論文 - 中目 和彦
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Masuya R., Muto M., Nakame K., Murakami M., Sugita K., Yano K., Onishi S., Harumatsu T., Yamada K., Yamada W., Matsukubo M., Kaji T., Nanashima A., Ieiri S.
Journal of Laparoendoscopic and Advanced Surgical Techniques 32 ( 5 ) 571 - 575 2022年5月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：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.
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Biliary atresia: graft-versus-host disease with maternal microchimerism as an etiopathogenesis 査読あり 国際誌
Masuya R., Muraji T., Harumatsu T., Muto M., Nakame K., Nanashima A., Ieiri S.
Transfusion and Apheresis Science 61 ( 2 ) 103410 - 103410 2022年4月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Transfusion and Apheresis Science
Biliary atresia (BA) is an inflammatory disease of the biliary system in newborns and infants. The etiology is largely unknown. Approximately half of BA patients require liver transplantation by 20 years of age, even after surgical correction due to progressive fibrosis of the liver. Regarding the disease mechanism, there is circumstantial evidence to support the hypothesis of graft-versus-host disease because of the existence of maternal cells in the liver (maternal microchimerism, MMC), histopathological similarity of the liver and an intense maternal response to the BA patient with mixed lymphocyte culture. Immune dysregulation with decreased Treg and increased Th1 and Th17 cells are the pathogenic features of BA, which are homologous to the pathogenic features of GvHD. Further elucidation of the etiopathogenetic mechanism of BA is warranted for development of new therapeutic strategies for native liver survival.
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Yamada A., Kinoshita M., Kamimura S., Nakame K., Moritake H.
Journal of Pediatric Hematology/Oncology 44 ( 2 ) E589 - E592 2022年3月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of Pediatric Hematology/Oncology
Neuroblastoma with bone metastasis is well known to have an extremely poor prognosis. We experienced the case of a patient with adrenal ganglioneuroblastoma (GNB) with metastases of subcutaneous nodules, a lymph node, and multiple bones. A pathologic examination of tumors from different sites revealed both GNB and ganglioneuroma. A genetic comparison between these tumors identified the same molecular signatures, suggesting the possibility of spontaneous differentiation in the remaining GNB. The patient has been healthy without aggressive chemotherapy, and the patient's pathologic urinary catecholamines normalized. Even if unusual, we have to recognize probable spontaneous differentiation from neuroblastoma to GNB and then to ganglioneuroma, even in sites of bone metastasis.
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Retroperitoneal teratomas in children: a single institution experience 査読あり
Kawano T., Sugita K., Kedoin C., Nagano A., Matsui M., Murakami M., Kawano M., Yano K., Onishi S., Harumatsu T., Yamada K., Yamada W., Masuya R., Matsukubo M., Muto M., Machigashira S., Nakame K., Mukai M., Kaji T., Ieiri S.
Surgery Today 52 ( 1 ) 144 - 150 2022年1月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：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.
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Onishi S., Kaji T., Nakame K., Yamada K., Murakami M., Sugita K., Yano K., Matsui M., Nagano A., Harumatsu T., Yamada W., Matsukubo M., Muto M., Ieiri S.
Surgery Today 52 ( 1 ) 92 - 97 2022年1月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：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.
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Masuya R., Matsukubo M., Nakame K., Kai K., Hamada T., Yano K., Imamura N., Hiyoshi M., Nanashima A., Ieiri S.
Surgery Today 1 - 4 2022年
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Surgery Today
We describe a laparoscopic surgical technique using indocyanine green (ICG) fluorescence to identify and preserve rare arterial branching associated with pediatric congenital biliary dilatation. Congenital biliary dilatation with pancreaticobiliary maljunction was diagnosed in a 9-year-old girl, who presented with upper abdominal pain. Abdominal enhanced computed tomography (CT) showed that the accessory right hepatic artery (aRHA) branched from the posterior superior pancreaticoduodenal artery (PSPDA) and flowed through the right aspect of the dilated common bile duct (CBD) directly into the right lobe of the liver. We performed laparoscopic dilated biliary duct resection and hepaticojejunostomy, administering ICG intravenously, at a dose of 0.6 mg/kg. The ICG fluorescence overlay mode showed an aRHA running along the right side of the dilated CBD. The aRHA was dissected from the CBD without injury. After finishing the anastomosis, the beating of the aRHA was preserved, confirming that blood flow had been maintained.
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Sugita K., Muto M., Oshiro K., Kuda M., Kinjyo T., Masuya R., Machigashira S., Kawano T., Nakame K., Torikai M., Ibara S., Kaji T., Ieiri S.
