研究者詳細 - 城田　千代栄

NON-INVASIVE SCREENING FOR DETECTING ESOPHAGOGASTRIC VARICES IN CHILDREN WITH BILIARY ATRESIA

Yokoyama, S; Ishigami, M; Honda, T; Kuzuya, T; Ishizu, Y; Ito, T; Shirota, C; Uchida, H; Fujishiro, M

HEPATOLOGY 70 巻頁： 200A - 200A 2019年10月

Spleen stiffness by 2-D shear wave elastography is the most accurate predictor of high-risk esophagogastric varices in children with biliary atresia

Yokoyama, S; Ishigami, M; Honda, T; Kuzuya, T; Ishizu, Y; Ito, T; Hirooka, Y; Tanaka, Y; Tainaka, T; Shirota, C; Chiba, K; Uchida, H; Fujishiro, M

HEPATOLOGY RESEARCH 49 巻 ( 10 ) 頁： 1162 - 1168 2019年10月

記述言語：英語出版者・発行元：Hepatology Research

Aim: Esophagogastric variceal hemorrhage is a cause of poor prognosis in patients with biliary atresia (BA). To prevent variceal hemorrhage, simple and reliable screening methods for high-risk esophagogastric varices (HR-EGV) are needed. We evaluated the efficacy of liver stiffness (LS) and spleen stiffness (SS) as measured by 2-D shear wave elastography (2D-SWE), which was reported to be more accurate than transient elastography, for detecting HR-EGV in children with BA. Methods: Thirty-four children with BA were enrolled. Both LS and SS were measured by 2D-SWE. The presence of large esophageal varices or esophageal varices of any size with red wale marking and/or the presence of gastric varices along the cardia were defined as HR-EGV. Clinical data were collected and previously reported prediction indices for varices were calculated. Results: Liver stiffness and SS were obtained from all patients. Fourteen patients showed HR-EGV. Significantly different variables between patients with and without HR-EGV were as follows: spleen diameter (116 mm vs. 95 mm), clinical prediction rule (104.7 vs. 124.7), King's variceal prediction score (78.8 vs. 99.4), aspartic aminotransferase-to-platelet ratio index (2.03 vs. 0.98), LS (2.63 m/s vs. 1.87 m/s), and SS (4.44 m/s vs. 3.69 m/s). The highest area under the receiver operating characteristic curve for detecting HR-EGV was that for SS (0.900), and the cut-off SS of 4.12 m/s yielded 92.9% sensitivity and 90% specificity. The intraclass correlation coefficient for intra-observer reproducibility was 0.828. Conclusions: Spleen stiffness from 2D-SWE offered the most accurate predictor of HR-EGV in BA children.

DOI： 10.1111/hepr.13381

Nuss procedure for patients with pectus excavatum with a history of intrathoracic surgery

Takanari, K; Toriyama, K; Kambe, M; Nakamura, Y; Uchibori, T; Ebisawa, K; Shirota, C; Tainaka, T; Uchida, H; Kamei, Y

JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY 72 巻 ( 6 ) 頁： 1025 - 1029 2019年6月

記述言語：英語出版者・発行元：Journal of Plastic, Reconstructive and Aesthetic Surgery

Background: The aim of this study was to demonstrate the feasibility and safety of the Nuss procedure for patients with pectus excavatum (PE) with a history of intrathoracic surgery. Patients: From April 2010 to December 2013, we performed 6 cases of PE repair in patients with a history of intrathoracic surgery. The causes of previous operations were congenital cystic adenomatoid malformation in 4 patients and congenital diaphragmatic hernia in 2. The patients’ median age was 5 years (range, 4–9 years) and median preoperative pectus severity index was 4.63 (range, 3.42–10.03). Their intraoperative and postoperative courses were reviewed retrospectively. Results: The mean overall operation time was 127.5 ± 17.0 minutes, and the mean operation time for endoscopic pneumolysis was 28.8 ± 12.3 minutes. Intraoperative exploration for pleural adhesion revealed that the endoscopic approach in the previous operation was associated with low pleural adhesion, and the open thoracotomy or laparotomy approach was associated with low to high pleural adhesion. One patient developed a pneumothorax on the first postoperative day. All the other patients had uneventful postoperative courses. All the patients received bar removal 2–3 years after bar insertion. One patient developed atelectasis after bar removal. All the other patients had an uneventful postoperative course. The mean postoperative follow-up time after bar removal was 20.1 ± 14.7 months. Conclusions: History of intrathoracic surgery seems not a contraindication for the Nuss procedure. However, perioperative complications should be carefully monitored in both the bar insertion and removal operations.

