Authorship：Lead author   Language：Japanese   Publisher：Surgery Today  

Purpose: To identify the prognostic factors for pediatric severe intestinal motility disorder (IMD). Methods: We reviewed the medical records of patients with severe IMD, who required total parenteral nutrition (TPN) for ≥ 60 days at our institution between April, 1984 and March, 2023, examining their characteristics to identify prognostic factors. Results: The types of IMD in the 14 patients enrolled in this study were as follows: isolated hypoganglionosis (IHG, n = 6), extensive aganglionosis (EAG: n = 6), and chronic idiopathic intestinal pseudo-obstruction (CIIP, n = 2). There was no significant difference in mortality among the three types of severe IMD. Weaning-off TPN and the use of the colon were not significant prognostic factors, but cholestasis was a significant prognostic factor (p = 0.005). There was a high mortality rate (50%), with the major causes of death being intestinal failure-associated liver disease (IFALD) following hepatic failure, and catheter-related blood stream infection (CRBSI). One IHG patient underwent small bowel transplantation but died of acute rejection. Conclusion: Severe IMD is still associated with a high mortality rate and cholestasis predicts the prognosis. Thus, preventing or improving IFALD and CRBSI caused by long-term TPN is important for reducing the mortality rate.

DOI： 10.1007/s00595-024-02910-1

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PubMed

Authorship：Lead author   Language：English   Publisher：シュプリンガー・ジャパン(株)  

小児の腸管蠕動不全症(IMD)の予後因子を検討した。当院で1984年4月から2023年3月に60日以上の完全静脈栄養(TPN)を要した重症IMD14例を対象とした。内訳は、腸管神経節細胞僅少症(IHG)6例、広範囲無神経節症(EAG)6例、慢性特発性偽性腸閉塞症(CIIP)2例であった。死亡率は50%(7例)で、3つのタイプ間で死亡率に有意差は認めなかった。死因は、胆汁うっ滞を伴った腸管不全関連肝障害(IFALD)による肝不全(EAG4例、IHG1例)、カテーテル関連血流感染症(CRBSI)(CIIP1例)、小腸移植後の急性拒絶反応(IHG1例)であった。重症IMDの予後不良因子として、(1)TPN離脱、(2)手術による遠位側腸管の使用、(3)胆汁うっ滞の3つをカプランマイヤー法で解析したところ、(3)に有意差を認めた。以上より、重症IMDは依然として死亡率が高いこと、IFALDの予防が死亡率低下に重要であること、胆汁うっ滞が予後予測因子であることが示された。

Authorship：Lead author   Language：Japanese   Publisher：(公社)日本小児科学会  

Authorship：Lead author   Language：Japanese   Publisher：Pediatric Surgery International  

Purpose: The purpose of this study was to investigate the autophagy associated with apoptosis in hepatic damage in the short bowel syndrome rat model. Methods: SD rats underwent jugular vein catheterization for continuous total parenteral nutrition (TPN) and 90% small bowel resection. Animals were divided into two groups: TPN plus SBS (Control group) or TPN plus SBS plus intravenous administration of HGF (HGF group). On day 7, the rats were harvested, and hepatocellular injury was evaluated. Results: In an SBS rat model, hepatic steatosis and lobular inflammation were histologically suppressed in the HGF group (p < 0.01). The expression of tumor necrosis factor-α in the HGF group tend to be higher than that in the control group (p = 0.13). The gene expression of transforming Growth Factor-β in the HGF group was suppressed compared to the control group (p < 0.01). HGF treatment may have an antiapoptotic effect via the intrinsic pathway by caspase 9. Protein expressions of Rubicon (p = 0.03) and p62 (p < 0.01) in the HGF group were found to have increased compared to those in the control group. Conclusion: The inhibitory effect of HGF on hepatic steatosis remains unclear, and further studies focusing on the mechanisms of fat accumulation are needed.

DOI： 10.1007/s00383-023-05593-w

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PubMed

Authorship：Lead author   Language：Japanese   Publisher：Pediatric Surgery International  

Purpose: This study aimed to investigate the impact of hepatocyte growth factor (HGF) on colonic morphology and gut microbiota in a rat model of short bowel syndrome (SBS). Methods: SD rats underwent jugular vein catheterization for total parenteral nutrition (TPN) and 90% small bowel resection [TPN + SBS (control group) or TPN + SBS + intravenous HGF (0.3 mg/kg/day, HGF group)]. Rats were harvested on day 7. Colonic morphology, gut microflora, tight junction, and Toll-like receptor-4 (TLR4) were evaluated. Results: No significant differences were observed in the colonic morphological assessment. No significant differences were observed in the expression of tight junction-related genes in the proximal colon. However, the claudin-1 expression tended to increase and the claudin-3 expression tended to decrease in the distal colon of the HGF group. The Verrucomicrobiota in the gut microflora of the colon tended to increase in the HGF group. The abundance of most LPS-producing microbiota was lower in the HGF group than in the control group. The gene expression of TLR4 was significantly downregulated in the distal colon of the HGF group. Conclusion: HGF may enhance the mucus barrier through the tight junctions or gut microbiome in the distal colon.

DOI： 10.1007/s00383-024-05776-z

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PubMed

Authorship：Lead author   Publisher：東京医学社  

DOI： 10.24479/ps.0000000964

CiNii Research

Authorship：Lead author   Language：Japanese   Publisher：(株)東京医学社  

＜文献概要＞はじめに　われわれは,短腸症候群(short bowel syndrome:SBS)の基礎研究は腸管順応の促進と腸管不全関連肝障害の予防という2つの大きな柱があると考えて基礎研究を進めている。すなわち主な臓器ターゲットは消化管と肝臓と考えられ,両者に直接的に十分な効果を発揮する生理活性物質や薬剤が理想である。また近年定着しつつあるgut-liver axisも新たに重要な治療ターゲットとして認識されつつあり,われわれの施設ではこの3領域に焦点を当て研究している。SBSに対する細胞増殖因子の研究は以前から行われており,上皮増殖因子(epidermal growth factor:EGF)や肝細胞増殖因子(hepatocyte growth factor:HGF)が研究されてきた。HGFはSchwarzらの研究室が1997年から10数年にわたり継続した研究を行っており,HGF以外は散発的に数えるほどしかない。新規性の高い生理活性物質ではないのかもしれないが,基礎研究の背景としては十分ではないかとわれわれの研究グループは考えている。

Authorship：Lead author   Language：Japanese   Publisher：(公社)日本小児科学会  

Authorship：Lead author   Language：Japanese   Publisher：日本小児呼吸器学会  

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：Japanese   Publisher：日本小児泌尿器科学会  

Authorship：Lead author   Language：English   Publisher：シュプリンガー・ジャパン(株)  

胆道閉鎖症(BA)患者93名を対象に、患者背景、初診時日齢、葛西手術(KPE)および術後経過を後ろ向きに検討した。93名中9名(9.7%)が出血傾向(BT)を伴い、うち7名は頭蓋内出血(ICH)、1名は消化管出血、1名はプロトロンビン時間0%を呈した。BT患者および非BT患者の初診時日齢、KPE時の日齢、初診から手術までの日数、自己肝生存率に有意差はなかった。ICH生存者の神経学的アウトカムは良好であった。以上の結果から、BTを伴うBA患者において、ICH発症後であっても、BTの適切な是正により早期のKPEを施行でき、重大な神経合併症なく、非BT患者と同等の自己肝生存率を達成できると考えられた。

Authorship：Lead author   Language：Japanese   Publisher：Surgery Today  

Purpose: We compared the clinical features of patients with biliary atresia (BA) associated with a bleeding tendency (BT) at the time of the diagnosis with those of patients without a bleeding tendency (NBT). Methods: The patients’ background characteristics, age in days at the first visit, Kasai portoenterostomy (KPE), and postoperative course were retrospectively analyzed. Results: Nine of the 93 BA patients (9.7%) showed a BT, including 7 with intracranial hemorrhaging (ICH), 1 with gastrointestinal bleeding, and 1 with a prothrombin time (PT) of 0%. The age at the first visit was 62 ± 12 days old for BT patients and 53 ± 27 days old for NBT patients (p = 0.4); the age at KPE was 77 ± 9 days old for BT patients and 65 ± 24 days old for NBT patients (p = 0.2); the time from the first visit to surgery was 13 ± 7 days for BT patients and 11 ± 10 days for NBT patients (p = 0.5); and the native liver survival rate was 56% for BT patients and 58% for NBT patients (p = 1), with no significant difference in any of the parameters. The neurological outcomes of survivors of ICH were favorable. Conclusions: Appropriate BT correction allowed early KPE even after ICH, resulting in native liver survival rates comparable to those of NBT patients without significant neurological complications.

DOI： 10.1007/s00595-023-02744-3

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PubMed

Authorship：Lead author   Publisher：東京医学社  

DOI： 10.24479/ps.0000000773

CiNii Research

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：Japanese   Publisher：(株)東京医学社  

Authorship：Lead author   Language：Japanese   Publisher：Journal of Pediatric Surgery  

Background: Most cases of intestinal malrotation appear in neonates with bilious vomiting due to midgut volvulus, whereas in cases that develop beyond infancy, the initial symptoms vary. This study investigated the clinical features of these two populations and identified issues that should be considered in daily practice. Methods: A retrospective chart review was conducted from January 1, 2010, to December 31, 2022. Data on patients with intestinal malrotation were collected in an anonymized fashion from five pediatric surgical hub facilities in the Southern Kyushu and Okinawa areas of Japan. Results: Of the 80 subjects, 57 (71.3%) were neonates (Group N) and 23 (28.7%) were infants and schoolchildren (Group I). The frequencies of initial symptoms, such as abdominal distention (Group N: 19.3% vs. Group I: 13.0%), bilious vomiting (59.6% vs. 43.5%), and hematochezia (8.8% vs. 21.7%), were not skewed by the age of onset (p = 0.535, 0.087, and 0.141, respectively). Midgut volvulus was significantly more frequent in Group N (71.9% [41/57] vs. 34.8% [8/23]; p = 0.005), while the degree of torsion was greater in group I (median 360° [interquartile range: 180–360°] vs. 450° [360–540°]; p = 0.029). Although the bowel resection rate was equivalent (7.0% [4/57] vs. 4.3% [1/23]; p = 1.000), half of the patients in Group N presented with 180° torsion. The neonatal intestine has been highlighted as being more susceptible to ischemia than that in older children. Conclusions: The incidence of midgut volvulus is higher in neonates than in older children. Even relatively mild torsion can cause ischemic bowel changes during the neonatal period. Level of Evidence: LEVEL III.

