Language：Japanese   Publisher：Pediatric Surgery International  

Purpose: To ensure the safe spread of pediatric endoscopic surgery, it is essential to build a training curriculum, and a survey of the current situation in Japan is necessary. The present study assessed an efficient training curriculum by clarifying instructor class pediatric surgeons’ experiences, including autonomy when performing advanced endoscopic surgeries. Methods: An online nationwide questionnaire survey was conducted among pediatric surgeons who had Endoscopic Surgical Skill Qualification (ESSQ) and board-certified instructors who had skills comparable to ESSQ. We assessed participants’ training experience, opinions concerning the ideal training curriculum, and the correlation between surgical experience and the level of autonomy. The Zwisch scale was used to assess autonomy. Results: Fifty-two participants responded to the survey (response rate: 86.7%). Only 57.7% of the respondents felt that they had received sufficient endoscopic surgery training. Most respondents considered an educational curriculum for endoscopic surgery including off-the-job training essential during the training period. Autonomy had been acquired after experiencing two to three cases for most advanced endoscopic surgeries. Conclusion: This first nationwide survey in Japan showed that instructor class pediatric surgeons acquired autonomy after experiencing two to three for most advanced endoscopic surgeries. Our findings suggest that training, especially off-the-job training, has been insufficient.

DOI： 10.1007/s00383-023-05550-7

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Language：Japanese   Publisher：Pediatric Surgery International  

Purpose: Anovestibular fistula (AVF) is the most common type of ARM in female patients. The present study investigated changes over time in the postoperative defecation function of female patients with AVF. Methods: Patient data were collected from 1984 to 2021. Eighty-eight female patients with AVF were enrolled. Patients’ characteristics and the long-term outcome of defecation function were reviewed and analyzed retrospectively. The bowel function was evaluated according to the Japan Society of ARM Study Group evacuation score (ES). Results: Thirty-eight patients underwent anal transposition (AT), and 8 underwent anterior sagittal anorectoplasty (ASARP). The total evacuation score (ES) in AVF patients reached “excellent” at nine years old, regardless of the operative procedure. The constipation scores with AT showed better improvement than those with ASARP, but soiling scores in the ASARP group showed better improvement than those in the AT group. The postoperative complications did not affect the postoperative bowel function in AVF patients. Conclusion: Most patients with AVF eventually achieved a satisfactory total ES. Given the difference in defecation score transition depending on the operative procedure or postoperative complications, it may be important to perform long-term defecation management via surgical procedures.

DOI： 10.1007/s00383-023-05554-3

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Language：English  

DOI： 10.2186/jpr.JPR_D_22_00178

PubMed

Publisher：東京医学社  

DOI： 10.24479/ps.0000000550

Language：English   Publisher：John Wiley & Sons Australia, Ltd  

Publisher：東京医学社  

DOI： 10.24479/ps.0000000493

Language：Japanese   Publisher：World Journal of Pediatric Surgery  

Objective The present study attempts to clarify the clinical features of pediatric intra-abdominal solid organ injury at two institutions. Methods The injured organ, patient age, sex, injury grade, imaging findings, intervention, length of hospital stay, and complications were retrospectively reviewed using medical records at two centers from 2007 to 2021. Results There were 25 cases of liver injury, 9 of splenic injury, 8 of pancreatic injury, and 5 of renal injury. The mean age of all patients was 8.6±3.8 years old, with no difference between organ injury types. Radiological intervention was performed in four cases of liver injury (16.0%) and one case of splenic injury (11.1%), and surgery was performed in two cases of liver injury (8.0%) and three cases of pancreatic injury (37.5%). All other cases were treated conservatively. Complications included adhesive ileus in one case of liver injury (4.0%), splenic atrophy in one case of splenic injury (11.1%), pseudocysts in three cases of pancreatic injury (37.5%), atrophy of the pancreatic parenchyma in one case of pancreatic injury (12.5%), and urinoma in one case of renal injury (20.0%). No mortalities were observed. Conclusion Pediatric patients with blunt trauma had favorable outcomes at two pediatric trauma centers covering a broad medical area, including remote islands.

DOI： 10.1136/wjps-2023-000560

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Language：English  

DOI： 10.2186/jpr.JPR_D_22_00105

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Language：English  

DOI： 10.1186/s40792-023-01679-8

PubMed

Language：Japanese   Publisher：Journal of Gastroenterology  

Background: Pancreatic neuroendocrine neoplasms (PanNENs) are a heterogeneous group of tumors. Although the prognosis of resected PanNENs is generally considered to be good, a relatively high recurrence rate has been reported. Given the scarcity of large-scale reports about PanNEN recurrence due to their rarity, we aimed to identify the predictors for recurrence in patients with resected PanNENs to improve prognosis. Methods: We established a multicenter database of 573 patients with PanNENs, who underwent resection between January 1987 and July 2020 at 22 Japanese centers, mainly in the Kyushu region. We evaluated the clinical characteristics of 371 patients with localized non-functioning pancreatic neuroendocrine tumors (G1/G2). We also constructed a machine learning-based prediction model to analyze the important features to determine recurrence. Results: Fifty-two patients experienced recurrence (14.0%) during the follow-up period, with the median time of recurrence being 33.7 months. The random survival forest (RSF) model showed better predictive performance than the Cox proportional hazards regression model in terms of the Harrell’s C-index (0.841 vs. 0.820). The Ki-67 index, residual tumor, WHO grade, tumor size, and lymph node metastasis were the top five predictors in the RSF model; tumor size above 20 mm was the watershed with increased recurrence probability, whereas the 5-year disease-free survival rate decreased linearly as the Ki-67 index increased. Conclusions: Our study revealed the characteristics of resected PanNENs in real-world clinical practice. Machine learning techniques can be powerful analytical tools that provide new insights into the relationship between the Ki-67 index or tumor size and recurrence.

DOI： 10.1007/s00535-023-01987-8

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Language：English   Publisher：Springer Berlin Heidelberg  

Language：English  

DOI： 10.4103/jmas.jmas_10_23

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Publisher：東京医学社  

DOI： 10.24479/ps.0000000445

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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Language：Japanese   Publisher：Journal of prosthodontic research  

Purpose Denture adhesives improve the stability of incompatible dentures; however, complete removal of adhesives after use is difficult. Only a few studies have focused on the removal of denture adhesives. Hence, this study aimed to assess the efficacy of surfactants in removing cream denture adhesives from acrylic resin materials.Methods Solutions of twelve surfactants with various hydrophilic-lipophilic balance (HLB) values were prepared. Two cream denture adhesives, colored for visualization, were spread onto transparent acrylic resin plates. After immersion into surfactant solutions, the effects of the surfactants on residual adhesives were evaluated. We also investigated the effect of denture cleaners (with or without the surfactants) on the removability of adhesives and artificial oily dirt, and their effects on the surface properties of denture materials. The obtained data were analyzed using appropriate statistical methods.Results Five surfactants [BT-5, BL-4.2, BT-7, BT-9, and Triton X-100 (TX)] with HLB values in the 10.5-13.5 range effectively removed adhesives. Addition of BT-9 and TX (HLB=13.5) to denture cleaners improved the adhesives' removal. Furthermore, the addition of TX to the cleaners did not interfere with the removal of artificial oily dirt and did not damage the denture materials' surface.Conclusions Surfactants with HLB values in the 10.5-13.5 range are suitable for removal of cream denture adhesives from acrylic resin materials. In particular, TX (HLB=13.5) efficiently removes adhesives without damaging denture materials or impairing original detergency.