DOI： 10.1016/j.bjps.2018.12.027

A Novel Laparoscopic Surgery Model with a Device to Expand the Abdominal Working Space in Rats: The Influence of Pneumoperitoneum and Skin Incision Length on Postoperative Inflammatory Cytokines

Murase, N; Tainaka, T; Uchida, H; Hinoki, A; Shirota, C; Yokota, K; Oshima, K; Shirotsuki, R; Chiba, K; Tanaka, Y

JOURNAL OF INVESTIGATIVE SURGERY 32 巻 ( 1 ) 頁： 55 - 60 2019年1月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Investigative Surgery

Purpose: Experimental models of laparoscopic surgery generally use large animals owing to a sufficient abdominal working space. We developed a novel laparoscopic surgery model in rats. We performed intestinal anastomosis to demonstrate the feasibility and reliability of this model. Materials and Methods: We designed a device for rats that expanded the abdominal working space and allowed us to manipulate the intraperitoneal organs by hand under direct vision with pneumoperitoneum. We performed small bowel resection and intestinal anastomosis in rats using this model. To elucidate the effects of pneumoperitoneum and skin incision length, rats were randomly divided into four groups with differing surgical techniques: small incision group, large incision group, small incision + pneumoperitoneum group, and large incision + pneumoperitoneum group. Intraoperative abdominal pressure and postoperative cytokines were measured. Results: One experimenter completed small bowel resection and hand-sewn anastomosis under direct vision without any difficulties or assistance. Carbon dioxide pneumoperitoneum was maintained at 8–10 mmHg during surgery in both pneumoperitoneum groups. Necropsies revealed no evidence of anastomotic leakage at 24 h after surgery. The interleukin-6 and C-reactive protein concentrations were significantly greater in large incision group than in small incision group, but were not significantly different between small incision + pneumoperitoneum group and small incision group. These cytokines concentrations were the greatest in large incision + pneumoperitoneum group. Conclusions: Our laparoscopic surgery model in rats is a simple and reliable experimental model. The length of skin incision might be a more influential determinant of surgical invasiveness than pneumoperitoneum.

DOI： 10.1080/08941939.2017.1366603

Air test as a simple method of screening for Hirschsprung's disease

Sumida, W; Uchida, H; Ono, Y; Tanaka, Y; Tainaka, T; Shirota, C; Yokota, K; Oshima, K; Chiba, K

CLINICAL RADIOLOGY 73 巻 ( 12 ) 頁： 1041 - 1045 2018年12月

記述言語：英語出版者・発行元：Clinical Radiology

Aim: To present the technique and the diagnostic accuracy of the air test to diagnose Hirschsprung's disease (HD). Materials and methods: Children who attended hospital for chronic constipation (CC) between January 2012 and December 2016 for whom the air test was performed were enrolled. The test was conducted during contrast enema under fluoroscopic observation using 20–50 ml injections of air into the rectum through a 10 F Nelaton catheter. The demographics, results of the air test, and additional examinations, as well as the outcomes of subsequent treatments were analysed retrospectively. Results: The air test was conducted in 179 patients (median: 3 years, range: 0–14 years), and was positive in 150 and negative in 29 cases. Of the 29 patients with negative results, four were diagnosed with HD by rectal suction biopsy (RSB). Of the remaining 25 patients, RSB was conducted in seven and HD was excluded in all cases. In all 150 patients with positive air test results, CC was adequately controlled with conservative treatment. The sensitivity and specificity of the air test were 100% (4/4) and 85.7% (150/175), respectively. Conclusions: The air test can be used as a new non-invasive screening method for HD, performed simultaneously with contrast enema.

