研究者詳細 - 内田　広夫

Factors associated with bleeding after endoscopic variceal ligation in children 査読有り

Yokoyama Shinya, Ishizu Yoji, Ishigami Masatoshi, Honda Takashi, Kuzuya Teiji, Ito Takanori, Hinoki Akinari, Sumida Wataru, Shirota Chiyoe, Tainaka Takahisa, Makita Satoshi, Yokota Kazuki, Uchida Hiroo, Fujishiro Mitsuhiro

PEDIATRICS INTERNATIONAL 63 巻 ( 10 ) 頁： 1223 - 1229 2021年10月

記述言語：日本語掲載種別：研究論文（学術雑誌）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

Late postoperative complications of congenital biliary dilatation in pediatric patients: a single-center experience of managing complications for over 20 years 査読有り

SERUM MATRIX METALLOPROTEINASE-7 IN JAPANESE INFANTS WITH BILIARY ATRESIA 査読有り

Mizuochi, T; Sakaguchi, H; Konishi, KI; Yasuda, R; Kinoshita, M; Fukahori, S; Shoji, H; Yoshimaru, K; Matsuura, T; Sanada, Y; Tainaka, T; Uchida, H; Sasaki, H; Iwama, I; Fujishiro, J; Nio, M

HEPATOLOGY 74 巻頁： 1178A - 1178A 2021年10月

Amano Hizuru, Shirota Chiyoe, Tainaka Takahisa, Sumida Wataru, Yokota Kazuki, Makita Satoshi, Takimoto Aitaro, Tanaka Yujiro, Hinoki Akinari, Kawashima Hiroki, Uchida Hiroo

SURGERY TODAY 51 巻 ( 9 ) 頁： 1488 - 1495 2021年9月

記述言語：日本語掲載種別：研究論文（学術雑誌）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

An imaging study on tracheomalacia in infants with esophageal atresia: the degree of tracheal compression by the brachiocephalic artery is a good indicator for therapeutic intervention 査読有り

血清MMP-7は胆道閉鎖症の肝移植予測マーカーとなりうるか? 査読有り

安田亮輔, 坂口廣高, 深堀優, 吉丸耕一朗, 松浦俊治, 眞田幸弘, 藤代準, 田井中貴久, 内田広夫, 佐々木英之, 仁尾正記, 水落建輝

日本小児栄養消化器肝臓学会雑誌 35 巻 ( Suppl. ) 頁： 106 - 106 2021年9月

Sumida Wataru, Tainaka Takahisa, Shirota Chiyoe, Yokota Kazuki, Makita Satoshi, Takimoto Aitaro, Yasui Akihiro, Okamoto Masamune, Nakagawa Yoichi, Hinoki Akinari, Uchida Hiroo

PEDIATRIC SURGERY INTERNATIONAL 2021年8月

記述言語：日本語掲載種別：研究論文（学術雑誌）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

Urinary N-1,N-12-diacetylspermine as a biomarker for pediatric cancer: a case-control study 査読有り

Yokota Kazuki, Hinoki Akinari, Hiramatsu Kyoko, Amano Hizuru, Kawamura Machiko, Kuwatsuka Yachiyo, Tainaka Takahisa, Shirota Chiyoe, Sumida Wataru, Makita Satoshi, Okamoto Masamune, Takimoto Aitaro, Yasui Akihiro, Nakagawa Yoichi, Uchida Hiroo, Kawakita Masao

PEDIATRIC SURGERY INTERNATIONAL 2021年8月

記述言語：日本語掲載種別：研究論文（学術雑誌）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

Comparative study of open and laparoscopic Kasai portoenterostomy in children undergoing living donor liver transplantation for biliary atresia 査読有り

Takeda Masahiro, Sakamoto Seisuke, Uchida Hajime, Shimizu Seiichi, Yanagi Yusuke, Fukuda Akinari, Uchida Hiroo, Yamataka Atsuyuki, Kasahara Mureo

PEDIATRIC SURGERY INTERNATIONAL 2021年8月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：Pediatric Surgery International