DOI： 10.1016/j.jpedsurg.2023.11.020

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PubMed

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：Japanese   Publisher：Journal of Minimal Access Surgery  

We, herein, report a surgical technique for laparoscopy-assisted jejunostomy tube placement in an infant using a loop needle device to fix the jejunum and abdominal wall. A 3-year-old boy with Down's syndrome underwent nutritional management by gastrostomy due to oral feeding difficulty after radical surgery for congenital duodenal stenosis and following bile duct stenosis. However, intractable gastrostomy site leakage emerged; hence, laparoscopy-assisted gastrostomy takedown and simultaneous laparoscopy-assisted jejunostomy tube placement were planned. After laparoscopy-assisted gastrostomy closure was performed, the jejunum was extracted through the umbilical trocar wound. A jejunostomy tube kit was inserted at the left side of the umbilicus. After tube insertion into the jejunum, the jejunostomy tube was wrapped with four interrupted sutures using the Witzel technique. Suture threads were extracted by percutaneous insertion of a loop needle device, and then, the jejunum was fixed to the abdominal wall. The post-operative course was uneventful. Percutaneous insertion of a loop needle device is useful for fixing a jejunostomy tube to the abdominal wall using the Witzel technique. Our technique is safe, secure and expected to reduce the risk of dislodgement of tube and peritonitis associated with jejunostomy tube placement.

DOI： 10.4103/jmas.jmas_10_23

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PubMed

Authorship：Lead author   Language：Japanese   Publisher：Pediatric Surgery International  

Purpose: Midgut volvulus is an urgent disease often occurring in neonates. This study clarified the clinical features of midgut volvulus and evaluated predictors to avoid bowel resection. Methods: This bi-center retrospective study enrolled 48 patients who underwent surgery for intestinal malrotation between 2010 and 2022. Patients’ background characteristics and preoperative imaging findings were reviewed. Results: Midgut volvulus was recognized in 32 patients (66.7%), and 6 (12.5%) underwent bowel resection. Based on a receiver operating curve analysis of bowel resection, the cut-off value of the body weight at birth and at operation were 1984 g [area under the curve (AUC) 0.75, 95% confidence interval (CI) 0.52–0.99] and 2418 g (AUC 0.70, 95% CI 0.46–0.94), respectively. The cut-off value of intestinal torsion was 540° (AUC 0.76, 95% CI 0.57–0.95), and that of the time from the onset to the diagnosis was 12 h (AUC 0.85, 95% CI 0.72–0.98). For midgut volvulus with an intestinal torsion > 540°, the most sensitive preoperative imaging test was ultrasonography (75%) Patients with bloody stool tended to undergo bowel resection. Conclusions: Patients with a low body weight and bloody stool should be confirmed to have whirlpool sign by ultrasonography and scheduled for surgery as soon as possible.

DOI： 10.1007/s00383-023-05406-0

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PubMed

Authorship：Lead author   Language：Japanese   Publisher：Pediatric Surgery International  

Purpose: Our previous clinical pilot study reported that miconazole (MCZ) prevented morbidity from surgical necrotizing enterocolitis (NEC). The present study re-investigated this effect in a long-term cohort over 20 years. Methods: We conducted a retrospective cohort study from April 1998 to March 2020. A total of 1169 extremely low-birth-weight infants (ELBWIs) admitted to our neonatal intensive care unit, including 45 with NEC (3.8%), underwent surgery. Since 2002, protocol MCZ administration for 3 weeks has been applied for neonates born before 26 weeks’ gestation or weighing under 1000 g. We compared the background characteristics and clinical outcomes between patients with and without MCZ administration. Results: The morbidity rate decreased after applying the MCZ protocol, but no improvement in mortality was seen. A propensity score-matched analysis indicated that treated patients by MCZ showed a delay in developing surgical NEC by 12 days. The MCZ protocol also helped increase body weight at surgery. Prophylactic MCZ administration did not improve the neurological development of the language–social and postural–motor domains in the surgical NEC patients. But cognitive–adaptive domain caught up by a chronological age of 3 years old. Conclusions: Revising the protocol to extend the dosing period may improve the outcomes of surgical NEC after the onset.

DOI： 10.1007/s00383-023-05390-5

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PubMed

Authorship：Lead author   Language：Japanese   Publisher：Pediatric Surgery International  

Purpose: Management of persistently patent ductus arteriosus (PDA) in extremely low-birth-weight infants (ELBWIs) requires attention due to the risk of tissue hypoperfusion. We investigated the association between PDA and gastrointestinal perforation. Methods: We performed a retrospective chart review from 2012 to 2021. Preterm (≤ 32 weeks) ELBWIs with PDA after birth who developed necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and idiopathic gastric perforation were included; ELBWIs with congenital heart disease were excluded. Data were analyzed using chi-squared tests with Yates; correction, and Student’s t test. Results: Five hundred thirty-five preterm ELBWIs were analyzed, including 20 with NEC, 22 with FIP, and 1 with gastric perforation. In NEC and FIP, the ductus arteriosus remained open in 40% (4/10) and 63.6% (14/22) of cases, respectively, and cyclo-oxygenase inhibitor treatment showed poor efficacy (p = 0.492 and 0.240). The incidence of perforation in NEC (4/9 vs. 6/11, p = 0.653), mortality in NEC (3/4 vs. 3/6, p = 0.895) and FIP (6/14 vs. 3/8, p = 0.838) did not differ according to whether the PDA persisted or resolved. Conclusion: The presentation of PDA did not affect the mortality or morbidity of ELBWIs. However, it is essential to consider the possibility of gastrointestinal perforation due to decreased organ blood flow caused by ductal steal.

DOI： 10.1007/s00383-023-05420-2

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PubMed

Authorship：Lead author   Language：Japanese   Publisher：(公社)日本小児科学会  

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：Japanese   Publisher：(公社)日本小児科学会  

Authorship：Lead author   Language：English   Publisher：John Wiley & Sons Australia, Ltd  

原発性副腎神経芽細胞腫(NB)に対する腹腔鏡下手術の安全性と実行可能性を検討した。当院で手術を施行した小児副腎NB患者22例(男児16例、女児6例、年齢中央値2.5歳)を対象とした。腫瘍の局在は右副腎が13例、左副腎が9例で、国際神経芽細胞腫リスクグループステージングシステム(INRGSS)スコアはL1が2例、L2が5例、Mが15例であった。Image-Defined Risk Factor(IDRF)陽性であった20例に対して腫瘍生検を実施し、IDRF陰性の2例には腫瘍全摘を行った。開腹下切開生検の施行が15例、腹腔鏡下切開生検が5例であり、両群の間に手術時年齢、性別、腫瘍の局在、最大腫瘍径、INRGSSスコア、術中出血量、術後摂食開始時期、術後化学療法開始時期に有意差はなく、手術時間は開腹術群の方が有意に短かった。化学療法後、4例に対して腹腔鏡下切除術、11例に対して開腹下切除術を行い、ステージL1の2例には腹腔鏡下手術を施行した。IDRF陰性患者に対する腹腔鏡下手術によって手術時間の短縮、出血量の抑制、術後早期の経口摂取が得られた。症例を選択することにより、小児副腎NBに対して腹腔鏡下手術を安全に施行可能であることが示された。

Authorship：Lead author   Language：Japanese   Publisher：Asian Journal of Endoscopic Surgery  

Introduction: Surgical management of neuroblastoma (NB) has been performed by open procedures for decades. However, advances in surgical devices and technology have made minimally invasive surgery safe and reproducible. In this study, we compared open and laparoscopic surgery regarding biopsy success and curative resection to determine the safety and feasibility of laparoscopic surgery for pediatric patients with adrenal NB. Methods: We reviewed the clinical data of 22 NB patients who underwent surgery from 2006 to 2021 in our institution. All patients with adrenal NB were diagnosed histologically, and we retrospectively analyzed the data. Results: The male/female ratio was 16/6. The median age was 2.5 (interquartile range: 2–4) years old, and the laterality was on the right in 13 and on the left in 9. A total of 20 patients underwent a tumor biopsy: 14 via laparotomy, five laparoscopically, and one retroperitoneally. Four patients underwent laparoscopic resection and 11 patients underwent open resection after chemotherapy. Two patients with stage LI underwent primary tumor resection laparoscopically. For curative resection in image-defined risk factor (IDRF)-negative patients, laparoscopic surgery resulted in shorter operation time, with less bleeding and an earlier oral intake. The three IDRF-single-positive patients on the liver (laparoscopic surgery: one patient) had a shorter operation time and less bleeding than the IDRF-multiple positive patients. Conclusion: Laparoscopic surgery was performed in a limited number of adrenal NB cases. A laparoscopic biopsy for adrenal NB seems to be safe and feasible to perform. Laparoscopic surgery, in carefully selected cases, permits safe and efficient resection of adrenal NB in pediatric patients.

DOI： 10.1111/ases.13204

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PubMed

Authorship：Lead author   Language：English  

DOI： 10.1186/s40792-023-01679-8

PubMed

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

Authorship：Lead author   Language：English   Publisher：(一社)日本外科学会  

症例は4歳男児。出生前に臍帯ヘルニアと診断された。妊娠37週5日で前期破水となり、帝王切開分娩により出生した。出生時に全肝脱出巨大臍帯ヘルニアを認め、ヘルニア門は4×3cmであった。Wound Retractorによる手術はリングの挿入時に肝静脈の損傷の恐れがあるため、Gore-Texシートを用いてAllen-Wrenn法によりサイロを装着した。ヘルニア門周囲の筋層閉鎖に難渋したため、一期的に腹壁閉鎖をせず、減張切開して皮膚を縫合閉鎖した。4歳時にComponents Separation法による腹壁閉鎖術を施行した。初回手術で減張切開した腹壁皮膚の血流遮断を懸念し、腹壁の栄養血管をできるだけ温存することを方針とした。十分な血流を維持するため、筋弛緩剤の用量を調整した。初回手術創に沿って腹壁を正中切開し、肝表面に癒着した腹壁皮下瘢痕を剥離した。上腹壁動脈と下腹壁動脈を損傷しないよう注意しながら腹直筋鞘前葉を切離し、外腹斜筋を露出した。腹壁欠損孔径は12×10cmであった。外腹斜筋腱膜を縦切開により減張して、両側の腹直筋内側縁を結紮縫合して閉鎖した。術後経過は良好で、4年間で再発はなかった。

Authorship：Lead author   Language：Japanese   Publisher：Journal of Laparoendoscopic and Advanced Surgical Techniques  

Purpose: Severely neurologically impaired patients sometimes require anti-reflux surgery with preceding gastrostomy. We apply a traction technique for laparoscopic fundoplication (LF) without gastrostomy takedown (GTD) in such cases. We conducted a multicenter review to assess the feasibility of our approach. Materials and Methods: In brief, the traction technique involves left-lateral-traction of the stomach body, right-lateral-traction of the round ligament of the liver, and elevation of the left liver lobe to create a sufficient field for manipulating the forceps. Patients who underwent LF with Nissen's procedures in 2010-2022 were retrospectively reviewed. Data were analyzed by a one-way analysis of variance. Results: The operative approaches included the traction technique (n = 16; Group 1), GTD and reconstruction (n = 5; Group 2), and LF followed by gastrostomy (n = 92; Group 3). In comparison with Group 1, significant differences were only found in pneumoperitoneum time (Group 1 versus Group 2 versus Group 3: 174.4 minutes versus 250.4 minutes versus 179.5 minutes; P = .0179). Operating time (222.7 minutes versus 303.0 minutes versus 239.7 minutes; P = .0743), duration to full-strength enteral nutrition (10.4 days versus 17.2 days versus 11.0 days; P = .0806), and length of hospital stay (17.2 days versus 31.0 days versus 18.5 days; P = .3247) were equivalent. No re-fundoplication was required in Group 1. Conclusion: The traction technique secures the operative quality and outcome of LF without GTD.

