論文 - 七島 篤志
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Hepaticoplasty prevents cholangitis after pancreaticoduodenectomy in patients with small bile ducts 査読あり
Hiyoshi M., Wada T., Tsuchimochi Y., Hamada T., Yano K., Imamura N., Fujii Y., Nanashima A.
International Journal of Surgery 35 7 - 12 2016年11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
© 2016 IJS Publishing Group LtdBackground To reduce cholangitis after pancreaticoduodenectomy (PD), we perform ‘hepaticoplasty’, in which the left side of the bile duct is cut to widen the diameter of the bile duct wall before hepaticojejunostomy. The aim of this study was to clarify the usefulness of hepaticoplasty to reduce cholangitis after PD. Methods From January 2002 through December 2010, 161 patients underwent PD and were enrolled in this study. Patient demographics, surgical factors, and clinical and biochemical parameters were evaluated to examine the factors predictive of cholangitis after PD and confirm the usefulness of hepaticoplasty. Results Cholangitis after PD occurred in 13 patients (8.1%). Multivariate analysis revealed that the ratio of the postoperative bile duct diameter to that before surgery was the only independent risk factor for cholangitis after PD (p = 0.0012). In the small bile duct group, in which the diameter was ≤15 mm before surgery (n = 99), hepaticoplasty reduced the narrowing of the bile duct after PD, and no cholangitis occurred. There were no complications related to hepaticoplasty. Conclusions The ratio of postoperative reduction of the bile duct diameter to that before surgery was found to be the only risk factor for cholangitis after PD. Patients with a small bile duct of ≤15 mm in diameter preoperatively might benefit from hepaticoplasty to widen the bile duct diameter and prevent cholangitis after PD.
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Nanashima A., Nanashima A., Sakamoto A., Sakamoto I., Hayashi H., Sumida Y., Murakami G., Arai J., Wada H., Nagayasu T.
Acta Medica Nagasakiensia 60 ( 4 ) 135 - 140 2016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：Acta Medica Nagasakiensia
© 2016, Nagasaki University School of Medicine. All rights reserved.To evaluate pancreatic elasticity and tumor diagnosis, we preoperatively investigated the elasticity calculated by a new ultrasonography (US) technique, acoustic radiation force impulse (ARFI). Materials and Methods: We examined ARFI in non-tumorous and tumor regions by push pulse of probe in 30 patients with pancreatic malignancies undergoing pancreatectomy. Measurement of stiffness was indicated as the Vs (mm/sec). Results: The Vs in the non-tumor region was measured in the pancreas head in 17 and in the body in 13 patients. The Vs of pancreatic tumors was measured in 14 of 22 patients (64%). The Vs in pancreatic tumors (2.17±0.95 m/sec.) was significantly higher than that in the non-tumorous pancreas (1.41±0.47 m/sec.) (p<0.01). The Vs of the non-pancreatic regions in the pancreas head and body were not significantly different. The Vs of the non-tumorous pancreas was not associated with patient demographics, laboratory data, the hardness of the pancreatic tissue, or postoperative morbidity. The Vs of the resected pancreatic tumors was not associated with any tumor-related parameters. Conclusions: ARFI imaging elastography can be used to evaluate pancreatic malignant tumor lesion in comparison with the non-tumor lesion.
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Murakami G., Nanashima A., Nanashima A., Nonaka T., Tominaga T., Wakata K., Sumida Y., Akashi H., Okazaki S., Kataoka H., Nagayasu T.