Purpose: The effectiveness of laparoscopic Kasai portoenterostomy (Laparoscopic-KPE) for biliary atresia (BA) has been reported but remains controversial. We reviewed our own cases and cases described in previous studies of liver transplantation (LT) for BA after Laparoscopic-KPE to investigate the efficacy of Laparoscopic-KPE. Methods: Subjects were children of ≤ 2 years old with LT for BA after KPE who underwent Laparoscopic-KPE (n = 10) or Open-KPE (n = 115) between 2009 and 2020. Propensity score matching was performed to reduce the effect of treatment selection bias. The clinical data regarding the preoperative characteristics and surgical results were compared. Results: The rates of hypoplastic portal vein and retrograde portal vein flow were lower in the Laparoscopic-KPE group than in the Open-KPE group (0 vs. 40.0%, p = 0.02 and 0 vs. 35.0%, p = 0.04). There was no marked difference in the operation time or duration of hepatectomy. For portal vein reconstruction, a vein graft was not required in the Laparoscopic-KPE group (0 vs. 35.0%, p = 0.03). No patients in the Laparoscopic-KPE group developed portal vein complications or required re-laparotomy for bowel perforation or re-bleeding, in contrast to the Open-KPE group (0 vs. 15.0% and 0 vs. 10.0%, respectively). Conclusion: Laparoscopic-KPE may reduce postoperative complications that necessitate re-laparotomy in LT.

DOI： 10.1007/s00383-021-04994-z

Current thoracoscopic approach for mediastinal neuroblastoma in Japan-results from nationwide multicenter survey 査読有り

Kawano Takafumi, Souzaki Ryota, Sumida Wataru, Shimojima Naoki, Hishiki Tomoro, Kinoshita Yoshiaki, Uchida Hiroo, Tajiri Tatsuro, Yoneda Akihiro, Oue Takaharu, Kuroda Tatsuo, Hirobe Seiichi, Koshinaga Tsugumichi, Hiyama Eiso, Nio Masaki, Inomata Yukihiro, Taguchi Tomoaki, Ieiri Satoshi

PEDIATRIC SURGERY INTERNATIONAL 2021年8月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：Pediatric Surgery International

Background: Minimally invasive surgery (MIS) is appropriate for the treatment of some neuroblastomas (NBs); however, the indications and technical issues are unclear. This study aimed to clarify the current status of MIS for mediastinal NB in Japan. Methods: Preliminary questionnaires requesting the numbers of neuroblastoma cases in which MIS was performed from 2004 to 2016 were sent to 159 Japanese institutes of pediatric surgery. Secondary questionnaires were sent to institutions with MIS cases to collect detailed data. Results: One hundred thirty-four (84.2%) institutions returned the preliminary questionnaire and 83 institutions (52.2%) reported a total of 1496 operative cases. MIS was performed for 175 (11.6%) cases. Among the 175 cases, completed forms of 140 patients were returned and 40 (male, n = 28; female, n = 12) cases had mediastinal NB. Fourteen patients received thoracoscopic biopsy, none were converted to thoracotomy. Twenty-eight patients received MIS for radical resection, none were converted to thoracotomy. Perioperative complications (Horner’s syndrome) were recognized after radical resection in one (2.5%) case. Conclusions: MIS was performed in a limited number of mediastinal NB cases. A thoracoscopic approach would be feasible for mediastinal NB.

DOI： 10.1007/s00383-021-04998-9

Clinical characteristics and outcomes of the right congenital diaphragmatic hernia compared to the left: a 10-year single-center experience 査読有り

Okamoto Masamune, Amano Hizuru, Uchida Hiroo, Hinoki Akinari, Tainaka Takahisa, Shirota Chiyoe, Sumida Wataru, Yokota Kazuki, Makita Satoshi, Takimoto Aitaro, Yasui Akihiro, Nakagawa Yoichi

PEDIATRIC SURGERY INTERNATIONAL 2021年8月

記述言語：日本語掲載種別：研究論文（学術雑誌）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

Double common bile duct associated with pancreaticobiliary maljunction 査読有り

Yamada Kenta, Ishikawa Takuya, Ohno Eizaburo, Iida Tadashi, Suzuki Hirotaka, Uetsuki Kota, Yashika Jun, Yoshikawa Masakatsu, Takami Hideki, Inokawa Yoshikuni, Uchida Hiroo, Kawashima Hiroki, Fujishiro Mitsuhiro

NAGOYA JOURNAL OF MEDICAL SCIENCE 83 巻 ( 3 ) 頁： 655 - 661 2021年8月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：Nagoya Journal of Medical Science

A 45-year-old female was admitted to the hospital with a diagnosis of acute pancreatitis. A computed tomography scan showed two extrahepatic bile ducts. Magnetic resonance cholangiopancreatography suggested a stone in one of the bile ducts. Endoscopic retrograde cholangiopancreatography revealed two extrahepatic bile ducts joining at the hilum of the liver accompanied with pancreaticobiliary maljunction. Sphincterotomy was performed and a protein plug was drained from the bile duct. Several treatment options were discussed, and the patient was treated with laparoscopic cholecystectomy without extrahepatic bile duct resection and planned to be followed up considering the risk of carcinogenesis in the bile ducts.

DOI： 10.18999/nagjms.83.3.655