DOI： 10.1016/j.crad.2018.08.008

Investigation of the feasibility and safety of single-stage anorectoplasty in neonates with anovestibular fistula 査読有り

Shirota, C; Suzuki, K; Uchida, H; Kawashima, H; Hinoki, A; Tainaka, T; Sumida, W; Murase, N; Oshima, K; Chiba, K; Makita, S; Tanaka, Y

PEDIATRIC SURGERY INTERNATIONAL 34 巻 ( 10 ) 頁： 1117 - 1120 2018年10月

記述言語：英語掲載種別：研究論文（学術雑誌）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

Introduction of resection of intrahepatic bile duct stenosis-causing membrane or septum into laparoscopic choledochal cyst excision

Tanaka, Y; Tainaka, T; Sumida, W; Hinoki, A; Shirota, C; Murase, N; Oshima, K; Shirotsuki, R; Chiba, K; Uchida, H

PEDIATRIC SURGERY INTERNATIONAL 34 巻 ( 10 ) 頁： 1087 - 1092 2018年10月

記述言語：英語出版者・発行元：Pediatric Surgery International

Purpose: We previously showed that meticulous probing and resection of the intrahepatic bile duct stenosis (IHBDS)-causing membrane or septum was effective in preventing hepatolithiasis after choledochal cyst excisions in open surgeries. Then, we introduced this maneuver into laparoscopic choledochal cyst excisions in 2014 and performed routine resections since then. The aim of this study was to show the feasibility of this method in laparoscopic surgery. Methods: We retrospectively reviewed the demographics and outcomes of patients who underwent laparoscopic choledochal cyst excisions at our hospital between January 2014 and December 2017. The patients who underwent surgical treatment for IHBDS-causing membrane or septum were compared with those who did not undergo the procedure. The outcomes of the patients with IHBDS were also compared between patients who were ≥ 3 years of age and those < 3 years at operation. Results: Seventeen of 35 patients underwent laparoscopic resection of IHBDS-causing membrane or septum. There were no complications related to the procedure although the operative time and intraoperative bleeding amount increased in the patients with IHBDS who were ≥ 3 years of age. Conclusions: Meticulous probing and excision of the IHBDS-causing membrane or septum is safe and feasible during laparoscopic choledochal cyst excision.

DOI： 10.1007/s00383-018-4320-7

Long-term outcomes and complications after laparoscopic-assisted anorectoplasty vs. posterior sagittal anorectoplasty for high- and intermediate-type anorectal malformation

Tainaka, T; Uchida, H; Tanaka, Y; Hinoki, A; Shirota, C; Sumida, W; Yokota, K; Makita, S; Oshima, K; Chiba, K; Ishimaru, T; Kawashima, H

PEDIATRIC SURGERY INTERNATIONAL 34 巻 ( 10 ) 頁： 1111 - 1115 2018年10月

記述言語：英語出版者・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

Single-stage laparoscopic transanal pull-through modified Swenson procedure without leaving a muscular cuff for short- and long-type Hirschsprung disease: a comparative study

Yokota, K; Uchida, H; Tainaka, T; Tanaka, Y; Shirota, C; Hinoki, A; Kato, T; Sumida, W; Oshima, K; Chiba, K; Ishimaru, T; Kawashima, H

PEDIATRIC SURGERY INTERNATIONAL 34 巻 ( 10 ) 頁： 1105 - 1110 2018年10月

記述言語：英語出版者・発行元：Pediatric Surgery International

Purpose: The Soave procedure (SO) is performed most commonly for Hirschsprung disease. SO reduces the risk of injury to the pelvic structures; however, a residual aganglionic muscle cuff could interfere with bowel movement and lead to obstructive enterocolitis. The Swenson procedure is considered ideal in terms of peristalsis. Currently, laparoscopic surgery provides better visualization and facilitates precise dissection, possibly leading to feasible performance of the laparoscopic modified Swenson procedure (SW). We present our operative technique and the efficacy of the SW compared with that of SO. Methods: We retrospectively reviewed the records of 16 and 27 patients who underwent SW and SO, respectively, between 2012 and 2017. Results: Operative time, blood loss, length of stay, and frequency of bowel movements showed no significant difference between the two groups. In the SW group, temporary dysuria occurred in one patient, postoperative enterocolitis in two, wound infection in one, and severe perianal excoriation in four, whereas in the SO group, obstructive symptoms occurred in three patients, small-bowel obstruction in one, and severe perianal excoriation in three. The complications and outcomes were comparable between both groups. Conclusion: Laparoscopic SW was safe and feasible for the short-term follow-up outcomes.