DOI： 10.1089/lap.2022.0576

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PubMed

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：Japanese   Publisher：The Japanese Society of Pediatric Surgeons  

<p>An 18-day-old female neonate showing abdominal distention was transferred to our hospital. Since X-ray images showed abdominal free air, we performed emergent laparotomy and also performed direct closure of the perforation site located at the end of the ileum. At 1 month after discharge, ileus was recognized; however, she recovered with conservative therapy. At 7 months after birth, she presented with bloody stool and anemia. Contrast-enhanced CT showed enhanced areas at the end of the ileum. We confirmed that bleeding was responsible for the enhancement of these areas; therefore, we performed laparotomy. Since a hemangioma was recognized on the ileum wall and mesentery, we resected the ileocecal portion. The pathological diagnosis was infantile intestinal hemangioma. She was discharged 10 days after the operation. There have been no signs of recurrence or progressive anemia. Infantile intestinal hemangioma shows rapid proliferation from one week after birth, peaking at 1 year of age. In this case, the intestinal perforation in the neonatal period was consistent with the beginning of the proliferation phase. Bloody stool was recognized in the peak proliferation period. We presume that both events were caused by infantile intestinal hemangioma.</p>

DOI： 10.11164/jjsps.59.2_203

CiNii Research

Authorship：Lead author   Language：Japanese   Publisher：Journal of Pediatric Surgery  

Background: The size of the display used for endoscopic surgery has been increasing recently, but the effect of the display size on procedure outcomes is unclear. The present study clarified the effect of display size on the outcomes of endoscopic surgical procedures. Methods: Eight pediatric surgeons performed the laparoscopic fundoplication task using a disease-specific laparoscopic simulator with 3 different display sizes (43, 32, and 24 inches). The movement of the forceps during the task was measured using an electromagnetic spatial three-dimensional position-measuring instrument. The movements of the eyes and head during the task were also measured using glasses-style smart eyewear. We assessed the time required to complete the task, total path length of forceps, average velocity of forceps, number of blinks, number and strength of eye movements, and head tilt of participants during the task. Results: There were no significant differences in the required time, total path length, average velocity, number of blinks, number and strength of eye movements, or head tilt among the three display sizes. After the task, participants were asked which display felt the easiest to use. Four participants (50%) answered that the 32-inch display was easiest to use. Conclusion: This study showed that display size differences did not influence endoscopic surgical procedures. However, 50% of participants felt that the task was easiest using the middle display size. There may be an optimal monitor size for a given procedure. Level of evidence: Level II.

DOI： 10.1016/j.jpedsurg.2022.12.023

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PubMed

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

症例は女児.日齢18に腹部膨満が出現し,当院紹介となった.単純X線写真で腹腔内遊離ガスを認めたため緊急手術を施行し,回腸末端の消化管穿孔に対して単純縫合閉鎖を行った.術後1ヵ月時にイレウスを認めたが保存的に軽快した.その後7ヵ月時に下血を主訴として来院し,血液検査ではHb7.5g/dlと貧血を呈し,造影CT検査で回腸末端に著明な造影効果を認めた.腸管血管腫からの出血を疑い,入院翌日に試験開腹術を施行した.回盲弁から口側15cmの回腸と腸間膜に血管腫を認め,回盲部切除を行った.病理診断は乳児血管腫であった.術後10日目に自宅退院し,現在まで再発を認めていない.乳児血管腫は通常生後1週頃から増生し始め,生後10ヵ月頃までに増生のピークを迎えると言われている.本症で見られた消化管穿孔の発生部位は,その後に判明した血管腫の部位と一致しており,穿孔の原因として血管腫が関与している可能性が考えられた.(著者抄録)

Authorship：Lead author   Language：Japanese   Publisher：(公社)日本小児科学会  

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：Japanese   Publisher：Asian Journal of Endoscopic Surgery  

Intradiaphragmatic extralobar pulmonary sequestration (IDEPS) is considered to be very rare among extralobar pulmonary sequestration (EPS), and IDEPS combined with congenital diaphragmatic hernia (CDH) with sac is extremely rare. The patient was a neonatal girl. Left-sided CDH with a hernia sac was diagnosed based on computed tomography (CT). Thoracoscopic repair was planned for the 5th day after birth. Left CDH with sac was recognized on the posterolateral side and isolated EPS was recognized on the sac. The hernia sac, including the EPS, was resected, and the diaphragm defect was closed. The resected specimen consisted of fibrous connective tissue and pulmonary sequestration (PS) connected with the sac. It was diagnosed as the hybrid form, with features of both type 2 congenital pulmonary airway malformation (CPAM) and EPS. The postoperative course was uneventful. At 1 year and 9 mo after the operation, no recurrence of herniation or laterality of the diaphragm was recognized.

DOI： 10.1111/ases.13120

Scopus

PubMed

Authorship：Lead author   Language：Japanese   Publisher：International Journal of Computer Assisted Radiology and Surgery  

Purpose: The present study clarified the efficacy of repeating laparoscopic surgery training using a disease-specific simulator and investigated the clinical outcomes of laparoscopic surgery for congenital biliary dilatation (CBD) in pediatric patients after training. Methods: A high-fidelity laparoscopic hepaticojejunostomy simulator was used. Four pediatric surgeons performed practice laparoscopic hepaticojejunostomy three times using the simulator. The details of forceps manipulation during the task were analyzed. The clinical outcomes of 13 CBD cases treated with laparoscopic surgery in our institution were also evaluated based on medical records. Results: The time required to complete the task became significantly shorter each successive time (1st: 1062.18 ± 346.79 s vs. 3rd: 717.44 ± 260.80 s, p = 0.039). There were no significant differences in the total path length of the right forceps (1st: 55.56 ± 23.21 m vs. 3rd: 28.25 ± 17.01 m, p = 0.17), total path length of the left forceps (1st: 47.79 ± 20.79 m vs. 3rd: 31.83 ± 17.62 m, p = 0.17), average velocity of the right forceps (1st: 58.78 ± 21.29 mm/s vs.44.98 ± 10.25 mm/s, p = 0.47), or the average velocity of the left forceps (1st: 50.39 ± 19.25 mm/s vs. 52.26 ± 19.59 mm/s, p = 0.78). Regarding the clinical outcome, all CBD patients underwent laparoscopic surgery performed by practiced pediatric surgeons who had no experience. The operative time was 545.53 ± 91.01 min, and the blood loss was 24.2 ± 25.8 ml. There were no cases of open conversion, intraoperative adverse events, or anastomotic leakage. Conclusion: Disease-specific simulator training significantly decreased the task performance time by improving the forceps manipulation economy. In addition, simulator training may improve the operative safety and quality of laparoscopic hepaticojejunostomy in pediatric CBD patients.

DOI： 10.1007/s11548-022-02793-y

Scopus

PubMed

Authorship：Lead author   Language：English   Publisher：John Wiley & Sons Australia, Ltd  

症例は新生児女児。胎児成長遅滞に対して経過観察されており、在胎35週目の超音波検査で左横隔膜挙上を認め、ヘルニア嚢を伴った先天性横隔膜ヘルニア(CDH)が疑われた。在胎39週3日に経腟分娩にて出生し、呼吸不全や重度先天異常は認められず、CTでヘルニア嚢を伴う左側CDHと診断された。生後5日、全身状態の改善を得た後に外科的修復術を施行した。術中所見では後外側に左CDHを認め、さらに孤発性肺葉外肺分画症(EPS)がみられた。胃と脾臓を腹腔内に愛護的に還納し、EPSを含めたヘルニア嚢を切除、さらに胃底部を横隔膜から剥離して横隔膜欠損部を非吸収性縫合糸で閉鎖処理した。摘出標本の病理所見では線維性結合組織から成るヘルニア嚢胞であり、肺分画症(PS)とヘルニア嚢との結合がみられた。PSは気管気管支との正常な連絡や血管結合を欠いており、拡張末端細気管支に類似する多発嚢胞が検出され、繊毛立方上皮、円柱上皮や菲薄化した線維筋層がみられたことから、2型先天性肺気道奇形とEPSを呈するハイブリッド型と診断された。術後経過は良好で22日目に退院となり、1年9ヵ月後、ヘルニア再発は認めていない。

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本栄養治療学会  

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本栄養治療学会  

Authorship：Lead author   Language：Japanese   Publisher：Annals of Pediatric Surgery  

Background: The mortality rate of esophageal atresia (EA) has significantly improved, but late complications remain problematic. We evaluated the physical growth, late complications, and social prognosis of postoperative patients with EA who have reached 15 years of age. Methods: EA patients who were treated at our institution from 1984 to 2003 were enrolled. The follow-up, physical growth at the last visit, late complications and treatment, academic status, and employment situation were evaluated. Results: Twenty-nine EA patients were registered, and the 23 surviving patients (79.3%) were followed. Anthropometry at the latest visit tended to be below the standard values. Fundoplication was performed in 6 (26.1%) of 9 (39.1%) patients with gastroesophageal reflux. Anastomotic stenosis was found in 12 patients (52.2%), and 2 (8.7%) were treated with re-anastomosis. Thirteen patients were attending a regular school, and one was attending a school for disabled children. Four had jobs from 18 years of age. Follow-up was aborted during early childhood in nine patients. Conclusions: The physical size of EA was smaller than in the healthy population of the same age. Late complications had not affected the physical growth but were sometimes recognized in adolescence. The social prognosis of the patients was largely favorable.