Pediatric Surgery International 2022年
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Pediatric Surgery International
Purpose: We compared cases of anemia in gastroschisis versus omphalocele and investigated this clinical question. Methods: A multicenter study of five pediatric surgery departments in southern Japan was planned. Sixty patients were collected between 2011 and 2020, with 33 (gastroschisis: n = 19, omphalocele: n = 14) who met the selection criteria ultimately being enrolled. Anemia was evaluated before discharge and at the first outpatient visit. Results: Despite gastroschisis cases showed more frequent iron administration during hospitalization than omphalocele (p = 0.015), gastroschisis cases tended to show lower hemoglobin values at the first outpatient visit than omphalocele cases (gastroschisis: 9.9 g/dL, omphalocele: 11.2 g/dL). Gastroschisis and the gestational age at birth were significant independent predictors of anemia at the first outpatient visit, (gastroschisis: adjusted odds ratio [OR] 19.00, p = 0.036; gestational age at birth: adjusted OR 0.341, p = 0.028). A subgroup analysis for gastroschisis showed that the ratio of anemia in the 35–36 weeks group (8/10, 80.0%) and the > 37 weeks group (6/6, 100%) was more than in the < 34 weeks group (0/3, 0.0%). Conclusions: Gastroschisis may carry an increased risk of developing anemia compared with omphalocele due to the difference of direct intestinal exposure of amnion fluid in utero.
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胃穿孔による汎発性腹膜炎を生じた急性胃軸捻転の1例 査読あり
桝屋 隆太, 中目 和彦, 楯 真由美, 黒木 純, 河野 文彰, 市原 明子, 池田 拓人, 武野 慎祐, 七島 篤志, 家入 里志
日本小児外科学会雑誌 57 ( 6 ) 1002 - 1007 2021年10月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：特定非営利活動法人 日本小児外科学会
2歳女児．3日前から反復する嘔吐で加療されていた．急激な腹部膨満から消化管穿孔を疑われ当院へ搬送された．来院時顔面蒼白，活気不良，末梢冷感著明，脈拍数200/分，血圧60/42 mmHg，呼吸数43/分とショックを呈していた．腹部造影CTで多量のfree airおよび腹水を認め，胃軸捻転の所見を認めた．胃軸捻転による消化管穿孔と診断し緊急腹腔鏡手術を行った．腹腔鏡下に胃軸捻転を解除したが，穿孔部位が同定困難で開腹へ移行した．胃体上部大弯に付着した大網を剥離したところ同部位にピンホール状の穿孔を認めた．同部位を楔状に切除し胃を腹壁に固定した．遊走脾は認めなかった．術後DIC治療と胃蠕動改善に日数を要したが徐々に回復し，術後19日目に軽快退院した．その後再発なく経過している．急性胃軸捻転に伴い胃穿孔を生じた報告が散見される．重篤化して急激な経過をたどる報告もあるため，迅速な診断と治療を必要とする．
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Malignant perivascular epithelioid cell neoplasm in the liver: report of a pediatric case. 査読あり 国際誌
Baba T, Kawano T, Saito Y, Onishi S, Yamada K, Yamada W, Masuya R, Nakame K, Kawasaki Y, Iino S, Sakoda M, Kirishima M, Kaji T, Tanimoto A, Natsugoe S, Ohtsuka T, Moritake H, Ieiri S
Surgical case reports 7 ( 1 ) 212 - 212 2021年9月
記述言語：英語 掲載種別：研究論文（学術雑誌）
BACKGROUND: Perivascular epithelioid cell neoplasm (PEComa) in a child is very rare. We herein report the first malignant case of PEComa developing in the liver of a pediatric patient. CASE PRESENTATION: A 10-year-old boy visited a private clinic with prolonged fever of unknown etiology. Abdominal ultrasonography was performed to evaluate the fever's origin, revealing a large tumor in the liver. He was thus referred to a nearby hospital to investigate the tumor further. Enhanced computed tomography (CT) showed a 6.8 × 5.9 × 10.5-cm solid lesion on S4 and S5. On magnetic resonance imaging (MRI), the tumor had a low signal intensity on T1 imaging and high signal intensity on T2 imaging, with partial diffusion restriction. 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) showed a marked uptake in the mass lesion with no evidence of metastasis. The patient was negative for all tumor markers, including AFP, CEA and PIVKA-II. The results of a needle biopsy suggested hepatocellular carcinoma. The tumor's rapid growth suggested malignancy. Hepatic segmentectomy (S4 + S5 + S8) was performed. The tumor was resected en bloc with a margin. Microscopically, the tumor showed atypical spindle, polygonal or oval-shaped cells with a high nuclear grade, and vascular invasion. Immunohistochemistry was positive for alpha-smooth muscle antigen (α-SMA), human melanin black-45 (HMB-45) and melan A. The pathological diagnosis was malignant PEComa. In the 6 months after surgery, the patient complained of shoulder pain. MRI showed a dumbbell-shaped tumor at the 2nd thoracic vertebrae, which was confirmed to be bone metastasis of PEComa. After chemotherapy, including ifosfamide and doxorubicin, vertebrectomy was performed. Two years later, thoracoabdominal CT showed a 10-cm solid mass occupying the pelvis and a 15-mm nodule in the middle lobe of the right lung. Under a diagnosis of peritoneal and lung metastases, they were surgically removed and metastasis of PEComa was pathologically confirmed. Four months after the 2nd relapse, pelvic metastasis appeared again and mTOR (mammalian target of rapamycin) inhibitor was initiated. To our knowledge, this is the first report of malignant hepatic PEComa in a pediatric patient. CONCLUSION: Although extremely rare, malignant hepatic PEComa can develop in a child.