DOI： 10.2186/jpr.JPR_D_21_00286

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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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Language：Japanese   Publisher：International Journal of Surgery Case Reports  

Introduction and importance: Mucoepidermoid carcinoma presents as an exophytic endobronchial mass that induces obstructive symptoms often followed by distal collapse atelectasis of the lung parenchyma. Case presentation: A six-year-old girl had recurrent bacterial pneumonia and atelectasis of the right upper lobe. Computed tomography revealed a 30-mm mass in the anterior segment of the right upper lobe with an obstructed trachea and peripheral atelectasis. A minor salivary gland tumor was suspected, so thoracoscopic right upper lobectomy (RUL) was performed. Intraoperative bronchoscopy showed no protrusion of the tumor into the tracheal lumen. We confirmed that there was no injury to the middle lobe branch and no residual tumor via bronchoscopy before transection of the trachel bronchus of the right upper lobe. The histological type was low-grade mucoepidermoid carcinoma. The postoperative course was uneventful, and no recurrence was evident after one year. Clinical discussion: Primary pulmonary cancers in children are extremely rare. Mucoepidermoid carcinoma is the most common disease in pediatric primary lung tumors but remains relatively rare. Mucoepidermoid carcinoma of the tracheobronchial tree sometimes requires sleeve resection. Intraoperative bronchoscopy helped determine the exact position of the tumor. The value of intraoperative bronchoscopy for sparing the lung parenchyma and preserving as much of the respiratory function as possible. Intraoperative bronchoscopy should be actively performed in cases of pediatric lobectomy, especially those involving tracheobronchial tumors. Conclusion: Intraoperative bronchoscopy allowed for complete RUL without residual tumor or injury of the middle lobe bronchus.

DOI： 10.1016/j.ijscr.2023.108119

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Publisher：東京医学社  

DOI： 10.24479/pm.0000000804

Language：Japanese   Publisher：Frontiers in Pediatrics  

Introduction: In some patients with congenital biliary dilation (CBD), biliary cirrhosis has been reported to rapidly progress from the neonatal period to the infantile period. We herein report an infantile case of CBD that showed severe biliary cirrhosis at the diagnosis, which was treated by laparoscopic surgery. Case presentation: A 16-month-old girl underwent conservative therapy for liver dysfunction and cholangitis on a remote island of our prefecture. She was transferred to our hospital after the detection of a huge dilated common bile duct on imaging at the previous hospital. Contrast-enhanced computed tomography showed a dilated common bile duct (maximum diameter: 5 cm), thus suggesting CBD. However, her laboratory data on admission showed a poor nutritional status and severe liver dysfunction (Alb, 2.5 mg/dl; AST, 79 IU/L; ALT, 43 IU/L; γ-GTP, 491 mg/dl; D-bil, 0.3 mg/dl; CHE, 90 IU/L; NH3, 123 μg/dl). We initially performed laparoscopic exploration and bile drainage via the gallbladder, noting severe hepatic fibrosis resembling end-stage liver cirrhosis. After placing a drainage tube in the gallbladder, cholangiography was performed. Cholangiography showed Todani type IVa CBD with pancreaticobiliary maljunction. Contrast agent flowing into the duodenum could not be confirmed. The patient received liver-supporting therapy and nutritional support for 7 weeks before definitive surgery. Following the improvement of the hepatic synthetic capacity (Alb, 4.0 mg/dl; AST, 82 IU/L; ALT, 78 IU/L; γ-GTP, 157 mg/dl; D-bil, 0.2 mg/dl; CHE, 232 IU/L; NH3, 75 μg/dl), we performed extrahepatic bile duct excision and hepaticojejunostomy laparoscopically. Laparoscopic surgery was successfully performed along with liver biopsy. Histopathologically, the liver specimen showed chronic hepatitis and fibrosis (F3A2). Biliary scintigraphy showed good bile excretion at postoperative day 15. The postoperative course uneventful, and the patient was discharged on the 23rd day after surgery. A needle liver biopsy six months later showed mild improvement of chronic hepatitis and fibrosis (F2-3A1). The patient was regularly followed at the outpatient clinic. Conclusions: Severe liver fibrosis was suspected to be continuous cholestasis of CBD after birth. CBD with severe liver fibrosis may avoid liver transplantation by two-stage surgery with hepatoprotection therapy and immunonutritional support.

DOI： 10.3389/fped.2022.1101000

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Language：Japanese   Publisher：Pediatrics international : official journal of the Japan Pediatric Society  

DOI： 10.1111/ped.15459

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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

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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。

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

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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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Language：Japanese   Publisher：Manuscripta Mathematica  

We shall study minimal complex surfaces with c2= 9 and χ= 5 whose canonical classes are divisible by 3 in the integral cohomology groups, where c12 and χ denote the first Chern number of an algebraic surface and the Euler characteristic of the structure sheaf, respectively. The main results are a structure theorem for such surfaces, the unirationality of the moduli space, and a description of the behavior of the canonical map. As a byproduct, we shall also rule out a certain case mentioned in a paper by Ciliberto–Francia–Mendes Lopes. Since the irregularity q vanishes for our surfaces, our surfaces have geometric genus pg= 4.

DOI： 10.1007/s00229-022-01442-7

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Language：English   Publisher：John Wiley & Sons Australia, Ltd  

Language：Japanese   Publisher：Journal of Laparoendoscopic and Advanced Surgical Techniques  

Background: Endoscopic surgery also has been becoming widespread in the field of pediatric surgery. However, most disease treated by pediatric surgery in a single institution are small number of cases. Besides, the variety of operative procedures that need to be performed in this field is quite wide. For these reasons, pediatric surgeons have limited opportunities to perform endoscopic surgery. Therefore, it is difficult to introduce advanced endoscopic surgery at a single local hospital. To educate pediatric surgeons in local hospitals, for widespread advanced pediatric endoscopic surgery safely, and to eliminate the need for patient centralization, we have introduced a proctoring system. We compared the surgical results of our institution, a center hospital, with other local institutions, to investigate the feasibility of our proctoring system. Methods: The experienced pediatric surgeon of our institution visits local hospitals to provide onsite coaching and supervises pediatric surgeons on the learning curve. All patients who underwent laparoscopic cyst excision and hepaticojejunostomy for choledochal cysts, one of the advanced pediatric endoscopic surgeries was retrospectively reviewed. Results: Thirty-four cases were evaluated (14 cases in our institution, 20 cases in 9 other institutions). The procedures of all 34 cases were performed by surgeons with 0-2 cases of experience in the procedure. There were no open conversion cases. There was no significant difference in the operative date. There was 1 case (6.7%) of postoperative complications during hospitalization at our institution and 3 cases (14.3%) at other institutions (P = .47). Two cases of late complications (13.3%) occurred at our institution, whereas 6 cases (28.6%) occurred at other institutions (P = .28). Conclusion: With the proctoring system, the performance and completion of advanced pediatric endoscopic surgery at local institutions was feasible. This has important implications given the ever-growing demand for pediatric endoscopic surgery and the increasing need for competent pediatric endoscopic surgeons.