DOI： 10.1186/s43159-022-00185-0

Scopus

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：Japanese   Publisher：Pediatric Surgery International  

Purpose: Various prognostic predictors for biliary atresia (BA) have been identified. This study aimed to evaluate the serial changes in the preoperative and postoperative ubiquitous inflammatory biomarkers and their relationship with the outcomes in patients with BA. Patients and methods: Forty-three BA patients were retrospectively reviewed to investigate serial levels of ubiquitous inflammatory biomarkers, including C-reactive protein (CRP) and lymphocyte ratio, and outcomes. The patients with BA were divided based on their outcomes into two prognostic groups: the native liver survivor group (n = 30) and the survivors with living-donor liver transplant group (n = 13). Results: The area under the receiver operating characteristic (ROC) curve analysis showed that a preoperative lymphocyte ratio of < 61% and CRP value > 0.1 mg/dl predicted a poor outcome. In the ROC curve analysis, the timing of reaching the cut-off value of CRP after Kasai portoenterostomy was postoperative day (POD) 57. The third postoperative week, which was the timing of the discontinuation of steroid therapy, was the branchpoint of inflammatory markers between the two prognostic groups. Conclusion: The POD 57 CRP level predicts the surgical outcome of Kasai portoenterostomy. The postoperative anti-inflammatory management of BA can be monitored by the ubiquitous inflammatory biomarkers CRP and the preoperative lymphocyte ratio.

DOI： 10.1007/s00383-022-05231-x

Scopus

PubMed

Authorship：Lead author   Language：Japanese   Publisher：Asian Journal of Endoscopic Surgery  

Laparoscopic choledochal cyst excision and hepaticojejunostomy is a representative surgical procedure requiring laparoscopic suturing including needle driving and knot tying. Laparoscopic needle driving and knot tying is a highly technically demanding skill, especially in small infants and children. We developed a laparoscopic hepaticojejunostomy simulator for training. This simulator was developed for a 1-year-old infant body size based on computed tomography data and reproduced a pneumoperitoneum condition based on 3D scanner data of the clinical situation. Surgeon in training (SITs) of our institution have to acquire practice of laparoscopic hepaticojejunostomy using a simulator before performing clinical cases. Thirteen cases of choledochal cyst have been managed at our institution since the introduction of practice using this simulator in 2016. Six SITs performed 13 cases of laparoscopic choledochal cyst excision and hepaticojejunostomy. There were no cases of anastomotic bile leakage. Laparoscopic disease-specific simulator practice is effective for the acquisition of secure hepaticojejunostomy skills for the treatment of choledochal cysts in children as off-the-job training.

DOI： 10.1111/ases.13083

Scopus

PubMed

Authorship：Lead author   Language：English   Publisher：John Wiley & Sons Australia, Ltd  

症例は13歳男児で、腹痛と触知可能な腫瘤を呈し、造影CTで上行結腸に浸潤する最大径13cmの巨大腹部腫瘍を認め、バリウム注腸にて上行結腸の重度狭窄がみられた。PET-CTで多発性腹部リンパ節転移が検出され、MRIでは腫瘍は大網に起源し、T1強調像にて軽度低信号、T2強調像にて軽度高信号を呈していた。大網に生じる線維形成性小円形細胞腫瘍が考えられ、鑑別疾患としてリンパ腫、結核性腹膜炎が挙げられた。腹腔鏡下手術を行うこととし、腹腔内に進入すると右側腹部に大網を覆う巨大腫瘍を確認し、漿液性腹水がみられたが肉眼的に腹膜播種は認められなかった。腹水を採取すると悪性細胞は検出されず、転移が疑われるリンパ節の腫大を同定、巨大腫瘍は炎症性変化をきたして腹膜に癒着しており、超音波デバイスを用いて慎重に切離した。続いてリンパ節4Dと6を大網と右胃大網動脈から切離し、リンパ節202は回結腸動静脈を結紮後に切除した。さらに、回腸末端近位部に沿って回腸を15cmにわたって切離し、巨大腫瘍と横行結腸に対する摘出術を施行した。手術時間は5時間47分、出血量は20mLであった。術後の病理所見、免疫組織化学染色の結果から11q異常を伴うBurkitt様リンパ腫と確定診断を下した。術後経過は良好で、4日目に経口摂取を開始し、腫瘍融解症候群の症状なく寛解が得られている。

Authorship：Lead author   Language：Japanese   Publisher：Surgery Today  

We describe a laparoscopic surgical technique using indocyanine green (ICG) fluorescence to identify and preserve rare arterial branching associated with pediatric congenital biliary dilatation. Congenital biliary dilatation with pancreaticobiliary maljunction was diagnosed in a 9-year-old girl, who presented with upper abdominal pain. Abdominal enhanced computed tomography (CT) showed that the accessory right hepatic artery (aRHA) branched from the posterior superior pancreaticoduodenal artery (PSPDA) and flowed through the right aspect of the dilated common bile duct (CBD) directly into the right lobe of the liver. We performed laparoscopic dilated biliary duct resection and hepaticojejunostomy, administering ICG intravenously, at a dose of 0.6 mg/kg. The ICG fluorescence overlay mode showed an aRHA running along the right side of the dilated CBD. The aRHA was dissected from the CBD without injury. After finishing the anastomosis, the beating of the aRHA was preserved, confirming that blood flow had been maintained.

DOI： 10.1007/s00595-022-02516-5

Scopus

PubMed

Authorship：Lead author   Language：Japanese   Publisher：Asian Journal of Endoscopic Surgery  

Purpose: The intravenous administration of acetaminophen (IAA) has become standard postoperative analgesic management for pediatric surgery. However, the most effective methods of IAA for postoperative acute appendicitis are unclear. We evaluated the analgesic efficacy of scheduled IAA vs on-demand IAA for postoperative acute appendicitis. Methods: Ninety-four patients who underwent laparoscopic appendectomy in our institution between January 2017 and December 2020 were enrolled. The patients were divided into two groups based on the postoperative pain control protocols. The scheduled IAA group (SA group, n = 42) was managed by scheduled IAA and additional on-demand use of pentazocine as rescue therapy. The on-demand IAA group (ODA group, n = 52) was managed by on-demand IAA as the first choice, with pentazocine as the second choice for pain control. The patients' background characteristics, operative results and postoperative outcomes were reviewed. Results: The number of times pain complaints were made per patient per day (NPPD) on postoperative days (POD) 1 and 2 was significantly lower in the SA group than in the ODA group (POD 1; 1.12 ± 1.21 vs 2.62 ± 1.89, p < 0.01; POD 2; 0.45 ± 0.86 vs. 1.31 ± 1.69, p < 0.01). According to pathological findings, NPPD was lower in the SA group than in the ODA group for both phlegmonous appendicitis (0.71 ± 1.01 vs. 2.10 ± 2.13, P <.05) and gangrenous appendicitis (1.33 ± 1.50 vs 2.94 ± 1.68, P <.01). On POD 2, the incidence of gangrenous appendicitis was significantly lower in the SA group than in the ODA group (0.57 ± 0.93 vs 1.78 ± 1.86, P <.01). Conclusions: Scheduled IAA may have favorable efficacy for postoperative pain control after emergency surgery for acute appendicitis in pediatric patients.

DOI： 10.1111/ases.13068

Scopus

PubMed

Authorship：Lead author   Language：Japanese   Publisher：Asian Journal of Endoscopic Surgery  

We herein report a 13-year-old boy with a chief complaint of abdominal pain and a palpable mass. Contrast-enhanced computed tomography (CT) scan showed an abdominal bulky tumor involving the ascending colon causing severe stenosis, with multiple abdominal lymph node metastases detected by positron emission tomography (PET)-CT. Laparoscopic radical resection with right hemicolectomy and lymph node dissection was planned. The bulky tumor was dissected from the retroperitoneum and resected en bloc with the right-side colon and omentum. The preoperatively detected metastatic lymph nodes were resected along with the tumor. A 6-cm longitudinal umbilical incision was made, and the huge tumor was removed, with functional end-to-end anastomosis performed for intestinal reconstruction. The pathological diagnosis was Burkitt-like lymphoma with 11q aberration. The postoperative course was uneventful. Laparoscopy-assisted extirpation is feasible for pediatric solid tumors involving other organs, but indications and procedures should be carefully determined based on preoperative imaging, intraoperative findings and surgeon's skills.

DOI： 10.1111/ases.13081

Scopus

PubMed

Authorship：Lead author   Language：Japanese   Publisher：Asian Journal of Endoscopic Surgery  

Purpose: In this study, we used a near-infrared ray catheter (NIRC) to visualize the urethral line. We herein report our intraoperative visualization technique of the urethra using an illuminating catheter in laparoscopy-assisted anorectoplasty (LAARP) for imperforated anus. Patient and surgical technique: A 3.0-kg term male neonate with anorectal malformation was delivered. An invertogram revealed the type as intermediate. Transverse colostomy was performed at the left upper abdomen. A recto-bulbar urethral fistula (RBUF) was diagnosed via distal colostogram and voiding cystourethrogram. LAARP was planned at 6 months of age. We performed the operation with four trocars. A 45° 5-mm scope was used to clearly view the deep pelvic space. Before starting rectal dissection, a 6-Fr pig-tail-type NIRC was inserted through the external opening of the urethra to visualize the urethra during the laparoscopic procedure. The catheter tip was placed in the bladder, and excretion of urine was maintained through the NIRC during the procedures. While dissecting the deep pelvic space between the posterior wall of the urethra and anterior wall of the rectum, the exact line of the urethra was clearly confirmed by overlay images of the NIRC. The RBUF was dissected safely using this innovative image-guided technique. Anoplasty was performed between the rectal stump and perineal skin. The postoperative course was uneventful. Oral intake was started on postoperative day 1. Postoperative dynamic urography showed no complications. Conclusion: An NIRC is useful for detecting the urethra during LAARP.