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Masuya R., Miyoshi K., Nakame K., Nanashima A., Ieiri S.
International Journal of Surgery Case Reports 86 106300 - 106300 2021年9月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：International Journal of Surgery Case Reports
Introduction: The right hepatic artery crossing the ventral side of the common hepatic duct is a relatively frequent abnormality. This aberrant right hepatic artery not only interferes with dissection of the common bile duct and hepaticojejunostomy for choledochal cyst but can also cause postoperative anastomotic stenosis. Case presentation: A 14-year-old patient presented with upper abdominal pain and was diagnosed with a choledochal cyst (Type IVA in Todani Classification) and pancreaticobiliary maljunction. Abdominal enhanced computed tomography showed aberrant right hepatic artery located at the ventral side of the common hepatic duct. Laparoscopic choledochal cyst resection and hepaticojejunostomy were planned. Intraoperative findings also showed the aberrant right hepatic artery crossing the common hepatic duct ventrally as detected on preoperative computed tomography. Laparoscopic dorsal side repositioning of the aberrant right hepatic artery was performed because it appeared to compress the common hepatic duct and risked causing postoperative anastomotic stenosis. We performed laparoscopic hepaticojejunostomy by replacing the aberrant right hepatic artery dorsally to facilitate suturing and prevent postoperative anastomotic stenosis. The postoperative course was uneventful, with no findings suggestive of anastomotic stenosis. Discussion: The abnormality of the right hepatic artery is reported to be a primary cause of anastomotic stenosis after hepaticojejunostomy. Once anastomotic stenosis or stricture develops, it is often difficult to treat. The prevention of the stenosis is important. Conclusions: In choledochal cyst with aberrant right hepatic artery, dorsal repositioning is effective for preventing postoperative anastomotic stenosis and cholestasis.
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A case of facial cellulitis caused by group B streptococcus in an extremely low birthweight infant 査読あり
Muraoka J., Kodama Y., Higashi M., Yamada N., Yamashita R., Nakame K., Kaneko M., Sameshima H.
Journal of Infection and Chemotherapy 27 ( 9 ) 1369 - 1372 2021年9月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of Infection and Chemotherapy
Group B streptococcus (GBS) is an important pathogen that causes neonatal sepsis and meningitis, which have high mortality and morbidity. Cellulitis is a rare presentation of late-onset neonatal GBS infection. We report the case of an extremely low birthweight infant with facial cellulitis caused by late-onset GBS infection. A 590-g male neonate was delivered by Cesarean section at 23 gestational weeks due to intrauterine GBS infection. Although he was effectively treated with 2 weeks of antimicrobial therapy for early-onset GBS sepsis, he subsequently developed facial and submandibular cellulitis caused by GBS at 44 days of age. He was treated with debridement and antibiotic therapy, and after 2 months his facial involvement had improved, but cosmetic issues remained. Neonatal GBS infection requires a prompt sepsis workup followed by the initiation of empiric antibiotic therapy. Additionally, lifesaving surgical debridement is sometimes necessary for cellulitis, even in premature infants.