DOI： 10.1089/lap.2023.0087

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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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Language：Japanese   Publisher：Frontiers in Pediatrics  

Near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) has gained popularity in pediatric surgery as it has in general surgery. In addition, a water-jet dissector (WJD) has been successfully introduced in adult hepatic surgery. Tissue structures are dissected selectively and gently by the WJD. However, there have been no reports of hepatic resection for pediatric patients using a WJD. We applied NIR fluorescence imaging with ICG to visualize the resection line of the liver and used a WJD for liver parenchyma dissection in pediatric hepatoblastoma. The patient was a 3-year-old girl with a large liver tumor. Enhanced computed tomography revealed a liver tumor (maximum diameter: 120 mm) in the right lobe and three small lung metastases. The liver tumor was diagnosed as hepatoblastoma (PRETEXT 2) based on an open biopsy. We performed right hepatectomy after neoadjuvant chemotherapy. The right lobe was mobilized from the diaphragm, and then intraoperative ultrasound was performed to detect the localization of the tumor and its proximity to the vascular structures. We detected the right hepatic artery (RHA), right portal vein (RPV), and right hepatic vein (RHV). The middle hepatic vein was not involved. After ligation of the RHA and RPV to selectively control the right lobe inflow, ICG was administered intravenously and observed by an NIR endoscope. The resection line was clearly visualized by overlaying images in comparison to conventional demarcation line detection. Then, we used a WJD to dissect the parenchyma. Small vessels were divided from parenchymal tissue and were clearly visible. We resected them after clamping with metal clips. Finally, the RHV was transected by a linear stapler, and right hepatectomy was completed with 25 ml of blood loss. There was no postoperative hemorrhage. We performed hepaticojejunostomy because of stricture of the common bile duct on postoperative day 302. The patient was discharged after adjuvant chemotherapy. NIR imaging clearly showed the resection line. The WJD automatically separated, and thus made visible, the more resistant duct and vessel structures from the parenchyma. The combined use of NIR imaging and WJD was useful for pediatric hepatectomy.

DOI： 10.3389/fped.2023.1221596

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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

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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

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Language：Japanese   Publisher：Scientific Reports  

To determine whether increasing thrombectomy-capable hospitals with moderate comprehensive stroke center (CSC) capabilities is a valid alternative to centralization of those with high CSC capabilities. This retrospective, nationwide, observational study used data from the J-ASPECT database linked to national emergency medical service (EMS) records, captured during 2013–2016. We compared the influence of mechanical thrombectomy (MT) use, the CSC score, and the total EMS response time on the modified Rankin Scale score at discharge among patients with acute ischemic stroke transported by ambulance, in phases I (2013–2014, 1461 patients) and II (2015–2016, 3259 patients). We used ordinal logistic regression analyses to analyze outcomes. From phase I to II, MTs increased from 2.7 to 5.5%, and full-time endovascular physicians per hospital decreased. The CSC score and EMS response time remained unchanged. In phase I, higher CSC scores were associated with better outcomes (1-point increase, odds ratio [95% confidence interval]: 0.951 [0.915–0.989]) and longer EMS response time was associated with worse outcomes (1-min increase, 1.007 [1.001–1.013]). In phase II, neither influenced the outcomes. During the transitional shortage of thrombectomy-capable hospitals, increasing hospitals with moderate CSC scores may increase nationwide access to MT, improving outcomes.

DOI： 10.1038/s41598-022-06074-1

Scopus

Language：Japanese   Publisher：International Journal of Environmental Research and Public Health  

Oral care involving a denture cleaning regimen is important for reducing the incidence of systemic diseases. However, limited information is currently available on denture cleaning frequencies and regimens. Therefore, the present study investigated the relationship between the number of Candida spp. present on the complete dentures of nursing home residents and cleaning regimens. Residents were surveyed to assess their denture cleaning methods. Plaque was collected by applying a sterile swab to the mucosal surface of each examined complete denture worn by 77 residents, and the Candida spp. collected were cultured, identified, and quantified. The relationship between denture cleaning regimens and the quantity of Candida spp. was investigated. Correlation and multivariable analyses revealed that the strongest factor influencing the number of Candida spp. on dentures was the frequency of use of denture cleansers. The number of Candida spp. was the lowest on dentures cleaned daily with a denture cleanser. The present results demonstrated that the daily use of a denture cleanser effectively controlled the adherence of Candida spp. to dentures. Oral and other healthcare providers need to provide instructions on and assist nursing home residents with the daily care of dentures, using denture cleansers, including the environment where cleaning is performed.

DOI： 10.3390/ijerph192315805

Scopus

PubMed

Publisher：東京医学社  

DOI： 10.24479/ps.0000000249

Publisher：金原出版  

DOI： 10.18888/op.0000003013

Language：Japanese   Publisher：Asian journal of endoscopic surgery  

INTRODUCTION: Management of neonates with long gap esophageal atresia (LGEA) is one of the most challenging situations facing pediatric surgeons. Delayed anastomosis after internal traction for esophageal lengthening was reported as a useful technique for long gap cases. Additionally, the use of near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) has gained popularity in pediatric surgery, especially for blood perfusion validation. We report a novel technique for safe and secure anastomosis for LGEA in the neonatal period using internal traction and ICG-guided NIR fluorescence. PATIENT AND SURGICAL TECHNIQUE: A pregnant woman with polyhydramnios was admitted to the department of obstetrics in our hospital. At 29 weeks of gestation, ultrasound showed mild polyhydramnios and absence of the fetal stomach. A male neonate was born at 38 weeks of gestation with 21 trisomy. EA (Gross type A) was diagnosed based on an X-ray study that showed the absence of gastric bubble with a nasogastric tube showing the "coil-up" sign. Thoracoscopic internal traction and laparoscopic gastrostomy were performed on day 4 after birth. We confirmed the distance between the upper pouch and lower pouch on X-ray. On day 16 after birth, thoracoscopic anastomosis was performed. We successfully performed esophageal anastomosis without tearing the esophageal wall. Blood perfusion of the upper and lower pouch was validated after anastomosis using ICG-guided NIR fluorescence. CONCLUSION: Delayed anastomosis for LGEA in the neonatal period using internal traction and ICG-guided NIR fluorescence is safe and feasible.