DOI： 10.1111/ases.13061

Scopus

PubMed

Authorship：Lead author   Language：English   Publisher：John Wiley & Sons Australia, Ltd  

小児の腹腔鏡下虫垂切除術にみられる術後痛に対するアセトアミノフェン静注の予定投与とオンデマンド投与の有効性を比較検討した。腹腔鏡下虫垂切除術を施行された小児患者94例を静注アセトアミノフェン予定投与群(SA群)42例(平均9.31±2.31歳)とオンデマンド投与群(ODA群)52例(平均9.21±2.89歳)に分類し、両群の患者背景、手術成績、術後アウトカムを比較した。体重、白血球数、CRP、AST値、ALT値、虫垂サイズに関してSA群とODA群との間に有意差はなかった。手術時間、気腹時間、癒着の有無、病理学的診断、術後摂食開始までの期間、抗生剤投与、術後在院期間にも有意な群間差はなく、術後合併症の発症はみられなかった。術後痛に関して、術翌日、2日後ともに疼痛の訴えはSA群の方がODA群より有意に少なく、蜂巣炎性虫垂炎、壊疽性虫垂炎のいずれでも術翌日はSA群の方が疼痛を訴える患児は少なかった。このほか、静注アセトアミノフェンの投与量はSA群の方が有意に多く、救済鎮痛薬としてのペンタゾシンの投与回数に有意な群間差はなかった。小児の腹腔鏡下虫垂切除術後の疼痛に対して、静注アセトアミノフェンの予定投与は有用であることが示された。

Authorship：Lead author   Language：English   Publisher：シュプリンガー・ジャパン(株)  

症例は9歳女児で、再発性重症上腹部痛を呈して他院を受診し先天性胆道拡張症と診断された。腹部造影CTで総胆管、総肝管、肝内胆管の拡張がみられ、腹部症状軽快後のMRCPにて膵胆管合流異常が検出されたため、加療目的に当院紹介となった。腹部3D-CTを施行した。その結果、後上膵頭十二指腸動脈(PSPDA)から分岐する副右肝動脈(aRHA)が認められ、拡張した総胆管の右側面に沿って走行し肝右葉後区に直接流入していた。先天性胆道拡張症の確定診断目的に腹腔鏡下胆管切開術とRoux-en-Y肝管空腸吻合術を行う方針とした。TIPCAM 1 Rubina 4K3Dシステムを用いて手術を開始し、拡張総胆管の切離直後にインドシアニングリーン(ICG)0.6mg/kgを静注、ICG蛍光データと標準の白色光画像をオーバーラップさせることにより、PSPDAから分岐するaRHAを確認した。さらに、aRHAから伸展して総胆管を栄養する動脈分岐を視認し、血管シーリングシステムを用いて総胆管を切離後、総胆管と膵管の直上部で総胆管を摘出した。aRHAは損傷なく総胆管より分離切除し、続いて腹腔鏡下肝管空腸吻合術を施行した。吻合部漏の徴候なく術後経過は良好で、11日目に退院となった。

Authorship：Lead author   Language：Japanese   Publisher：Pediatric Surgery International  

Purpose: Representative neonatal surgical diseases are often complicated by congenital heart disease (CHD). We reviewed our decade of experience from the perspective of the prognosis and report on the management of infants with CHD. Methods: Cases with and without CHD between 2011 and 2020 were retrospectively compared. Qualitative data were analyzed using a chi-square test with Yates' correction, and quantitative data were compared using Student's t-test. Results: Of the 275 neonatal surgical cases, 36 had CHD (13.1%). Ventricular septal defect was the most common cardiac anomaly, followed by atrial septal defect. Esophageal atresia showed the highest complication rate of CHD (43.8%, 14/32) followed by duodenal atresia (38.5%, 10/26). The mortality rates of patients with and without CHD (22.2% [8/36] vs. 1.3% [3/239]) were significantly different (χ² = 30.6, p < 0.0001). Of the eight deaths with CHD, six patients had cyanotic complex CHD. Notably, four of these patients died from progression of inappropriate hemodynamics in the remote period after definitive non-cardiac surgery. Conclusion: Considering its high-mortality, the presence of CHD, especially cyanotic heart disease, is an important issue to consider in the treatment of neonatal surgical diseases. Pediatric surgeons should be alert for changes in hemodynamics after surgery, as these may affect mortality.

DOI： 10.1007/s00383-022-05178-z

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PubMed

Authorship：Lead author   Language：Japanese   Publisher：日本膵・胆管合流異常研究会  

Authorship：Lead author   Language：Japanese   Publisher：Journal of Pediatric Surgery  

Purpose: Short bowel syndrome (SBS) patients require total parenteral nutrition (TPN) following massive small bowel resection (SBR), which may cause intestinal failure-associated liver disease (IFALD), a life-threatening complication. Hepatocyte growth factor (HGF) acts as a potent hepatocyte mitogen with anti inflammatory and antioxidant actions. The present study evaluated the effect of recombinant human HGF (rh-HGF) on SBR and subsequent IFALD using a parentally fed rat model of SBS. Methods: Rats underwent jugular vein catheterization for continuous TPN and 90% SBR. They were divided into 2 groups: TPN alone (SBS/TPN group: n = 7) or TPN plus the intravenous administration of rh-HGF (0.3 mg/kg/day) (SBS/TPN+HGF group: n = 7). On day 7, their tissues and stool were harvested to evaluate the effects of HGF. Results: Regarding the histological findings, based on the nonalcoholic fatty liver disease (NAFLD) activity score, the SBS/TPN+HGF group showed significantly less hepatic steatosis and inflammatory cell infiltration than the SBS/TPN group (NAFLD activity score, 4.00 ± 1.83 vs. 1.00 ± 0.82; p < 0.01). The SBS/TPN+HGF group showed a higher expression of Farnesoid X receptor in the liver and lower expression of Toll-like receptor 4 in the ileum than the SBS/TPN group. Regarding the composition of the bacterial gut microbiota, Actinobacteria, Bacteroidetes and Proteobacteria were decreased in the SBS/TPN+HGF group compared with the SBS/TPN group. Conclusion: In our SBS with TPN rat model, rh-HGF administration had a preventive effect against hepatic steatosis and dysbiosis. rh-HGF may therefore be a potentially effective therapeutic agent for SBS and subsequent IFALD. Type of study: Experimental research.

DOI： 10.1016/j.jpedsurg.2022.02.030

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PubMed

Authorship：Lead author   Language：Japanese   Publisher：日本小児泌尿器科学会  

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：Japanese   Publisher：日本小児泌尿器科学会  

Authorship：Lead author   Language：Japanese   Publisher：日本小児泌尿器科学会  

【目的】急性陰嚢症では精巣捻転症を見逃さないことが重要となるが、鑑別疾患が多く診断に苦慮することを経験する。TWISTスコアは精巣捻転症を示唆する身体所見から算出する臨床スコアとして非専門医でも用い易い。当院での小児急性陰嚢症に対するTWISTスコアについて臨床的検討を行った。【対象と方法】2015年1月から2019年12月までの5年間に当院で経験した16歳未満の急性陰嚢症94例のうち、TWISTスコアが算出され治療後の経過が確認できた68例を後方視的に検討した。【結果】疾患内訳は精巣付属小体捻転症が30例(44.1%)、精巣上体炎18例(26.5%)、精巣捻転症14例(20.6%)、急性精巣炎と精巣外傷が2例(2.9%)、陰嚢浮腫と精巣腫瘍が1例(1.5%)であった。TWISTスコアは、精巣捻転症が非精巣捻転症(54例)より高値で、手術群(51例が)非手術群(17例)より高値で、更に手術群の中でも精巣捻転症が非精巣捻転群(37例)より有意に高値であった(いずれもp値<0.01)。しかし精巣捻転症のうち精巣摘出群(9例)と温存群(5例)の間には有意差はなかった。【結論】精巣捻転症のTWISTスコアは他疾患より高値であり、TWISTスコア0点では精巣捻転症を否定することが出来た。しかしTWISTスコアのみで精巣捻転症の診断を行うことは難しく、従来通り総合的な判断が必要である。今後本邦の臨床に則したTWISTスコアを見出せれば、その有用性を示すことも可能であると考える。(著者抄録)

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：Japanese   Publisher：Journal of Laparoendoscopic and Advanced Surgical Techniques  

Background and Aim: The distribution of board-certified pediatric surgeons (BCPSs) in Japan is highly biased. While Prefecture M has one of the smallest numbers of BCPSs per pediatric population, neighboring Prefecture K has one of the largest numbers of BCPSs per pediatric population. We examined the effect of BCPSs population on laparoscopic surgery and postoperative management and outcomes. Materials and Methods: We compared postoperative duration to full-dose enteral nutrition, postoperative hospital stay, and complications of neurologically impaired patients who underwent laparoscopic fundoplication in two prefectures from 2006 to 2019. Results: Laparoscopic fundoplication was performed in 17 patients in Prefecture M and 63 in K. The mean operative time was 248.8 ± 79.9 minutes in Prefecture M and 260.8 ± 94.8 in K (P = .64). The median number of days to full-dose enteral nutrition was 11.5 in Prefecture M and 10 in K (P = .29). The median postoperative hospital stay was 14 days in Prefecture M and 15 days in K (P = .38). Postoperative complications occurred in 7 cases in Prefecture M and in 10 in K. The incidence was significantly higher in Prefecture M than in K (P = .041). Conclusion: Areas with insufficient numbers of BCPSs have a higher risk of complications in laparoscopic surgery than areas with sufficient numbers.