Anticancer Research 36 ( 9 ) 4493 - 4501 2016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：Anticancer Research
Background/Aim: Photodynamic therapy (PDT) is an effective laser treatment for locally treating advanced bile duct carcinoma (BDC). The study's objective was to evaluate the increased cytocidal effect by apoptotic PDT using a novel photosensitizer, glucose-conjugated chlorin, by irradiation of light-emitting diode laser (G-PDT) in comparison with conventional PDT using talaporfin sodium (T-PDT). Materials and Methods: The cytocidal effect of GPDT was compared to that of T-PDT as a control. Tumor viability was determined by an in vitro MTS assay. The percentage of apoptosis-positive cells was examined by triple stain flow cytometry (annexin V, ethidium homodimer III and Hoechst 33342) in the BDC cell line (NOZ cell) in vitro. The change in transplanted tumor volume in vivo (4-week-old male BALB/c mice) was examined 7 days after PDT. Results: Cell death was induced in a light dose-dependent manner by PDT. The laser power was set at 5 Jules/cm2 to obtain half maximal inhibitory concentration (IC50) in T-PDT and GPDT and the concentration of photosensitivity for G-PDT (2.02 g/ml) was lower than that for T-PDT (4.14 g/ml). Both T-PDT and G-PDT showed increased induction rates in comparison to the light only or G-chlorin only. Furthermore, the rate of apoptosis in the G-PDT (92.6%) was increased in comparison to that in the T-PDT (38.9%). The increased rates of tumor volume during the 7 days in both the G-PDT and T-PDT groups were significantly lower than that in the non-PDT group (p<0.01). At day 7, the increased rates of tumor volume in the G-PDT group were significantly lower than that in the T-PDT group (p<0.05). Conclusion: The new G-PDT treatment showed a high prevalence of apoptosis and inhibition of tumor growth in treatment of BDC cells.
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Nanashima A., Takagi K., Murakami G., Arai J., Sumida Y., Nagayasu T., Kodama T.
Acta Medica Nagasakiensia 60 ( 4 ) 153 - 159 2016年9月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Acta Medica Nagasakiensia
© 2016, Nagasaki University School of Medicine. All rights reserved.Ghrelin is a peptide that is secreted from the stomach and plays a role in appetite, weight gain, and skeletal muscle composition. Compounded human ghrelin (CHG) is a candidate drug to improve the nutritional status after pancreatic surgery. However, adverse influences of ghrelin in terms of pancreatic fistula (PF) via the stimulation of exocrine secretion after pancreatectomy are a concern. The present study showed the influences of the administration of CHG with PF after distal pancreatectomy in a mouse model. Distal pancreatectomy was performed on 10-week-old male Wistar rats and 3 μg/kg or 30 μg/kg CHG was injected into the inferior vena cava during laparotomy. Ten rats were divided into two groups: a control group (no injection; n=5) and a CHG group (n=5 for each of 3 μg/kg and 30 μg/kg). Changes of body weight, amount of ascites, and the serum and ascetic amylase and lipase levels were examined on days 1, 3, and 7. In the case of administration of 3 μg/kg ghrelin, changes of body weight, amount of ascites, and serum amylase level were not significantly different between the groups during 7 days. Amylase level in ascites in the ghrelin administration group tended to be lower than that in the control group on day 3 (p=0.083), but there was no difference on days 1 and 7. In the case of a high dose of 30 μg/kg ghrelin, levels of weight loss were not significantly different between the groups. Although the lipase level in the serum and ascites tended to be lower in the ghrelin group than in the control group (p=0.08), the amylase levels in serum and ascites were not significantly different between the groups. There was also no remarkable difference in histological appearance between the groups during 7 days after surgery. The administration of CHG did not induce PF after distal pancreatectomy, which might inhibit lipase secretion in ascites. CHG injection can be safely performed after surgery.
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Clinical Value of Serum p53 Antibody in the Diagnosis and Prognosis of Colorectal Cancer. 査読あり
Kunizaki M, Sawai T, Takeshita H, Tominaga T, Hidaka S, To K, Miyazaki T, Hamamoto R, Nanashima A, Nagayasu T
Anticancer research 36 ( 8 ) 4171 - 4175 2016年8月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Nanashima A., Izumino H., Sumida Y., Tominaga T., Wakata K., Hidaka S., Tsuchiya T., Nagayasu T.