DOI： 10.1111/ases.13098

Scopus

PubMed

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

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

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

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

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。

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。

Language：English  

DOI： 10.1186/s40792-022-01535-1

PubMed

Language：Japanese   Publisher：Journal of Vascular Access  

Purpose: Tunneled central venous catheter (tCVC) placement plays an important role in the management of pediatric patients. We adopted a real-time ultrasound (US)-guided supraclavicular approach to brachiocephalic vein cannulation. We evaluated the outcomes of tCVC placement via a US-guided supraclavicular approach. Methods: A retrospective study was performed for patients who underwent US-guided central venous catheterization of the internal jugular vein (IJV group) and brachiocephalic vein (BCV group) in our institution. The background information and outcomes were reviewed using medical records. Results: We evaluated 85 tCVC placements (IJV group: n = 59, BCV group: n = 26). Postoperative complications were recognized in 19 patients in the IJV group (catheter-related bloodstream infection (CRBSI), n = 14 (1.53 per 1000 catheter days); occlusion, n = 1 (1.7%, 1.09 per 1000 catheter days); accidental removal, n = 3 (5.2%, 0.33 per 1000 catheter days); and other, n = 1 (1.7%, 1.09 per 1000 catheter days)) and five patients in the BCV group (CRBSI, n = 2 (0.33 per 1000 catheter days); catheter damage, n = 1 (3.8%, 1.67 per 1000 catheter days); and accidental removal, n = 2 (7.7%, 0.33 per 1000 catheter days)). In the BCV group, despite that, the incidence of postoperative complications was lower (p = 0.205) and the period of placement was significantly longer in comparison to the IJV group (p = 0.024). Conclusion: US-guided placement of tunneled CVC though the BCV results in a low rate of postoperative complications despite longer CVC indwelling times compared to IJV insertion. Our results suggest that BCV insertion of tunneled CVC in children may offer advantages in terms of device performance and patient safety.

DOI： 10.1177/11297298211008084

Scopus

PubMed

Language：English   Publisher：Springer Berlin Heidelberg  

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

Scopus

PubMed

Publisher：東京医学社  

DOI： 10.24479/ps.0000000183

Language：Japanese   Publisher：Asian journal of endoscopic surgery  

Severely neurologically impaired patients often require the creation of a gastrostomy when they develop difficulty with oral intake followed by antireflux surgery. We use a traction technique for laparoscopic fundoplication without removing the gastrostomy in such cases. Right lateral traction of the round ligament of the liver and left lateral traction of the stomach body are performed using a needle device. The left liver lobe is elevated with a liver retractor inserted via the epigastrium. This traction technique allows a sufficient surgical field for manipulating forceps to be created in cases with a gastrostomy, enabling fundoplication to be performed safely without removing the gastrostomy.

DOI： 10.1111/ases.13028

Scopus

PubMed

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

Scopus

PubMed

Language：English   Publisher：John Wiley & Sons Australia, Ltd  

症例は42歳男性で、低酸素性脳症を原因とする脳性麻痺を呈しており、経口摂取が困難で腹腔鏡下胃瘻造設術を受けていた。胃食道逆流のために頻回な誤嚥性肺炎をきたし、腹腔鏡下噴門形成術を行った。四肢拘縮と側彎を考慮して斜仰臥位にて右尾側から手術を開始した。臍切開部より12mm Hassonトロカーを挿入し、気腹を8mmHgに設定した後に腹腔鏡を挿入、左手ポート(5mm)を右上腹部より挿入しニードルデバイスを用いて肝円索を2-0絹糸により右側方に牽引し、さらに胃体部を3-0モノフィラメント縫合糸を用いて左側方に牽引した。続いて、右手ポート(5mm)を胃瘻部に近接する左上腹部に挿入し、補助ポート(5mm)を左側方冠側の胃瘻近接部に留置、肝開創器を心窩部を介して挿入し肝左葉を挙上した。さらに横隔膜脚部を同定し腹部食道を露出後、脚部を縫合処理し、3-0ポリエステル非吸収性縫合糸を用いて被覆固定を行い、被覆した胃底中部と横隔膜右脚部を固定処理して手術を終了した。

Language：Japanese   Publisher：(株)東京医学社  

対象は1984年～2015年に肛門形成術を施行した中間位および高位鎖肛の男児64例。仙骨会陰式鎖肛根治術(SP法)は2007年までの52例に、modified PSARP(m-PSARP)法は2007年以降の12例に施行された。肛門形成時月齢はSP法6.5ヵ月、m-PSARP法5.2ヵ月であった。術後排便機能臨床的評価基準の便意・便秘・失禁・汚染の合計点は、両群においてゆっくりと改善し10歳以降で6点以上となった。m-PSARP群は、便秘と失禁のスコアは7歳以降でSP群より高値を推移し、汚染スコアはSP群より低値で推移した。m-PSARP法が術後排便機能の観点では優位な結果であった。

Publisher：東京医学社  

DOI： 10.24479/ps.0000000160

Language：Japanese   Publisher：The Japanese Society of Pediatric Surgeons  

<p>We successfully treated a case of pancreatic pseudocyst caused by type IIIb pancreatic injury via laparoscopic external drainage. [Case] A 14-year-old boy presented with abdominal pain after having his upper abdomen bruised by contact with another player’s knee during a soccer match. Magnetic resonance cholangiopancreatography (MRCP) showed complete rupture of the pancreatic body, and fluid collection was detected around it. The patient was diagnosed as having type IIIb pancreatic injury based on the classification of the Japanese Society of Trauma. We selected a non-operative management approach because the patient was hemodynamically stable. However, after conservative treatment, a pancreatic pseudocyst of 3 cm diameter was found; thus, endoscopic retrograde pancreatography (ERP) was performed on the 11th day of illness. The pancreatic duct was transected at the body of the pancreas, and a pancreatic duct stent was placed into the cyst, but it fell off after three days. After that, the pancreatic pseudocyst tended to grow and increased in size from the subdiaphragm to the lower pole of the kidney. Therefore, we performed laparoscopic external drainage on the 45th day of hospitalization. After the operation, the patient showed no abdominal symptoms, and no recurrence of cysts was recognized. [Conclusion] Laparoscopic drainage of pancreatic pseudocysts can enable the observation of the entire abdominal cavity while also facilitating safe and reliable drainage. Therefore, depending on the patient condition, laparoscopic external drainage of pancreatic pseudocysts may be considered as a treatment option.</p>

DOI： 10.11164/jjsps.58.4_734

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)

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

今回、IIIb型膵損傷後の膵仮性嚢胞に対し、腹腔鏡下嚢胞ドレナージが奏功した1例を経験した。【症例】症例は14歳男児。サッカーの試合中に他選手の膝で上腹部を打撲後に腹痛を訴え救急搬送された。Magnetic resonance cholangiopancreatography(MRCP)では日本外傷学会分類IIIb型の膵損傷と診断した。全身状態は安定しており保存的に加療する方針とした。しかしその後に、3cm大の膵仮性嚢胞を認め、内視鏡的逆行性膵管造影を11病日に施行した。主膵管は膵体部で断裂し、膵管ステントを嚢胞内へ留置したが数日で脱落した。その後、嚢胞は横隔膜下から腎下極に及ぶまで増大したため、入院45日目に腹腔鏡下嚢胞開窓ドレナージ術を行った。術後は腹部症状や嚢胞の再発は認めず経過している。【結語】膵仮性嚢胞に対する腹腔鏡下嚢胞ドレナージは、腹腔内の観察ができ、確実なドレナージが可能である。病態に応じて膵仮性嚢胞のドレナージ法の選択肢として検討されうると考えられた。(著者抄録)

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

Publisher：東京医学社  

DOI： 10.24479/ps.0000000100

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

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PubMed

Language：Japanese   Publisher：Journal of Hepato-Biliary-Pancreatic Sciences  

DOI： 10.1002/jhbp.1100

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PubMed

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。

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。

Language：English  

DOI： 10.1186/s40792-022-01409-6

PubMed

Language：English   Publisher：Springer Berlin Heidelberg  

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。

Language：Japanese   Publisher：Materials  

Surface changes and microbiological effects following shot blast polishing with viscoelastic media of the mucosal surface of resin denture bases were examined. Average surface roughness (Ra) and the depth of surface removal of specimens were measured over time, and the clinical number of microbial adhesions on the mucosal surface of dentures was clinically assessed. The results obtained showed no changes in Ra after 20 s of polishing, Ra of <0.2 µm, and a depth of surface removal <20 µm. This method of finishing did not affect the fit of the mucosal surface of the dentures. Furthermore, the adhesion of microorganisms to the mucosal surface of dentures was significantly suppressed. Shot blast polishing with viscoelastic media is useful for finishing the mucosal surface of resin denture bases.