DOI： 10.1089/lap.2021.0713

Scopus

PubMed

Authorship：Lead author   Publisher：東京医学社  

DOI： 10.24479/ps.0000000100

CiNii Research

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：English   Publisher：John Wiley & Sons Australia, Ltd  

症例は1歳8ヵ月の男児で、生後一時的に胆汁嘔吐をきたしたが症状は自然消失し、発達障害はみられなかった。1歳4ヵ月時、間欠的な胆汁嘔吐を認め、精査目的に当院を受診した。上部消化管造影検査で十二指腸球部から下部にかけての拡張がみられ、下部から水平部にかけての造影剤のうっ滞が生じていた。造影CTでは上腸間膜動脈と上腸間膜静脈(SMV)の配置に異常はみられなかったが、末梢部にてコークスクリュー徴候を認め、SMVの著明な狭窄と側副循環が検出された。以上の所見から中腸軸捻を伴う腸回転異常と診断し、腹腔鏡下手術を計画した。中腸軸捻を回盲部からの小腸トレースにより逆行性に解除し腸間膜根部を確認、腸間膜に重度の癒着が生じていたため、インドシアニングリーンによる蛍光ナビゲーション下に組織をクランプして灌流を図った。これにより安全な組織の切離が可能となり、腸間膜根部の開大を確認できた。腸管を非回転位に収納し脾彎曲部の結腸はBill法を用いて固定した。術後2日目に飲水、3日目に摂食が可能となり、5日目に退院となった。その後4ヵ月、軸捻やイレウスの再発は認めていない。

Authorship：Lead author   Language：Japanese   Publisher：(株)東京医学社  

過去5年間に当施設で入院診療を行った重症心身障碍児82人(男性56人、女性26人、平均年齢19.8歳)を対象として、便秘や呑気などの臨床症状と、処方されていた薬を後方視的に分析した。手術は95件行われており、噴門形成術、胃瘻造設術、気管切開術などの予定手術が81件、イレウス解除術などの緊急手術が14件であった。術前の栄養形態は半消化態栄養剤が67人で最も多く、成分栄養剤7人、消化態栄養剤1人、ミルク6人で経口摂取は1人のみであった。術前薬については漢方製剤を20人、刺激性下剤を20人、整腸剤を19人、塩類下剤を15人、浸透圧下剤を1人が使用していた。浣腸のみを含めて無投薬は33人であった。術前の腹部単純X線で宿便を認めたのは5人のみであったが、広範な小腸ガス貯留など呑気による影響と考えられる所見は44人で認められた。呑気症を背景にイレウスを繰り返した2症例を提示した。

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：Japanese   Publisher：Asian Journal of Endoscopic Surgery  

We herein report a 20-month-old boy who underwent laparoscopic Ladd's surgery. He showed intermittent bilious vomiting after birth and received a definitive diagnosis of intestinal malrotation. Laparoscopic Ladd's procedure was performed with four trocars. Midgut volvulus (180° counterclockwise) was resolved by retrogradely tracing the small intestine from the ileocecal region. After dividing Ladd's ligament, fluorescent navigation with indocyanine green was used. We decided where to dissect the mesenteries by confirming the vascular perfusion through clamping the tissue. Fibrous adhesions were gradually dissected, and it was confirmed that the mesenteric root was sufficiently broadening. Surgeons hesitate to dissect the mesenteric root in laparoscopic procedures compared with open procedures because of the narrow operative view and the risk of vascular injury. Laparoscopic Ladd's procedure using indocyanine green to confirm intestinal blood flow is safe and useful for the small working space in pediatric patients with intestinal malrotation and midgut volvulus.

DOI： 10.1111/ases.13026

Scopus

PubMed

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：English  

DOI： 10.1186/s40792-022-01409-6

PubMed

Authorship：Lead author   Publisher：東京医学社  

DOI： 10.24479/ps.0000000080

CiNii Research

Authorship：Lead author   Language：English   Publisher：(一社)日本外科学会  

症例は3歳男児で、突然の腹痛を主訴に近医を受診した。ウイルス性胃腸炎と診断され、保存的治療が行われたが症状は改善しなかった。X線検査で腸管拡張とイレウスを認め、当院へ搬送された。腹部膨隆と腹部全体に圧痛を認め、特に下腹部で強い筋性防御(腹膜刺激徴候)を認めた。臨床検査で白血球数は20800/μL、C反応性蛋白質は5.79mg/dLの高値を呈した。ASTは29U/L、ALTは11U/L、総ビリルビンは0.8mg/dL、尿素窒素は8.0mg/dL、クレアチニンは0.21mg/dLであった。造影CTで構造が消化管に似た嚢胞性病変と腹水を認めた。腸管拡張またはイレウスの所見は見られなかった。消化管への血流は保持されていたため、メッケル憩室捻転の疑いで診断的腹腔鏡検査を実施した。右下腹部に黒色の管状構造を形成する嚢胞性病変が720°茎捻転していた。捻転を整復したところ、メッケル憩室捻転ではなく、消化管重複症であった。重複腸管を切除した。病理組織学的検査で切除標本は回腸壁の構成要素を有していた。術後経過は良好で、14日後に退院となった。3年後の再診で合併症は見られなかった。

Authorship：Lead author   Language：Japanese   Publisher：(株)東京医学社  

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児救急医学会  

【目的】急性虫垂炎(以下:本症)における生体防御反応である大網被覆の有無が臨床像へ与える影響を明らかにする。【方法】当科の3年間の本症手術症例53例(非穿孔性27例、穿孔性26例)について後方視的に検討した。【結果】穿孔性虫垂炎は非穿孔性虫垂炎と比較し高率に大網被覆を認めた。非穿孔性虫垂炎において、大網被覆(-)群と比較して大網被覆(+)群で白血球数とCRP値が有意に高値であった。穿孔性虫垂炎において、大網被覆(-)群と比較して大網被覆(+)群で病悩期間が有意に長く、当科受診前の他院受診回数が有意に多かった。穿孔性虫垂炎では、大網被覆(+)群で汎発性腹膜炎の合併率が低値であったが有意差はなかった。【結論】本症の大網被覆は炎症を限局化する生体防御反応だが、腹膜刺激症状を不明瞭化し症状や理学所見が過小評価され、受診回数の増加や病悩期間の延長につながり、一次施設での診断遅延の要因となっている可能性が示唆された。(著者抄録)

Authorship：Lead author   Language：English   Publisher：シュプリンガー・ジャパン(株)  

Hirschsprung病(HD)の小児患者65例を対象に、長期的な腸機能を基に、根治手術の最適な施行時期について検討した。根治手術の術式は、Soave-Denda式(SD)が25例、経肛門直腸プルスルー式(TA)が40例であった。対象を生後6ヵ月未満で根治術施行例(低年群)と、生後6ヵ月～12ヵ月で施行した患者(高年群)に振り分け、5歳、7歳、9歳時の腸機能を評価した。SD施行例では、術後の腸機能に低年群と高年群との間で有意差は認めなかった。TA施行患者でも同様に、年齢別による全体の腸機能スコアに有意差は認めなかった。TA施行例では、7歳時における下着の汚染スコアが、低年群よりも、高年群で有意に低かった。これらの結果から最適な腸機能を得るためには、TAは生後6ヵ月までに施行するべきと示唆された。

Authorship：Lead author   Language：Japanese   Publisher：Surgery Today  

Purpose: Retroperitoneal teratomas (RPTs) are rare in infants. We report our experience of treating pediatric patients with RPTs over many years at a single institution, with the aim of developing a safe and secure operative strategy for RPTs in infants. Methods: We reviewed the medical records of patients who underwent treatment for RPTs in our institution between April, 1984 and December, 2017, to analyze their background and clinical data. The diagnosis of RPT was confirmed histologically in all patients. Results: The subjects of this retrospective analysis were 14 pediatric patients (female, n = 11; male, n = 4), ranging in age from 6 days to 12 years, 11 (73.3%) of whom were under 1 year of age. Complete surgical resection was performed in all patients. The tumor ruptured during surgery in four (26.7%) patients and perioperative vessel injuries occurred in six (40.0%) patients, resulting in nephrectomy in one (6.7%). Three (20.0%) patients suffered unilateral renal dysfunction as a surgical complication. Only one patient received postoperative chemotherapy. All patients were free of disease at the time of writing. Conclusion: Perioperative complications are not uncommon during surgery for RPTs, despite their benign nature. Preoperative imaging evaluation is important and operative management may be challenging. Because of the favorable prognosis and the frequency of adverse events in surgery, partial resection or split excision is sometimes unavoidable. Meticulous follow-up for recurrence is required for such patients.

DOI： 10.1007/s00595-021-02327-0

Scopus

PubMed

Authorship：Lead author   Language：Japanese   Publisher：Surgery Today  

Purpose: Few studies have focused on the operative age for Hirschsprung’s disease (HD). We evaluated the optimal timing of surgery in HD patients based on their long-term bowel function. Methods: HD was diagnosed in 65 pediatric patients in our institute between 1992 and 2018. Twenty-five patients underwent the Soave–Denda procedure (SD) and 40 underwent transanal endorectal pull-through (TA). We divided these patients into two groups: those who underwent surgery at < 6 months of age (younger group) and those who underwent surgery at 6–12 months of age (older group). We assessed bowel function at 5, 7, and 9 years of age. Results: The bowel function of the patients who underwent the SD did not differ significantly between the groups. Similarly, the total bowel-function scores of the patients who underwent TA did not differ between the groups at any age. However, the soiling score at 7 years of age in the older group of patients who underwent TA was significantly lower than that in the younger group (p = 0.02). Conclusions: Our data suggest that to achieve optimal bowel function, TA should be performed at < 6 months of age.

DOI： 10.1007/s00595-021-02356-9

Scopus

PubMed

Authorship：Lead author   Language：English   Publisher：シュプリンガー・ジャパン(株)  

単施設において、1984年4月～2017年12月に後腹膜奇形腫(RPT)の治療を行った小児患者15例(男児4例、女児11例)の治療経験を報告した。年齢は日齢6～12歳であり、15例中11例(73.3%)が1歳未満であった。すべての患者で外科的完全切除術が施行された。術中の腫瘍破裂を4例(26.7%)に、周術期の血管損傷を6例(40.0%)に認め、最終的には1例(6.7%)が腎摘出術を要した。また、手術合併症として、片側腎機能障害を3例(20.0%)に認めた。術後化学療法を施行した患者は1例のみであった。その後いずれの患者も治癒している。

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本栄養治療学会  

Authorship：Lead author  

CiNii Research

Authorship：Lead author   Language：Japanese   Publisher：日本膵・胆管合流異常研究会  

DOI： 10.34410/jspbm.45.0_110

CiNii Research

Authorship：Lead author   Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2022081276

CiNii Research

Authorship：Lead author   Language：Japanese   Publisher：The Japanese Society of Pediatric Surgeons  

<p><i>Purpose</i>: The incidence of intussusception is low in older children for various reasons. Owing to the lack of a consensus concerning clinical management, the treatment approach differs among clinicians. To optimize the management of intussusception, we retrospectively analyzed cases in older children admitted to our hospital over 10 years.</p><p><i>Methods</i>: From 2007 to 2017, 10 children >5 years old were diagnosed with intussusception and admitted to our hospital. We retrospectively reviewed their clinical records.</p><p><i>Results</i>: The patients were six boys and four girls between 5 and 14 years old. The main symptoms were abdominal pain (10/10), vomiting (6/10), and hematochezia (2/10). Eight patients were successfully managed by enema, but four of them developed recurrence. Five patients, including three recurrent cases, underwent surgery. The pathological lead point (PLP) was found in three patients. On laparotomy, intestinal wall thickening was found in these three patients, leading to ileocecal resection or an intestinal biopsy. Pathologically, they all showed lymphoid hyperplasia or inflammatory changes. The type of intussusception was ileocolic in nine and enteroenteric in one. To explore the PLP, nine patients underwent computed tomography (CT), magnetic resonance imaging (MRI), Meckel’s scintigraphy, and colonoscopy depending on their condition.</p><p><i>Conclusions</i>: Patients presenting with recurrent intussusception were likely to undergo surgery because identifying the PLP by imaging is difficult. To avoid unnecessary surgery, it is important to repeat enema reduction, even for recurrent cases, while searching for PLP through various modalities, including colonoscopy.</p>