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超低出生体重児の術後生存率と発達予後とは一致していない
武藤 充, 杉田 光士郎, 茨 聡, 桝屋 隆太, 松久 保眞, 川野 孝文, 町頭 成郎, 中目 和彦, 鳥飼 源史, 林田 良啓, 向井 基, 池江 隆正, 下野 隆一, 家入 里志
日本周産期・新生児医学会雑誌 57 ( Suppl. ) P279 - P279 2021年6月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：(一社)日本周産期・新生児医学会
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超低出生体重児の術後生存率と発達予後とは一致していない
武藤 充, 杉田 光士郎, 茨 聡, 桝屋 隆太, 松久 保眞, 川野 孝文, 町頭 成郎, 中目 和彦, 鳥飼 源史, 林田 良啓, 向井 基, 池江 隆正, 下野 隆一, 家入 里志
日本周産期・新生児医学会雑誌 57 ( Suppl. ) P279 - P279 2021年6月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：(一社)日本周産期・新生児医学会
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A case of facial cellulitis caused by group B streptococcus in an extremely low birthweight infant 査読あり
Naoshi Yamada
Journal of Infection and Chemotherapy 27 1369 - 1372 2021年5月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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A case of facial cellulitis caused by group B streptococcus in an extremely low birthweight infant 査読あり
Kazuhiko Nakame
Journal of Infection and Chemotherapy 27 1369 - 1372 2021年5月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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内視鏡手術の利点と問題点;合併症、中・長期成績、医療経済、教育 腹腔鏡下胆道拡張症手術の患者集約化は必要か?プロクターによる手術成績の施設間検討 査読あり
村上 雅一, 矢野 圭輔, 春松 敏夫, 大西 峻, 山田 耕嗣, 久田 正昭, 古賀 義法, 林田 真, 桝屋 隆太, 中目 和彦, 新山 新, 桑原 淳, 竜田 恭介, 柳 祐典, 廣瀬 龍一郎, 生野 猛, 右田 美里, 松藤 凡, 武藤 充, 加治 建, 家入 里志
日本小児外科学会雑誌 57 ( 2 ) 246 - 246 2021年4月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：(一社)日本小児外科学会
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Muto M., Sugita K., Ibara S., Masuya R., Matuskubo M., Kawano T., Saruwatari Y., Machigashira S., Sakamoto K., Nakame K., Shinyama S., Torikai M., Hayashida Y., Mukai M., Ikee T., Shimono R., Noguchi H., Ieiri S.
Pediatric Surgery International 37 ( 3 ) 411 - 417 2021年3月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Pediatric Surgery International
Purpose: Necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI) are major diseases that cause gastrointestinal disorders in extremely low-birth-weight infants (ELBWIs). We conducted a review to compare the postoperative outcomes of ELBWIs with these diseases in our neonatal intensive-care unit. Methods: A retrospective chart review of ELBWIs surgically treated for NEC (n = 31), FIP (n = 35), and MRI (n = 16) in 2001–2018 was undertaken. This period was divided into early (2001–2005), middle (2006–2010), and late (2011–2018) periods. Data were analyzed with the Cochran-Armitage test. Statistical significance was defined as p < 0.05. Results: The survival rates in ELBWIs with NEC (early/middle/late: 36.4%/42.9%/61.5%; p = 0.212) and FIP (20%/50%/70.6%; p = 0.012) improved over time; all patients with MRI survived. The neuropsychological development of 24 cases was assessed with the Kyoto Scale of Psychological Development in the Postural-Motor, Cognitive-Adaptative, and Language-Social domains. The mean developmental quotient of all domains was 68.4 (range 18–95) at corrected 1.5 years of age and 69.1 (range 25–108) at chronological 3 years of age, both were considered as poor development. There was no improvement over time (p = 0.899). Conclusion: Ideal neuropsychological development was not observed with the improvement of survival rate. Less-invasive surgical intervention and adequate postoperative care are required to encourage further development.
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【出生前診断された小児外科疾患の鑑別と周産期管理】梨状窩嚢胞
町頭 成郎, 中目 和彦, 村上 雅一, 川野 正人, 矢野 圭輔, 山田 耕嗣, 川野 孝文, 加治 建, 上塘 正人, 茨 聡, 家入 里志
小児外科 53 ( 2 ) 121 - 125 2021年2月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：(株)東京医学社
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腹腔鏡下噴門形成術後PT延長を認めた重症心身障がい児(者)の5例 査読あり
春松 敏夫, 村上 雅一, 矢野 圭輔, 馬場 徳朗, 大西 峻, 山田 耕嗣, 桝屋 隆太, 町頭 成郎, 中目 和彦, 向井 基, 加治 建, 家入 里志
学会誌JSPEN 2 ( Suppl.2 ) 30 - 31 2021年1月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：(一社)日本臨床栄養代謝学会
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術後機能を考慮した小児呼吸器外科手術 先天性嚢胞性肺疾患を中心に 査読あり
家入 里志, 中目 和彦, 長野 綾香, 松井 まゆ, 矢野 圭輔, 大西 峻, 春松 敏夫, 山田 耕嗣, 山田 和歌, 松久保 眞, 武藤 充, 加治 建, 村上 雅一, 杉田 光士郎
日本小児呼吸器学会雑誌 31 ( 2 ) 152 - 158 2021年1月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：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)