DOI： 10.3390/ma15062275

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PubMed

Language：Japanese   Publisher：International Journal of Environmental Research and Public Health  

The “Creative Heath” project, a participatory school activity to foster community resilience, was implemented in Fukushima, Japan, and children’s experiences of the project were assessed both quantitatively and qualitatively. The project consists of three workshops: BODY, FOOD, and ACT, with activities to facilitate students’ scientific and creative thinking, working in teams, presenting, and expressing their opinions. The first two schools participated with 105 students aged 9–11 years old. Before and after each workshop, students were given questionnaires to rate their satisfaction with their own health (BODY), local foods (FOOD), and the community at large (ACT) on a five-level scale, with space to add free comments. Ratings for BODY and FOOD changed significantly, and the proportion of students who increased their rating of an evaluation indicator after each workshop was 25% for BODY, 28% for FOOD, and 25% for ACT. Text analysis of free comments showed that students in the “increased” group appreciated presenting, measuring, learning connections between nutrition and health, and working collaboratively with peers. Children perceived their health and the foods in their community more positively after participating. Moreover, the Creative Health project could be a way to enhance children’s creativity and autonomy as agents of change in the community.

DOI： 10.3390/ijerph19063417

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PubMed

Language：Japanese   Publisher：The Japanese Society of Pediatric Surgeons  

<p>We treated two cases of testicular yolk sac tumor (YST) in infants, who underwent inguinal high orchiectomy combined with a trans-scrotal approach. [Case 1] A 20-month-old boy presented with swelling of his left scrotum and an elevated serum α-fetoprotein (AFP) level of 1,593 ng/ml. Testicular tumor was suspected, and inguinal radical high orchidectomy combined with a trans-scrotal approach was performed. The removed testis was 26 × 23 mm in size. The normal testicular tissue had been replaced by a simple solid tumor. The pathological diagnosis was YST limited to the testis pathologically. [Case 2] A 20-month-old boy presented with a left scrotum mass and elevated serum AFP level of 668 ng/ml. Testicular tumor was suspected, and inguinal radical high orchidectomy combined with a trans-scrotal approach was performed. The removed testis was 35 × 25 mm in size. The tumor had a multinodular component, and normal testicular tissue was partially recognized. The pathological diagnosis was YST limited to the testis. [Conclusion] In both cases, the tumors were completely resected without rupture or tumor spillage, leading to a diagnosis of stage I germ cell tumor (GCT). Basically, stage I testicular GCT requires no additional treatment and shows a good prognosis, but operative procedures sometimes affect both the postoperative diagnosis and prognosis. Radical orchiectomy with a trans-scrotal approach may be effective to ensure a good patient outcome.</p>

DOI： 10.11164/jjsps.58.1_29

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

今回、鼠径部アプローチに経陰嚢操作を加えて高位精巣摘除術(本法)を行った精巣原発卵黄嚢腫瘍の2幼児例を経験した。【症例1】1歳8ヵ月男児。左陰嚢腫大とAFPの上昇(1,593ng/ml)を認め、精巣腫瘍を疑い、本法を行った。精巣は26×23mmと腫大し、内部は充実性で単一の腫瘍であった。病理では卵黄嚢腫瘍の診断で精巣内に限局しており、病期I期の診断となった。【症例2】1歳8ヵ月男児。左陰嚢腫大とAFPの上昇(668ng/ml)を認め、精巣腫瘍を疑い、本法を行った。精巣は35×25mmと腫大し、内部は多結節性で正常精巣組織を一部に認めた。病理では卵黄嚢腫瘍の診断で精巣内に限局しており、病期I期の診断となった。【結語】病期I期の卵黄嚢腫瘍は予後良好であるが、術中操作が術後診断や予後に影響を与える可能性がある。本法を行うことで、より適切な手術操作を行うことが可能であると考えられた。(著者抄録)

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。

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。

Language：English  

DOI： 10.1055/s-0042-1751051

PubMed

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

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PubMed

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

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PubMed

Language：English  

DOI： 10.1055/s-0042-1747913

PubMed

Language：Japanese   Publisher：The Japan Society of Computer Aided Surgery  

DOI： 10.5759/jscas.24.191

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

DOI： 10.34410/jspbm.45.0_112

Language：Japanese   Publisher：Dental Materials Journal  

The need for denture adhesives is increasing worldwide, but few denture-care products target denture adhesive users. Foam denture cleaners have been recently marketed to assist brush denture cleaning, but there is a lack of objective evaluation. In this study, we compared the detergency of denture adhesives using six commercial foam-denture cleaners. For removing the adhesives, most of the tested cleaners were effective in immersion experiments, and three cleaners were more effective in the denture cleaning experiment compared to control water. However, only one could effectively remove the slime that is derived from the adhesive and detergency of artificial dirt. The surface roughnesses of the denture base and the relining material revealed that prolonged immersion in some cleaners could be affected. The results suggest that different commercial foam denture cleaners have different detergency levels, and that some cleaners may affect the properties of denture materials upon long-term use.

DOI： 10.4012/dmj.2022-007

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PubMed

Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2022081276

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

Language：Japanese   Publisher：Journal of Laparoendoscopic and Advanced Surgical Techniques  

Background: Endosurgery provides several advantages over open surgery in the context of global surgery; however, there are several barriers to its introduction. The preliminary assessment of needs and barriers is essential for carrying out effective support as Global Surgery. However, no report has described the initiation of support for endosurgery based on a preliminary survey of the needs and barriers. The present survey study aimed at determining the needs and barriers of pediatric endosurgery in Nepal. Materials and Methods: A needs assessment survey was conducted among all pediatric surgeons in Nepal via an online platform. This was followed by workshop on pediatric endosurgical skills in Nepal. To assess the skills of participants and effectiveness of the workshop, the skill evaluation tests and the questionnaire survey were conducted. Results: Fourteen pediatric surgeons (response rate: 60.9%) responded to the needs assessment survey. More than 70% of the participants did not have any experience with advanced endosurgical procedures. However, advanced endosurgical procedures were strongly needed. A lack of training was indicated as a major barrier for the introduction of pediatric endosurgery. Fifteen participants completed the workshop. Participants' confidence in their endosurgical skills improved significantly after the workshop. The skill evaluation tests revealed that participants' endosurgical skills also improved significantly after the workshop, although even after the workshop, participants still took an average of 415.6 seconds to place and knot one suture. Conclusions: The needs assessment survey and workshop for Nepalese pediatric surgeons helped clarify their needs for endosurgery and the barriers to its introduction.