DOI： 10.11164/jjsps.57.7_1049

CiNii Research

Authorship：Lead author   Language：Japanese   Publisher：Pediatric Surgery International  

Purpose: Total parental nutrition (TPN) causes gastrointestinal mucosal atrophy. The present study investigated the effects of hepatocyte growth factor (HGF) on the intestinal mucosal atrophy induced by TPN. Methods: Rats underwent jugular vein catheterization and were divided into four groups: oral feeding (OF), TPN alone (TPN), TPN plus low-dose HGF (0.3 mg/kg/day; TPNLH), and TPN plus high-dose HGF (1.0 mg/kg/day; TPNHH). On day 7, rats were euthanized, and the small intestine was harvested and evaluated histologically. The expression of c-MET, a receptor of HGF, and nutrition transporter protein were evaluated using quantitative polymerase chain reaction. Results: The jejunal villus height (VH) and absorptive mucosal surface area in the TPNHH group were significantly higher than in the TPN group (p < 0.05). The VH in the ileum showed the same trend only in the TPNHH group, albeit without statistical significance. The crypt cell proliferation rate (CCPR) of the jejunum in both HGF-treated groups was significantly higher than in the TPN group (p < 0.01). The expression of c-MET and transporter protein in all TPN-treated groups was decreased compared with that in the OF group. Conclusion: HGF attenuated TPN-associated intestinal mucosal atrophy by increasing the villus height, which was associated with an increase in CCPR.

DOI： 10.1007/s00383-021-05002-0

Scopus

PubMed

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：Japanese   Publisher：(株)東京医学社  

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

【目的】年長児腸重積症(以下本症)の発生頻度は少ないが、病的先進部を有する割合が多いとされている。年長児の本症に対しては一定の診療指針がなく、症例毎に様々なアプローチがなされている。今回、年長児症例に対する適切な診断、治療法を確立すべく自験例を後方視的に検討した。【方法】2007年1月～2017年12月の間に、鹿児島市立病院小児外科に入院した5歳以上の腸重積症10例を対象とし、診療録を用いて後方視的に検討した。【結果】対象は男児6例、女児4例、年齢は5～14歳であった。主要症状は、腹痛10例、嘔吐6例、血便2例であった。8名に非観血的整復が行われ、全例整復に成功したが、その内4例が1～5回再発した。病的先進部は3例(30%)に認められた。重積のタイプは、9名が回結腸型、1名が小腸小腸型であった。手術適応を5例に認め、そのうち整復後に再発をきたした3例において、術中腸管壁肥厚を触知し、悪性疾患が否定できないため、回盲部切除または腸管壁生検を行ったが、病理診断は、リンパ濾胞過形成または炎症性変化であった。病的先進部の検索で、腹部CT検査が9例に行われ、その他症例に応じてメッケル憩室シンチグラム、MRI検査、大腸内視鏡検査が行われていた。【結論】画像検査による病的先進部の検索には限界があり、本症を繰り返す症例には、手術が選択されることが多かった。本症は再発例でも特発性が一定の割合で存在するため、その都度非観血的整復を繰り返し、大腸内視鏡検査も含めた病的先進部の検索を行うことが不必要な手術の減少につながると思われた。(著者抄録)

Authorship：Lead author   Language：English   Publisher：シュプリンガー・ジャパン(株)  

胃切除が施行された患者にみられる胃排出能遅延の差に繋がる因子を検討した。腹腔鏡下噴門形成術と胃切除術を受けた神経症状を有する患者32例を対象とし、術前の胃の配位によって非挙上(NESP)群21例(男性19例、女性2例、平均12.5±11.2歳)と挙上(ESP)群11例(男性8例、女性3例、平均26.5±17.6歳)に分類、各群の患者特性、治療成績、術後の胃排出能を比較した。検討の結果、体重はNESP群の方がESP群より有意に低値であったが、男女比、身長、BMIに群間差はみられなかった。手術時間、気腹時間、出血量、術後合併症の発症率に関して有意差はなく、胃ドレナージ減少までの期間はESP群の方が有意に長く、経腸栄養開始までの期間には有意な群間差はなかった。ただし、全経腸栄養達成までの期間はNESP群の方が有意に長く、胃排出能遅延率と胃運動促進薬の使用率に有意差はみられなかった。多変量解析では、年齢と体重を補正後にも全経腸栄養達成までの期間はNESP群の方がESP群より長い傾向にあった。胃配位の調整は胃排出能遅延に関与する可能性が示された。

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本栄養治療学会  

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：Japanese   Publisher：Journal of Pediatric Surgery  

Purpose:: We aimed to investigate potential predictors of focal intestinal perforation (FIP) in extremely low birth weight infants (ELBWIs) among coagulation and fibrinolysis markers at birth. Methods:: We reviewed the medical records of FIP patients and their coagulation and fibrinolysis markers at birth between 2010 and 2019, and matched patients according to gestational age. FIP was diagnosed based on macroscopic intestinal perforation with a punched-out lesion without necrosis. Patient characteristics and blood test results, including coagulation and fibrinolysis marker levels, were compared between the groups. Results:: Two hundred forty ELBWIs were enrolled in this study (FIP, n = 18; controls, n = 222). In the FIP group, the gestational age at birth was significantly younger (p = 0.023) and the birth weight was significantly lower (p = 0.007) in comparison to the control group. Furthermore, the FIP group showed significantly lower levels of fibrinogen (p = 0.027) and factor XIII (F-XIII) (p = 0.007). The receiver operating characteristics curves for fibrinogen and F-XIII revealed that the 95% confidence intervals of fibrinogen and F-XIII were 0.530–0.783 (p = 0.027), and 0.574–0.822 (p = 0.007), respectively. Conclusions:: This is the first report focusing on coagulation and fibrinolysis markers in FIP patients at birth. The fibrinogen and F-XIII values at birth are potential predictors of FIP in ELBWIs. Type of Study:: Study of Diagnostic Test (Case Control Study) Level of Evidence:: Level IV

DOI： 10.1016/j.jpedsurg.2021.03.043

Scopus

PubMed

Authorship：Lead author   Language：Japanese   Publisher：(公社)日本小児科学会  

Authorship：Lead author   Language：Japanese   Publisher：The Japanese Society of Pediatric Surgeons  

<p>A 15-year-old boy complaining of abdominal pain visited a clinic and underwent an enema for constipation. However, his symptoms did not improve, so he was referred to our hospital. Gastroenteritis was suspected, and he was hospitalized owing to a lack of any specific findings concerning his clinical symptoms and examination results. The symptoms worsened after hospitalization, and he ultimately required analgesics of not only acetaminophen but also pentazocine. Enhanced computed tomography (CT) 45 h after the onset showed a strangulated intestinal obstruction due to mesenteric hiatus hernia. He then underwent emergent laparotomy. On entering the abdominal cavity, a mesenteric defect was found with incarceration in a 90-cm segment of the necrotic distal ileum. The necrotic small intestine was resected, primary anastomosis was performed, and the mesenteric defect was closed. The postoperative course was uneventful, and he was discharged 11 days after the operation without any complications. The mesenteric hiatus hernia was difficult to diagnose preoperatively. This case was diagnosed by preoperative enhanced CT, but the patient required small bowel resection because of the delayed diagnosis. Bowel obstruction without a history of laparotomy is often difficult to diagnose. We should pay close attention to not the need for analgesic medication but also changes in the symptoms in cases of constant abdominal pain in order to prevent the need for bowel resection.</p>

DOI： 10.11164/jjsps.57.4_735

CiNii Research

Authorship：Lead author   Language：English  

DOI： 10.1186/s40792-021-01231-6

PubMed

Authorship：Lead author   Language：English   Publisher：(一社)日本外科学会  

3ヵ月前から心窩部痛と嘔吐が2週毎に発生していた5歳女児症例について検討した。腹部超音波検査では肝円索付近に非血管病変が判明した。造影CTでは肝円索の右側にhyperdense lineとdisproportionate fat strandingに囲まれたlow attenuation massを認めた。腹水や出血はなく、肝円索膿瘍が示唆された。経口抗生物質投与で症状は改善し、待機的探索的腹腔鏡検査および切除術を計画した。マルチチャネルポートデバイスから臍に二つの5mmトロカール、右脇腹に一つの3mmトロカールを挿入した。腹腔の観察では肝円索に網が癒着しており、肉眼的観察では明らかな腫瘤病変は認めなかった。肝円索からの網癒着剥離術を行い、癒着形成部位を切除し、切除検体を臍創から摘出した。術後の経過は良好であった。病理学的所見では壊死性肝組織が判明し、切除組織は虚血性変化を伴った副肝葉であった。

Authorship：Lead author   Language：Japanese   Publisher：日本小児泌尿器科学会  

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

症例は15歳男児。腹痛で前医を受診したが症状改善なく、同日深夜に当科に紹介受診となった。臨床症状と検査結果には特異的な所見を認めず、急性胃腸炎を疑い入院となった。腹痛は増悪傾向で、頻回の鎮痛剤投与を必要とした。発症45時間後に撮影した造影CT検査で、小腸間膜裂孔ヘルニアによる絞扼性イレウスと診断し緊急手術を施行した。開腹所見は、小腸間膜裂孔に回腸が約90cm嵌頓し、嵌頓解除後も色調の改善を認めず壊死腸管の切除と裂孔の閉鎖を施行した。術後は良好に経過し、術後11病日に退院した。小腸間膜裂孔ヘルニアの術前診断は困難と言われている。自験例は術前の造影CT検査で小腸間膜裂孔ヘルニアの診断が得られたが、診断の遅れのため小腸切除を余儀なくされた。開腹歴のない腸閉塞例では、鎮痛剤の使用状況を含め症状の経過の注意深い観察の必要性を痛感したことより、反省を含めて報告する。(著者抄録)

Authorship：Lead author   Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2021229963

CiNii Research

Authorship：Lead author   Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2021229964