DOI： 10.1007/s00383-018-4318-1

Oral administration of eicosapentaenoic acid suppresses liver fibrosis in postoperative patients with biliary atresia

Sumida, W; Uchida, H; Tainaka, T; Shirota, C; Hinoki, A; Kato, T; Yokota, K; Oshima, K; Shirotuki, R; Chiba, K; Tanaka, Y

PEDIATRIC SURGERY INTERNATIONAL 34 巻 ( 10 ) 頁： 1059 - 1063 2018年10月

記述言語：英語出版者・発行元：Pediatric Surgery International

Purpose: Biliary atresia (BA) is characterized by progressive inflammation of the biliary system. This inflammation persists and causes liver fibrosis, although jaundice disappears after Kasai portoenterostomy (KP). We aimed to confirm whether the oral administration of eicosapentaenoic acid (EPA) suppresses liver fibrosis in postoperative patients with BA. Methods: We reviewed patients who underwent laparoscopic KP (lapKP) between January 2014 and September 2017. From December 2016, 30 mg/kg/day of EPA was orally administered to patients who opted to take medicine (EPA group). Patients who did not receive EPA were assigned to the non-EPA group. Mac-2 binding protein sugar chain modified isomer (M2BPGi) and hyaluronic acid (HA) levels were compared between the two groups in patients showing disappearance of jaundice at 6 months after the first lapKP. Results: Seventeen patients in the non-EPA group and 11 in the EPA group were enrolled. At 6 months after the first lapKP, 10 patients in the non-EPA group and six in the EPA group were without jaundice. M2BPGi and HA levels were significantly lower in the EPA group. Conclusions: Liver fibrosis was suppressed in patients without jaundice 6 months after lapKP, who were administered EPA. We believe that periductular inflammation was alleviated by EPA supplementation.

DOI： 10.1007/s00383-018-4313-6

特集小児外科における消化器内視鏡外科手術胆道閉鎖症に対する腹腔鏡下肝門部空腸吻合術

内田広夫, 田中裕次郎, 田井中貴久, 城田千代栄, 住田亙, 村瀬成彦

手術 72 巻 ( 6 ) 頁： 861 - 870 2018年5月

保存的治療で軽快した特発性大網捻転症の1例

横田一樹, 内田広夫, 田中裕次郎, 田井中貴久, 城田千代栄, 檜顕成, 住田亙, 加藤充純, 大島一夫, 千馬耕亮

日本小児外科学会雑誌 54 巻 ( 2 ) 頁： 302 - 306 2018年

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>特に既往のない5歳男児．発熱と下腹部痛を認め，急性虫垂炎の疑いで当院を紹介受診した．血液検査で炎症反応の上昇を認めたもののCTでは虫垂の腫大はなく，上行結腸の壁肥厚を認めたため急性腸炎の診断で抗菌薬投与を開始した．再度CTを見直したところ渦巻き状を呈する脂肪吸収値腫瘤を認め，特発性大網捻転症と診断した．症状は軽快していたためこのまま保存的治療を継続し，4日目に軽快退院した．大網捻転症は特に小児では比較的稀な疾患であり，過去においては手術治療が原則とされてきたため，保存的治療例の報告は少ない．症状が類似しているため急性虫垂炎などと診断されて手術が行われる例も多いが，近年はCTなどの画像診断技術の進歩により診断が可能な例が増えてきた．大網捻転症の中には保存的治療が可能なものもあり，大網捻転症と診断できた場合は保存的治療も選択肢の一つとして考慮するべきと考えられた．</p>

DOI： 10.11164/jjsps.54.2_302

CiNii Research

The efficacy of resection of intrahepatic bile duct stenosis-causing membrane or septum for preventing hepatolithiasis after choledochal cyst excision

Tanaka, Y; Tainaka, T; Sumida, W; Shirota, C; Hinoki, A; Murase, N; Oshima, K; Shirotsuki, R; Chiba, K; Uchida, H

JOURNAL OF PEDIATRIC SURGERY 52 巻 ( 12 ) 頁： 1930 - 1933 2017年12月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Pediatric Surgery