DOI： 10.1089/lap.2021.0307

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PubMed

Language：Japanese   Publisher：Stroke and Vascular Neurology  

Background During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study's objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines. Methods We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March-31 May 2020. The prior 1-year control period (1 March-31 May 2019) was obtained to account for seasonal variation. Findings There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI -24.3% to -20.7%, p<0.0001). Embolisation of ruptured aneurysms declined with 1170-1035 procedures, respectively, representing an 11.5% (95%CI -13.5% to -9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI -28.0% to -22.1%, p<0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile. Interpretation There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction.

DOI： 10.1136/svn-2020-000695

Scopus

Language：Japanese   Publisher：Surgery Today  

Purpose: We sometimes experienced prolonged delayed gastric emptying (DGE) in neurologically impaired patients undergoing laparoscopic fundoplication and gastrostomy. We explored the difference in the DGE rate according to the preoperative stomach position. Methods: Thirty-two neurological impaired patients who underwent laparoscopic fundoplication and gastrostomy between 2015 and 2019 were classified into two groups based on stomach position: non-elevated stomach position (NESP) and elevated stomach position (ESP). Patients’ characteristics, operative result and postoperative gastric emptying were reviewed. Results: The 11 ESP patients were significantly older than the 21 NESP patients (p < 0.05). The ESP patients had a significantly heavier body weight (BW) than the NESP patients (p < 0.05). The time taken (days) to reduce gastric drainage (days, below BW × 10 ml) in the NESP (4.3 ± 3.6) was significantly longer than that of ESP (1.3 ± 1.6) (p < 0.05). The time taken (days) to achieve full enteral nutrition in the NESP (14.1 ± 8.9) was significantly longer than that of the ESP patients (8.8 ± 3.1) (p < 0.05). Conclusion: Elevated stomach position (ESP) patients archived full enteral nutrition earlier than NESP patients after laparoscopic fundoplication and gastrostomy. Stomach position correction might, therefore, be involved in the incidence of DGE.

DOI： 10.1007/s00595-021-02274-w

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PubMed

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。

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)

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

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PubMed

Language：Japanese   Publisher：The Japanese Society of Pediatric Surgeons  

<p><i>Purpose</i>: We reviewed the cases of patients who underwent umbilicoplasty (VY flap) with a reverse Y-shaped incision at our hospital and evaluated its therapeutic results and usefulness.</p><p><i>Methods</i>: We retrospectively evaluated sex, age at surgery, birth weight, gestational age, comorbidities, operation time, and postoperative complications in 191 patients who underwent umbilicoplasty during the 15-year period from April 2004 to November 2018. In addition, we conducted a questionnaire survey about patient satisfaction.</p><p><i>Results</i>: Umbilicoplasty was performed in 183 patients before they entered school. The most common complication was inguinal hernia (n = 18; 9.4%). Periumbilical dermatitis was the most common postoperative complication (n = 9; 13.8%). Only three patients (4.6%; two with exudate and one with dermatitis) required ointment treatment. Most of the patients with complications recovered without treatment. Among the 68 patients who completed the questionnaire survey, 48 described their umbilical appearance as “satisfactory”. In the comparison between the satisfied group and the unsatisfied group, there were significant differences in age at surgery and sex. The patients in the satisfied group were older and the group had a higher proportion of boys. Five children (average age, 7.6 years) responded that they themselves wanted to undergo the operation.</p><p><i>Conclusions</i>: Satisfaction with the surgical procedure at our hospital was fully evaluated. Currently, there are various procedures for umbilical hernia. However, it seems that the appropriate timing of operation may be different for each operative procedure.</p>

DOI： 10.11164/jjsps.57.6_938

Language：Japanese   Publisher：Asian journal of endoscopic surgery  

Laparoscopic choledochal cyst excision and hepaticojejunostomy for choledochal in children is performed only at particular institutions because of the technical difficulty. Although choledochal cyst excision and hepaticojejunostomy are feasible, the small working space of infants makes intraabdominal Roux-Y reconstruction technically challenging. A 2-month-old girl diagnosed with a choledochal cyst underwent complete laparoscopic choledochal cyst excision and hepaticojejunostomy, including intraabdominal Roux-Y reconstruction with a 5-mm stapler. After cyst excision, Roux-Y reconstruction was performed in the intraabdominal cavity. Jejunojejunostomy was performed in a side-to-side fashion using a 5-mm stapler, and the entry hole was closed laparoscopically by hand-sewing, along with the mesentery defect. All procedures were performed by laparoscopic surgery. The postoperative course was uneventful, and the patient showed a quick recovery. Using small-diameter instruments, completely laparoscopic procedures for choledochal cyst are feasible.

DOI： 10.1111/ases.12928

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Language：Japanese   Publisher：Asian journal of endoscopic surgery  

Laparoscopically assisted anorectoplasty (LAARP) for recto-bulbar urethral fistula (RBUF) is not now a standard operation due to urethra injury risk and incomplete removal of fistula. Our approach is a novel and secure technique of trans-perineal transection using a 5-mm stapler for RBUF. Before performing LAARP, the orifice of RBUF was confirmed under flexible cystoscope inspection. Before transection of RBUF, the center of the muscle complex was detected at perineal skin. The muscle complex and the pubo-rectal sling were then also confirmed with electrical nerve stimulator under laparoscopic approach. A 5-mm trocar was inserted to pass through the center of the muscle complex from perineal incision of the neo-anus. RBUF was stapled and transected using a 5-mm stapler inserted from the neo-anus. The operator successfully confirmed complete adequate closure of RBUF under flexible cystoscope inspection. A 5-mm stapler was effective and useful for the transection of RBUF.

DOI： 10.1111/ases.12934

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PubMed

Language：English   Publisher：John Wiley & Sons Australia, Ltd  

症例は生後2ヵ月の女児で、閉塞性黄疸をきたし造影CTとMR膵胆管造影で総胆管嚢胞と診断され、腹腔鏡下総胆管嚢胞全摘術と肝管空腸吻合術を施行した。10mm 30°腹腔鏡を臍部から挿入し、右上腹部に3mm、臍部右側に5mm、左側腹部に3mmのポートをそれぞれ留置し、左上腹部に2.4mmの経皮針型把持器をおいた。嚢胞切除後、肝管を嚢胞上部の総肝管にて切離した。さらに、Treitz靱帯から25cmの部位で5mmリニアステープラーを用いて空腸を分割し、断端血管は3mm血管用シーラーによって凝固分割した。空腸の安定を得た後にステープラーの挿入口を作製し、5mmリニアステープラーによって空腸-空腸側々吻合術を施行、腸間膜欠損部を手縫い縫合にて閉鎖した。さらに、空腸端部に小孔を作製して肝管左側に斜切開をおき、6-0吸収性モノフィラメント縫合糸を用いて肝管空腸吻合術を行った。手術時間は8時間24分、出血量は極微量に留まっていた。術後経過は良好で、短期間のうちに全身状態の改善が得られた。