Anticancer Research 36 ( 8 ) 3899 - 3903 2016年8月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Anticancer Research
Background/Aim: Oxidative stress is defined as an imbalance between the pro-oxidant and antioxidant potential of cells leading to intracellular DNA damage. To clarify the oxidative stress response as a tumor marker, we investigated measurement of urinary 8-hydroxydeoxyguanosine (8-OHdG) levels in hepatobiliary diseases. Materials and Methods: Relationships between urinary 8-OHdG levels and clinicopathological factors were analyzed in 101 patients, including 84 with hepatobiliary malignancies, and 18 healthy volunteers. Co-existing biliary inflammation was detected in 8 patients. Results: Urinary 8-OHdG levels did not correlate with any clinical or liver functional parameters. The existence of inflammation and any tumor-related factor did not correlate with urinary 8-OHdG levels either. Urinary 8-OHdG levels were significantly higher in patients with benign and malignant diseases than in healthy volunteers (p<0.05), but not significantly different between benign and malignant diseases. Among patients with intrahepatic cholangiocarcinoma and gallbladder carcinoma, urinary 8-OHdG levels tended to be higher in patients with lymph node metastasis-positive than in those with lymph node-negative disease (p=0.057). Conclusion: The clinical significance of oxidative DNA damage and increases in its urinary metabolites in patients with hepatobiliary malignancies or inflammatory diseases remain unknown. Further studies are necessary to clarify the relationship between node metastasis and oxidative stress as a prognostic marker.
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Beppu T., Okabe H., Okuda K., Eguchi S., Kitahara K., Taniai N., Ueno S., Shirabe K., Ohta M., Kondo K., Nanashima A., Noritomi T., Okamoto K., Kikuchi K., Baba H., Fujioka H.
Journal of the American College of Surgeons 222 ( 6 ) 1138 - 1148.e2 2016年6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 the American College of Surgeons
© 2016 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.Background Portal vein embolization (PVE) is useful to expand the indications of major hepatectomy; however, its oncologic effects are not fully understood. This study aimed to confirm the efficacy of preoperative PVE for hepatocellular carcinoma patients. Study Design Between 2000 and 2012, five hundred and ten patients with hepatocellular carcinoma undergoing right-side hemihepatectomy were enrolled (PVE group, n = 162 and non-PVE group, n = 348). To equalize background factors, one-to-one propensity case-matched analysis and multivariate analysis were performed. Short- and long-term outcomes were evaluated. Results Propensity score-matched patients, 148 in each group, were selected. The percentage of resected liver volume on admission was significantly greater in the PVE group (60.5% vs 48.3%; p < 0.001), but decreased considerably after PVE, from 60.5% to 50.3% (p < 0.001). The 5-year cumulative recurrence-free survival (36.4% vs 35.3%) and overall survival (58.6% vs 52.8%) rates were comparable. Extrahepatic recurrences were less common in the PVE group (18.1% vs 38.8%; p = 0.004). Independent prognostic factors for recurrence-free survival were morbidity (hazard ratio [HR] = 1.56), multiple tumors (HR = 1.97), red cell concentrate administration (HR = 1.57), older age (HR = 2.09), and massive portal invasion (HR = 2.33); and those for overall survival were morbidity (HR = 2.37), multiple tumors (HR = 1.71), and massive hepatic venous invasion (HR = 3.49). Conclusions Even though hepatocellular carcinoma patients who underwent preoperative PVE and right-side hemihepatectomy had a significantly larger resected liver volume on admission, they have a comparable long-term prognosis as patients with up front hepatectomy. In addition, PVE might decrease extrahepatic recurrences.
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Development and clinical usefulness of the liver hanging maneuver in various anatomical hepatectomy procedures. 査読あり
Nanashima A, Nagayasu T
Surgery today 46 ( 4 ) 398 - 404 2016年4月
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Nanashima A., Sumida Y., Murakami G., Sawai T., Nagayasu T.
