastinal tumors and five posterior mediastinal tumors. All anterior mediastinal tumors were diagnosed via bone marrow smear, thoracentesis, or core needle biopsy while maintaining spontaneous breathing. Regarding posterior tumors, two patients were diagnosed via a core needle biopsy and lymph node excisional biopsy under spontaneous breathing. Two cases were initially diagnosed solely using tumor markers. One patient with severe tracheal compression underwent tumor resection with extracorporeal membrane oxygenation stand-by. No patient died of diagnostic procedure-related complications. Conclusions: In 11 of the 12 cases reviewed, safe and accurate tumor diagnosis was accomplished without general anesthesia. A diagnostic strategy without general anesthesia considering the tumor location proved to be useful.

DOI： 10.1186/s12887-020-02183-w

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Scopus

PubMed

出版者・発行元：(株)東京医学社  

DOI： 10.24479/j00645.2020230886

CiNii Research

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  

DOI： 10.34410/jspbm.43.0_84

CiNii Research

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  

DOI： 10.34410/jspbm.43.0_36

CiNii Research

記述言語：日本語  

Web of Science

出版者・発行元：(株)東京医学社  

DOI： 10.24479/j00645.2020041175

CiNii Research

記述言語：日本語   出版者・発行元：Pediatric Surgery International  

Purpose: High-dose postoperative steroid therapy after Kasai portoenterostomy is reported to improve jaundice clearance and a strong anti-inflammatory activity might prevent fibrous tissue formation which is often observed at the porta hepatis in revision surgery. We started steroid pulse therapy for the patients with cessation of decrease in jaundice and aimed to evaluate the efficacy in this study. Methods: The demographics and outcomes of patients who underwent laparoscopic Kasai portoenterostomy and received steroid pulse therapy within 2 months postoperatively between September 2014 and December 2018 were retrospectively reviewed; the therapy was determined successful when the serum total bilirubin level decreased to or below two-thirds of the pre-therapy level after 2 weeks. Patient data in the successful group were compared with those in the unsuccessful group. Results: Steroid pulse therapy was successful in seven of 16 patients (43.8%). The percentage of patients whose serum total bilirubin level decreased to normal was significantly higher in the successful group at 3 months (85.7% vs. 11.1%, P = 0.0028) and after all (100% vs. 33.3%, P = 0.011). Conclusions: Steroid pulse therapy was effective for some patients. Unsuccessful cases may have little chances of jaundice clearance; revision Kasai portoenterostomy would be a good option.

DOI： 10.1007/s00383-019-04537-7

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Scopus

PubMed

記述言語：日本語   出版者・発行元：Pediatric Surgery International  

Purpose: Thoracoscopic repair can be safely performed in most types of congenital esophageal atresia (EA), including in patients with long gap EA or very low birth weight. Accordingly, we performed single- or multistage thoracoscopic repair for various EA types. We aimed to report our therapeutic strategy for thoracoscopic radical surgery for treating EA and its outcome. Methods: Outcomes of radical surgeries for treating congenital EA at our institute from 2013 to 2018 were retrospectively evaluated. Results: Thirty-eight radical surgeries were evaluated: 3 Gross type-A, 1 type-B, 30 type-C, 1 type-D, and 3 type-E. The cervical approach was performed in 5 cases and thoracoscopic esophageal anastomosis in 33, including 26 single-stage (all type-C) and 7 multistage surgeries (3 type-A, 3 type-C, and 1 type-D). There were no cases of thoracotomies or intraoperative thoracoscopic surgery complications. Three cases of minor leakage were conservatively resolved. Three postoperative chylothorax surgeries (9%) and seven balloon dilatations (21%) for anastomotic stenosis were performed. Conclusion: Thoracoscopic radical surgery for treating EA, including single- and multistage procedures, can be performed, except in type-E cases or when the end of the proximal esophagus is located higher than the clavicle.