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

【目的】当科で施行した逆Y字皮膚切開による臍形成術(VY皮弁)の治療成績及び術式の有用性に関する検討を行った。【方法】2004年4月から2018年11月までの15年間に当院で臍ヘルニアの手術を行った191例を対象に、性別、手術時年齢、出生体重、出生週数、合併疾患、手術時間、術後合併症に関して後方視的に検討した。加えて患者満足度調査として5項目からなるアンケートを実施し、結果について解析した。【結果】症例191例の内訳は男児94例、女児97例で性差は認めなかった。手術時年齢の中央値は2歳(0.16～15.50)で、2歳が85例(44.5%)と最多であり、就学時前が183例(95.8%)と大多数を占めた。合併疾患は鼠径ヘルニア類疾患が18例(9.4%)と最も多かった。術後合併症としては臍周囲皮膚炎が9例(13.8%)と最も多かった。アンケート回収率は50.0%であり、臍外観に70.6%が「大変満足」と回答した。理想の臍外観の項目は「へこみ」(23.3%)や「大きさ」(20.0%)よりも「全体」が最も多く約半分を占めていた。手術時年齢は満足群の方が有意に高年齢であった(p=0.032)。性別に関しては満足群に男児の割合が多い傾向にあった(p=0.007)。【結論】逆Y字皮膚切開による臍形成術は、比較的簡単で術後満足度の高い術式である。当術式の満足群は年齢が高い傾向にあり、安定した満足度を得るためには手術時期を2歳以降に設定する選択肢があると思われた。現在臍ヘルニアに対する術式は様々であるが、各々の術式により適切な手術時期が異なる可能性もあると考えられた。(著者抄録)

Language：English   Publisher：John Wiley & Sons Australia, Ltd  

症例は男児で、肛門直腸奇形を有しており、倒立位撮影では中間型で、左上腹部に横行結腸瘻を造設された。遠位コロストグラムと排尿時膀胱尿道造影にて直腸球部尿道瘻(RBUF)と診断され、生後6ヵ月時に腹腔鏡補助下肛門直腸形成術を施行した。臍部に縦切開をおいて5mmトロカーを挿入、気腹は8mm Hg CO2とし、45°硬性鏡用に5mmトロカーを右上腹部、術者の右鉗子用に5mmトロカーを右下腹部、助手の鉗子用に3mmトロカーを臍部左側にそれぞれ挿入した。十分な視野とワーキングスペースを確保してから膀胱を挙上し、会陰翻転部を切開して直腸を切離した。骨盤神経損傷を回避すべく、下腹神経前筋膜と直腸固有筋膜間の筋層を温存した。さらに、肛門形成を目的に会陰部に8mmの縦切開をおき、筋複合体中心部にペアン鉗子を挿入して5mmトロカーを留置、5mmステープラーを用いてRBUFを保持し、閉鎖が得られていることを確認した。RBUFは経会陰的に摘出し、吻合直腸を引き抜いて断端と会陰部皮膚との間に吻合術を施した。術後の排尿時膀胱尿道造影で瘻孔遺残がないことを確認し、その後15ヵ月、排尿症状は認めていない。

Language：English  

DOI： 10.1186/s40792-021-01298-1

PubMed

Language：English   Publisher：Springer Berlin Heidelberg  

症例は正期産で出生した男児で、肛門直腸奇形を認めた。Invertogramでは中間型であり、左上腹部に横行結腸瘻を造設し、直腸球部尿道瘻(RBUF)と診断、6ヵ月時にオープンMRIによる腹腔鏡下肛門直腸形成術を行った。手術の3週前にオープンMRIシステムを用いて骨盤底を撮像し、直腸pull-through法が施行可能であると判断した。全身麻酔下に手術を開始し、臍部に縦切開を置きトロカーを挿入、気腹を確立後に右上腹部、右下腹部および臍部左側にトロカーを追加した。骨盤神経損傷を回避する目的で直腸切離を行い、その後に縫合糸を用いてRBUFを閉鎖し、ステープラーで切離後に結紮を施した。肛門形成後にオープンMRIスキャンを実施し、pull-throughされた直腸が筋複合体中心に位置することを確認した。手術時間は420分、撮像時間は40分であった。術後経過は良好で術翌日に経口摂取が可能となり、14日目のダイナミック尿路造影では合併症はなく、15日目に退院となった。3ヵ月後、結腸造影を施行して横行結腸瘻を解除する予定である。

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

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PubMed

Language：English  

DOI： 10.1186/s40792-021-01231-6

PubMed

Language：English   Publisher：Springer Berlin Heidelberg  

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。

Language：Japanese   Publisher：Ecology and Evolution  

Latitude is correlated with environmental components that determine the distribution of biodiversity. In combination with geographic factors, latitude-associated environmental variables are expected to influence speciation, but empirical evidence on how those factors interplay is scarce. We evaluated the genetic and environmental variation among populations in the pair of sister species Dioon sonorense–D. vovidesii, two cycads distributed along a latitudinal environmental gradient in northwestern Mexico, to reveal their demographic histories and the environmental factors involved in their divergence. Using genome-wide loci data, we determined the species delimitation, estimated the gene flow, and compared multiple demographic scenarios of divergence. Also, we estimated the variation of climatic variables among populations and used ecological niche models to test niche overlap between species. The effect of geographic and environmental variables on the genetic variation among populations was evaluated using linear models. Our results suggest the existence of a widespread ancestral population that split into the two species ~829 ky ago. The geographic delimitation along the environmental gradient occurs in the absence of major geographic barriers, near the 28th parallel north, where a zonation of environmental seasonality exists. The northern species, D. vovidesii, occurs in more seasonal environments but retains the same niche of the southern species, D. sonorense. The genetic variation throughout populations cannot be solely explained by stochastic processes; the latitudinal-associated seasonality has been an additive factor that strengthened the species divergence. This study represents an example of how speciation can be achieved by the effect of the latitude-associated factors on the genetic divergence among populations.

DOI： 10.1002/ece3.7545

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Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2021229963

Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2021229964

Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2021163596

Language：Japanese   Publisher：Pediatric Surgery International  

Purpose: Total parenteral nutrition (TPN) sometimes induces parenteral nutrition-associated liver disease (PNALD). Hepatocyte growth factor (HGF) acts as a potent hepatocyte mitogen anti-inflammatory and antioxidant actions. We aimed to evaluate the effect of HGF on PNALD in a rat model of TPN. Methods: A catheter was placed in the right jugular vein for 7-day continuous TPN. All rats were divided into three groups: TPN alone (TPN group), TPN plus intravenous HGF at 0.3 mg/kg/day [TPN + HGF (low) group], and TPN plus HGF at 1.0 mg/kg/day [TPN + HGF (high) group]. On day 7, livers were harvested and the histology, inflammatory cytokines and apoptosis were evaluated. Results: Histologically, lipid droplets were apparent in the TPN group, but decreased in the TPN + HGF (low) and TPN + HGF (high) groups. The histological nonalcoholic fatty liver disease activity scores in the TPN + HGF (low) and TPN + HGF (high) groups were significantly lower than that in the TPN group (p < 0.01). There were no significant differences in the inflammatory cytokine levels of the three groups. The caspase-9 expression levels in the TPN + HGF (low) and TPN + HGF (high) groups were significantly decreased in comparison to that in the control group (p < 0.05). Conclusion: The intravenous administration of HGF attenuated hepatic steatosis induced by 7-day TPN dose dependently.