Background/purpose We previously found that many patients who developed hepatolithiasis after choledochal cyst excisions had intrahepatic bile duct stenosis (IHBDS). In 1992, we started resection of the membrane or septum which was found at the site of IHBDS during choledochal cyst excisions. Since intrahepatic stones usually take years to form, the efficacy of this procedure has not been proved. Methods The records of patients who had IHBDS-causing membrane or septum and underwent choledochal cyst excision with Roux-Y hepaticojejunostomy between January 1979 and December 2006 were retrospectively analyzed. The patients who underwent surgical treatment for IHBDS-causing membrane or septum were compared with those who did not undergo the procedure. Results Sixty-nine patients met the criteria, and seven patients who were followed up for less than 5 years were excluded from the study. Thirty-three patients underwent surgical treatment for IHBDS, and three of them developed intrahepatic stones. Meanwhile, 10 of 29 patients who did not undergo the procedure developed intrahepatic stones. A statistically significant difference in intrahepatic stone formation was observed between the two groups in a log-rank test (P = 0.016). Conclusions Meticulous probing and excision of the IHBDS-causing membrane or septum are effective for preventing hepatolithiasis after choledochal cyst excisions. Type of study Retrospective Comparative Study. Level of evidence Level III.

DOI： 10.1016/j.jpedsurg.2017.08.056

Comparison of outcomes of thoracoscopic primary repair of gross type C esophageal atresia performed by qualified and non-qualified surgeons

Tanaka, Y; Tainaka, T; Sumida, W; Shirota, C; Murase, N; Oshima, K; Shirotsuki, R; Chiba, K; Uchida, H

PEDIATRIC SURGERY INTERNATIONAL 33 巻 ( 10 ) 頁： 1081 - 1086 2017年10月

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

Purpose: Although thoracoscopic repair of esophageal atresia has become widespread, most studies are based on operations performed by expert surgeons. Therefore, the outcomes of operations performed by non-expert surgeons are not well known. The aim of this study was to compare outcomes based on operator skill level. Methods: We retrospectively reviewed the demographics and outcomes of patients with Gross type C esophageal atresia, who underwent primary thoracoscopic repair at our hospital between January 2014 and August 2016. Outcomes of surgeries performed by qualified surgeons, as determined by the Japanese Society for Endoscopic Surgery were compared with those of non-qualified surgeons. All operations were performed by or under the supervision of one qualified surgeon. Results: Nine operations were performed by qualified surgeons and six operations by non-qualified surgeons with >10 years of experience in surgery. None of the patients developed anastomotic leakage or recurrent tracheoesophageal fistula. However, the operative time and rate of stricture formation at the beginning of the weaning period were significantly higher in the latter group (P = 0.008 and 0.044). Conclusions: Although supervision of experts would improve results in thoracoscopic repair of esophageal atresia, the results indicate that good skill is necessary to avoid anastomotic stricture.

DOI： 10.1007/s00383-017-4140-1

Review of redo-Kasai portoenterostomy for biliary atresia in the transition to the liver transplantation era

Sumida, W; Uchida, H; Tanaka, Y; Tainaka, T; Shirota, C; Murase, N; Oshima, K; Shirotsuki, R; Chiba, K

NAGOYA JOURNAL OF MEDICAL SCIENCE 79 巻 ( 3 ) 頁： 415 - 420 2017年8月

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

Portoenterostomy (PE) is the standard therapy for biliary atresia (BA). PE offers the chance of survival to children with BA. PE was the ultimate therapeutic modality for BA before liver transplantation (LT) was available. Failure of biliary drainage with PE was almost invariably fatal in children with BA. In such cases, redo-PE was performed to salvage patients following PE failure. PE remains the standard first treatment for BA despite the availability of LT. Further, redo-PE is also performed in a limited number of cases despite the development of LT as an alternative means of PE. However, there is concern that redo-PE increases morbidity at the time of subsequent LT. Laparoscopic redo-PE has recently been described. Laparoscopic redo-PE is expected to reduce complications of LT by preventing abdominal adhesion associated with repetitive surgery. In the present article, the future utility of redo-PE and the history of its changing roles are reviewed.

DOI： 10.18999/nagjms.79.3.415