DOI： 10.1007/s00383-019-04541-x

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Scopus

PubMed

記述言語：日本語   出版者・発行元：Pediatric Surgery International  

Purpose: Anovestibular fistula (AVF) is the most common type of anorectal malformation in females. Delayed anorectoplasty with fistula dilatation is commonly performed during infancy; however, we have been actively performing anorectoplasty in neonates. We report the surgical complications and postoperative defecation function associated with single-stage anorectoplasty performed in neonates. Methods: Patients who underwent surgery for AVF between 2007 and 2017 at two institutions were retrospectively studied. The operation time, amount of bleeding, time to start oral intake, perioperative complications, and Kelly’s score were compared among patients who underwent surgery as neonates and those who underwent surgery as infants. Results: Eighteen neonates and 17 infants underwent anterior sagittal anorectoplasty. The median operation time and time to start oral intake were significantly shorter in the neonatal group (72 min; 3 days, respectively) than in the infant group (110 min, p = 0.0002; 5 days, p = 0.0024, respectively). Postoperative wound disruption was significantly more frequent in the infant group. Of the ten patients each in the neonatal and infant groups, there was no significant difference in Kelly’s score at age ≥ 4 years. Conclusion: Single-stage anorectoplasty in neonates with AVF can be feasibly performed and does not impair postoperative defecation function. Levels of evidence: III.

DOI： 10.1007/s00383-018-4324-3

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Scopus

PubMed

記述言語：日本語   出版者・発行元：Pediatric Surgery International  

Purpose: Laparoscopic-assisted anorectoplasty (LAARP) is a minimally invasive procedure in which the levator ani muscle is left to potentially improve postoperative fecal continence. This study aimed to retrospectively evaluate postoperative complications and long-term outcomes of fecal continence after LAARP and compare them to those after posterior sagittal anorectoplasty (PSARP). Methods: Forty-five male patients with high and intermediate anorectal malformation (aged ≥ 4 years) who underwent LAARP or PSARP (LAARP 29, PSARP 16) from 1999 to 2013 were included. Postoperative complications and postoperative fecal continence were retrospectively evaluated and compared. Postoperative complications were also compared before and after introducing a urethroscope during fistula resection. Results: Complications after LAARP and PSARP were seen in 12 vs. 2 cases (p = 0.09) of mucosal prolapse and in 9 vs. 1 case (p = 0.07) of posterior urethral diverticulum (PUD), respectively. The incidence of PUD decreased after introduction of a urethroscopy from 40% in 8/20 cases to 11% in 1/9 cases. No significant difference was found in terms of fecal continence in both groups. Conclusion: Through our study, greater improvement of postoperative fecal continence after LAARP has not been shown. LAARP was at higher risk for mucosal prolapse and PUD. However, precise dissection of the urethral fistula could be performed after the introduction of urethroscopy.

DOI： 10.1007/s00383-018-4323-4

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Scopus

PubMed

記述言語：日本語   出版者・発行元：Surgery Today  

Purpose: We aimed to identify the risk factors for thoracic and spinal deformities following lung resection during childhood and to elucidate whether thoracoscopic surgery reduces the risk of complications after lung resection. Methods: We retrospectively examined the medical records of all pediatric patients who underwent lung resection for congenital lung disease at our institution between 1989 and 2014. Results: Seventy-four patients underwent lung resection during the study period and were followed-up. The median age of the patients at the time of surgery was 5 months (range 1 day–13 years), and 22 were neonates. Thoracotomy and thoracoscopy were performed in 25 and 49 patients, respectively. Thoracic or spinal deformities occurred in 28 of the 74 patients (37%). Univariate analyses identified thoracotomy, being a neonate (age: <1 month) at the time of surgery, and being symptomatic at the time of surgery as risk factors for these deformities. However, a multivariate analysis indicated that only thoracotomy and being a neonate were risk factors for deformities. Conclusions: Thoracoscopic surgery reduced the risk of thoracic and spinal deformities following lung resection in children. We suggest that, where possible, lung resection should be avoided until 2 or 3 months of age.

DOI： 10.1007/s00595-016-1434-1

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Scopus

PubMed