DOI： 10.1007/s00383-020-04823-9

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Language：English   Publisher：SAGE Publications  

<jats:sec><jats:title>Purpose:</jats:title><jats:p> Real-time ultrasound (RTUS)-guided central venipuncture using the short-axis approach is complicated and likely to result in losing sight of the needle tip. Therefore, we focused on the eye gaze in our evaluation of the differences in eye gaze between medical students and experienced participants using an eye tracking system. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Ten medical students (MS group), five residents (R group) and six pediatric surgeon fellows (F group) performed short-axis RTUS-guided venipuncture simulation using a modified vessel training system. The eye gaze was captured by the tracking system (Tobii Eye Tacker 4C) and recorded. The evaluation endpoints were the task completion time, total time and number of occurrences of the eye tracking marker outside US monitor and success rate of venipuncture. </jats:p></jats:sec><jats:sec><jats:title>Result:</jats:title><jats:p> There were no significant differences in the task completion time and total time of the tracking marker outside the US monitor. The number of occurrences of the eye tracking marker outside US monitor in the MS group was significantly higher than in the F group (MS group: 9.5 ± 3.4, R group: 6.0 ± 2.9, F group: 5.2 ± 1.6; p  = 0.04). The success rate of venipuncture in the R group tended to be better than in the F group. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> More experienced operators let their eye fall outside the US monitor fewer times than less experienced ones. The eye gaze was associated with the success rate of RTUS-guided venipuncture. Repeated training while considering the eye gaze seems to be pivotal for mastering RTUS-guided venipuncture. </jats:p></jats:sec>

DOI： 10.1177/1129729820987362

PubMed

Language：English  

DOI： 10.1186/s40792-020-01099-y

PubMed

Language：English   Publisher：Springer Berlin Heidelberg  

出生体重2.2kgの正期産男児症例について検討した。出生時に肛門閉鎖、大動脈縮窄症、気管食道瘻/食道閉鎖(TEF/EA)、腎奇形、橈骨欠損、四肢異常を認め、VACTERL連合と診断した。右胸心を伴う右肺低形成も認めた。TEF/EAに対する2段階手術を計画し、まず新生児期に経腸栄養を行うために胃食道接合部での食道絞扼術と胃瘻造設術を行い、体重が増加し、心機能が安定した後に、TEF/EAに対する胸腔鏡下手術を施行した。食道吻合を行う際、十分な作業スペースを確保するため、3mmの補助ポートを挿入した。食道吻合は成功したが、術後の食道造影検査において下部食道と右肺下部の接合を確認した。IB型交通性気管支肺前腸奇形と確定診断し、経口摂取を確立するために胸腔鏡下手術を再施行した。気管支食道瘻を離断したところ、経口摂取が可能となり、肺炎や呼吸困難は認めなかった。

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

DOI： 10.34410/jspbm.44.0_62

Language：Japanese   Publisher：Journal of Prosthodontic Research  

Purpose: To investigate the difference in improvement of oral health-related quality of life (OHR-QoL) depending on the oral and denture conditions of a complete denture wearer when using a cream or powder type denture adhesive in a 10-center parallel randomized clinical trial. Methods: Two hundred edentulous subjects who wore complete dentures were allocated to each of the three groups according to denture adhesive type: cream, powder, and control (saline solution). The materials were applied to the mucosal surface of the dentures for 4 days, and baseline data and data after the intervention were collected. OHR-QoL was assessed using the Japanese version of the modified Oral Health Impact Profile for Edentulous Patients (OHIP-EDENT-J) scale for outcome. Multivariate analysis was used to investigate improvements in OHR-QoL according to participant characteristics among complete denture wearers using these materials. Results: OHIP-EDENT-J scores were significantly decreased in all groups after the intervention (p < 0.05); however, there were no statistically significant differences among the groups. Multiple logistic regression analysis revealed a significant association between the vertical height of the maxillary and mandibular alveolar ridge and OHIP-EDENT-J scores in the cream-type denture adhesive group. In contrast, there were no significant association between participant characteristics and OHIP-EDENT-J scores in the powder-type adhesive and control groups. Conclusions: The use of denture adhesives could improve OHR-QoL for complete denture wearers. The cream-type denture adhesives may be expected to improve OHR-QoL in patients with poor residual ridge conditions compared with patients with good residual ridge conditions.

DOI： 10.2186/JPR.JPR_D_20_00132

Scopus

PubMed

Language：Japanese   Publisher：(株)東京医学社  

Language：English   Publisher：John Wiley & Sons Australia, Ltd  

Language：English   Publisher：John Wiley & Sons Australia, Ltd  

Language：Japanese   Publisher：金原出版(株)  

＜文献概要＞当科では先天性胆道拡張症に対し,2016年4月の保険収載後,腹腔鏡手術による肝外胆管切除・肝管空腸吻合術を導入している。小児患者では成人に比べ胆管が細いため,安全・確実な吻合には工夫を要する。また,患児の年齢や体格によっては術前に胆管や血管を詳細に検索することが難しいため,術中にインドシアニングリーン(indocyanine green;ICG)蛍光ナビゲーションによる脈管の可視化が有用である。乳児から成人の体格までカバーすることに加え,小児特有の細径胆管や破格を伴う症例に対する吻合の工夫について解説する。さらに当科では疾患型シミュレータを作成し,執刀医のトレーニングに使用しており,その有用性について客観的評価を行っているため,あわせて報告する。

Language：English   Publisher：John Wiley & Sons Australia, Ltd  

Language：Japanese   Publisher：(一社)日本コンピュータ外科学会  

Language：Japanese   Publisher：(株)東京医学社  

Language：English   Publisher：John Wiley & Sons Australia, Ltd  

Language：Japanese   Publisher：(株)東京医学社  

Language：Japanese   Publisher：(株)東京医学社  

Language：Japanese   Publisher：(株)東京医学社  

Language：Japanese   Publisher：(株)東京医学社  

Language：Japanese   Publisher：(株)東京医学社  

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

小児先天性嚢胞性肺疾患は肺実質内に先天性に気道以外に恒常的に嚢胞が存在する状態をいう。近年は出生前に胎児肺の異常として診断される症例も多く、生直後に呼吸器症状がない場合でも、90%以上の症例で幼児期までに反復する肺感染などを発症するため、乳児期、遅くも幼児期早期までに手術的に病変を切除すべきとされている。治療としては病変部の外科的切除が原則となるが、従来はそのほとんどの症例に対して開胸手術による切除が行われてきた。近年では内視鏡外科手術、つまり胸腔鏡手術で施行される症例が増えている。これは乳幼児・小児の狭小な胸腔内であっても拡大視効果が得られ精緻な手術が可能であること、また従来は成人用デバイスを流用した手術であったが、小児用の細径デバイスが開発され、新生児期であっても技術的に可能となったことが大きい要因である。出生前診断例の手術時期も含めて術後機能を考慮した小児呼吸外科手術の現状を解説する。(著者抄録)

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