CiNii Research

Authorship：Lead author   Language：Japanese   Publisher：(株)東京医学社  

Authorship：Lead author   Language：Japanese   Publisher：(株)東京医学社  

Authorship：Lead author   Language：Japanese   Publisher：The Japanese Society of Pediatric Surgeons  

<p>Neonatal gastric rupture has become rare in recent years, but we encountered a total of five incidents in four cases during a single year. In this study, we reviewed each incident and considered the related pathogenetic factors reported in the literature in order to apply them to future neonatal management. All the patients were premature infants born by emergent Caesarean section. They developed gastric rupture at the greater curvature side (n = 3) or at the anterior wall of the gastric body (n = 2) early after birth. The ruptures occurred in anatomically vulnerable areas characteristic of the stomach wall in newborns. In our cases, the etiologies were considered as follows: in addition to an impaired blood flow in the gastric wall due to physiological diving reflex induced by perinatal hypoxia events, an increased intragastric pressure that exceeded the tolerable upper limit of the neonatal stomach due to obstruction of the gastrointestinal passage by a meconium plug; functional hypoperistalsis of the gastrointestinal tract induced by hypothyroidism; and an organo-axial gastric volvulus peculiar to newborns. We reconfirmed the significance of careful monitoring of the abdominal findings over time and maintaining an appropriate decompression of the upper gastrointestinal tract as needed. These managements are quite common in the neonatal intensive care unit, but are important as preventive measures for the onset of neonatal gastric rupture.</p>

DOI： 10.11164/jjsps.57.3_625

CiNii Research

Publisher：Pediatric Surgery International  

DOI： 10.1007/s00383-020-04842-6

Scopus

PubMed

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本小児外科学会  

新生児胃破裂は近年稀な疾患となったが、我々は1年間に4症例のべ5件を経験した。今後の新生児管理に生かすため、自験例の発生原因を文献的に考察検討した。全例が緊急帝王切開で出生した早期産未成熟児で、大彎側の破裂(3件)、体部前壁の破裂(2件)は生後早期にみられた。いずれも新生児の胃壁に特徴的な解剖学的脆弱部であった。自験例では、周産期のdiving reflexによる胃壁血流障害に加えて、胎便栓による通過障害、甲状腺機能低下による機能的胃腸蠕動不良、臓器軸性胃軸捻等により胃内圧が耐容上限を超えたことが要因として考えられた。我々は、経時的に注意深く腹部所見の観察を重ねること、適正に上部消化管減圧を維持することの意義を再確認した。これらはNICUでは当然の管理であるが、新生児胃破裂の発症予防策としても重要である。(著者抄録)

Authorship：Lead author   Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2021163596

CiNii Research

Authorship：Lead author   Language：Japanese   Publisher：(株)東京医学社  

DOI： 10.1177/1129729820987362

PubMed

Publisher：Pediatric Surgery International  

DOI： 10.1007/s00383-020-04802-0

Scopus

PubMed

DOI： 10.1186/s40792-020-01099-y

PubMed

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Nature  

DOI： doi: 10.1007/s00383-020-04823-9

Publisher：Springer Berlin Heidelberg  

Publisher：Surgery Today  

DOI： 10.1007/s00595-021-02274-w

Scopus

PubMed

Publisher：(一社)日本小児外科学会  

症例は日齢60女児。日齢40頃より灰白色便と黄疸を認めるようになり、前医で胆道閉鎖症(以下本症)を疑われ、当科に入院となった。身体所見で全身の黄疸と肝腫大を認め、血液検査で直接ビリルビンの上昇と肝機能異常を認めた。超音波検査で胆嚢の萎縮とtriangular cord signが確認され、胆道シンチでは核種の腸管内排泄を認めなかった。本症が強く疑われたため、日齢67に試験開腹術を施行した。術中所見では萎縮した胆嚢と索状の肝外胆管、肝門部の結合組織塊を認め、本症(III-b1-v)と診断し葛西手術を施行した。病理検査では肝門部結合織内の微小胆管構造の周囲に異所性軟骨組織を認めた。異所性軟骨を伴った本症の症例報告はこれまでにも散見され、発生学的異常や炎症による軟骨化生などが発症要因として推測されているが、原因は明らかとなっていない。異所性軟骨を伴った本症の症例報告をまとめて文献的考察を行った。(著者抄録)

Publisher：(一社)日本小児外科学会  

当院NICUは年間700例以上を支えるhigh volume centerであるが、今回、非観血的整復を完遂した腸重積症例を初めて経験したので報告する。症例は、日齢3の満期産男児。日齢2の夜間、緑色便に一部血性粘液の付着がみられた。翌朝、中等量の赤色粘血便をみとめ紹介となった。腹部膨満はなかったが、右側腹部にソーセージ様腫瘤を触知した。腹部超音波検査でmultiple concentric ring signをみとめ、回腸結腸型腸重積症と診断した。発症から19時間で高圧浣腸を試み、非観血的整復を完遂した。その後、再発はみられなかった。新生児期の腸重積は稀であるが、超音波検査により本症例の診断は容易であった。全身状態が良好で、腸管壊死を示唆する所見がない満期産新生児の回腸結腸型腸重積症例に対しては、穿孔時の緊急開腹手術体制を整えたうえで、安全に非観血的整復を試みることも妥当であると思われた。(著者抄録)

Publisher：(株)東京医学社  

1985年4月〜2020年3月までの鹿児島県における腹壁異常の手術症例69例の治療成績について後方視的検討を行った。なお、1985年4月〜2004年3月(前期)までは全例が鹿児島大学病院、2004年4月〜2020年3月(後期)までは鹿児島大学病院と鹿児島市立病院で診療された。対象の内訳は臍帯ヘルニア36例(男児19例、女児17例)、腹壁破裂33例(男児16例、女児17例)で、帝王切開での分娩は臍帯ヘルニア21例(58.3%)、腹壁破裂23例(70.0%)であった。術式は一期閉鎖術31例、silo造設のみ1例、silo造設後の二期閉鎖術37例であった。分娩様式や術式別の予後に有意差は認めなかった。死亡例は臍帯ヘルニア5例(13.9%)、腹壁破裂1例(3.0%)で、臍帯ヘルニア5例は染色体異常または重症合併奇形を認めた。出生前診断率、生存率は後期で増加していたが有意差は認めなかった。

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Publisher：日本外科代謝栄養学会  

&emsp;腸管リハビリテーションプログラムとは, 腸管不全患者の最終的な治療目標である経口あるいは経腸栄養の確立にむけてのさまざまな取り組みである. なかでも, 長期にわたる静脈栄養管理中に起こる腸管不全関連肝障害 (intestinal failure associated liver disease : IFALD) の予防, 治療が患者の生命予後に大きく影響する. FALDの原因としてさまざまな要因が考えられてきたが, 中でも大豆由来脂肪乳剤の影響について研究が行われ, IFALD治療には100％魚油由来脂肪乳剤の有効性が報告されてきた. また, 新規混合脂肪乳剤も欧米では認可され, 臨床経験も集積されてきた. これまでの研究結果から各脂肪乳剤の肝臓に及ぼす影響とその効果について解説する. 加えて, 自施設で行ってきた短腸症候群ラットモデルを用いた各種脂肪乳剤によるIFALDに関する研究では大豆由来脂肪乳剤によるhepatic steatosis, いわゆるNAFLDが起こり, 魚油由来脂肪乳剤ではhepatic steatosisが軽減し, T/T比は正常範囲内であることが明らかになった.

DOI： 10.11638/jssmn.54.6_241

CiNii Research

Publisher：日本外科代謝栄養学会  

&emsp;本稿では短腸症候群に焦点をあて, ペプチド成長因子を用いた残存腸管順応誘導について最近の知見を報告する. われわれは, ghrelin, glucagon‐like peptide‐2 (GLP‐2), epidermal growth factor（EGF）に注目している. Ghrelin投与は完全静脈栄養管理中の腸管粘膜委縮を抑制し, 吸収面積拡張にも寄与することが分かった. GLP‐2治療は, 腸切除後早期に行うとより効果的であると推測された. GLP‐2とEGFは相乗して粘膜透過性を抑制し, 腸管バリア機能強化に寄与することが分かった. 現在臨床応用されているペプチド成長因子はGLP‐2 analogのみであるが, さらに複数を組み合わせることで, より効果的に残存腸管順応を推進することが可能かもしれない. Ghrelin, EGFはその候補としてあげられる. これら因子の至適組み合わせ, 適正な投与タイミング, 量などに関する検討は今後の課題である.

DOI： 10.11638/jssmn.54.6_229

CiNii Research

Publisher：Pediatric Surgery International  

DOI： 10.1007/s00383-019-04579-x

Scopus

PubMed

Publisher：(一社)日本小児外科学会  

症例は日齢2、男児。在胎34週の母体超音波検査で左精巣に嚢胞性病変を指摘されていた。在胎37週2日、2,890g、帝王切開分娩で出生した。出生後のMRI検査では10mm大の嚢胞性病変を認め、明らかな充実成分・脂肪成分は指摘されず、単純嚢胞や類表皮嚢胞が疑われ、生後1ヵ月時に手術を施行した。手術所見は精巣実質と境界明瞭な単房性嚢胞であり、嚢胞のみを核出した。病理検査では嚢胞壁内に扁平上皮と一部脂肪を含む線維筋性組織、腸管組織を認め、成熟嚢胞奇形腫の診断であった。陰嚢内精巣腫瘍が出生前診断されることは非常に稀で、発生頻度的には圧倒的に胚細胞腫瘍が多いが、本症例では画像所見上、充実成分を全く認めず、精巣嚢胞が最も疑われた。新生児精巣腫瘍において嚢胞のみの病変であっても胚細胞腫瘍を念頭に診断・治療を行う必要がある。(著者抄録)

Publisher：Pediatric Blood and Cancer  

DOI： 10.1002/pbc.27804

Scopus

PubMed

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Publisher：(株)東京医学社  

Publisher：(株)東京医学社  

Publisher：(株)東京医学社  

Publisher：(株)東京医学社  

Publisher：(株)東京医学社  

Publisher：(株)東京医学社  

＜Key Points＞(1)女児の持続的あるいは間欠的な腹痛を診た場合は卵巣捻転を鑑別する。(2)卵巣捻転であっても消化器症状をメインに呈することもあるため注意を要する。(3)間欠的腹痛に白血球数と炎症反応の上昇を伴う場合は画像診断を考慮する。(4)画像上、卵巣の腫瘍性病変を伴う場合は早急な手術が必要となるため手術可能な施設に速やか紹介する。(著者抄録)

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