Acta Medica Nagasakiensia 60 ( 3 ) 109 - 117 2016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：Acta Medica Nagasakiensia
© 2016, Nagasaki University School of Medicine. All rights reserved.Background: Intermittent occlusion of hepatic inflow, so-called Pringle’s maneuver, is a useful technique to control intraoperative bleeding; however, it can lead to ischemia-reperfusion injury. We examined the influence of ischemic time on surgical factors, posthepatectomy liver function and morbidity. Methods: The clinical records of 296 patients who underwent an elective hepatectomy for liver disease between 2004 and 2013 were retrospectively examined. Univariate and multivariate analyses of clinicopathological and surgical factors associated with hepatic-inflow occlusion time were performed. Results: The mean and median times of total hepatic-inflow occlusion were 47±23 minutes (5-173 mL) and 45 minutes, respectively. The occlusion time was significantly correlated with increased indocyanine-green retention rate, total operation time, amount of blood loss or red cell transfusion, postoperative morbidity and hospital stay (each p<0.05). Blood loss upon the use of occlusion tended to be lower than that in its absence (568±602 mL vs. 887±841 mL) (p=0.075). The occlusion time was shorter in limited resection and longer in central bi-segmentectomy or sectionectomy (p<0.05). The occlusion time was significantly correlated with the maximum alanine aminotransferase level (r=0.291, p<0.01). The predictive cut-off value of occlusion time for these correlated parameters ranged between 45 and 46.5 minutes (p<0.05). Hepatic-inflow occlusion was not associated with morbidity in cirrhosis. Conclusion: A longer ischemic time induced increased blood loss or related transfusion, operating time, postoperative liver injury, complication rate and duration of hospital stay.
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Tominaga T., Takeshita H., Takagi K., Kunizaki M., To K., Abo T., Hidaka S., Nanashima A., Nanashima A., Nagayasu T., Sawai T., Sawai T.
International Journal of Colorectal Disease 31 ( 2 ) 217 - 225 2016年2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 Colorectal Disease
© 2015, Springer-Verlag Berlin Heidelberg.Purpose: The aim of this study was to clarify whether a surgical-specific risk scoring system estimating the physiologic ability and surgical stress (E-PASS) score was useful for prediction of postoperative morbidity and mortality. Methods: The E-PASS score consists of the preoperative risk score (PRS), surgical stress score (SSS), and the comprehensive risk score (CRS). Conventional scoring systems [colorectal physiologic and operative severity score for the enumeration of mortality (CR-POSSUM) and the prognostic nutritional index (PNI)] were also examined. We retrospectively compared these scores in patients with or without postoperative complications. We assessed the relationship between these scores, clinicopathological features and postoperative mortality. Results: Postoperative complications developed in 78 patients (33 %). American Society of Anesthesiologists score, performance status, PNI score, PRS, SSS, and CRS were significantly higher in patients with postoperative complications than in those without postoperative complications (p < 0.05). The area under the receiver operating characteristic curve (AUC) was highest for E-PASS [E-PASS (PRS, 0.74; SSS, 0.62; CRS, 0.78), PNI (0.62), CR-POSSUM (PS, 0.57; OSS, 0.52)]. Multivariate logistic analysis identified CRS ≥ 0.2 as a significant determinant of postoperative complications (p < 0.01; hazard ratio, 4.84). Overall survival was significantly better in the CRS < 0.2 group than in the CRS > 0.2 group (p < 0.01). Conclusions: The E-PASS score system was a useful predictor of postoperative complications and mortality, especially in patients with advanced age.
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Intraoperative Diagnosis of Lymph Node Metastasis in Non-small-cell Lung Cancer by a Semi-dry Bot-blot Method. 査読あり
Tomoshige, K., Tsuchiya, T., Otsubo, R., Oikawa, M., Yamasaki, N., Matsumoto, K., Miyazaki, T., Hayashi, T., Kinoshita, N., Nanashima, A. and Nagayasu, T.:
European journal of Cardio-Thoracic Surgery. 49 ( 2 ) 617 - 622 2016年2月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Intraoperative diagnosis of lymph node metastasis in non-small-cell lung cancer by a semi-dry dot-blot method. 査読あり
Tomoshige K, Tsuchiya T, Otsubo R, Oikawa M, Yamasaki N, Matsumoto K, Miyazaki T, Hayashi T, Kinoshita N, Nanashima A, Nagayasu T
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 49 ( 2 ) 617 - 22 2016年2月
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肉眼的に明らかな腫瘤性病変を認めなかった陰窩腺由来肛門管癌のPagetoid spreadの1例． 査読あり
土屋和代, 春山幸洋, 石﨑秀信, 南史朗, 柴田直哉, 池田拓人, 七島篤志：
日本大腸肛門病学会雑誌 69 ( 1 ) 20 - 26 2016年1月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
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Down-Regulation of Nogo-B Expression as a Newly Identified Feature of Intrahepatic Cholangiocarcinoma. 査読あり
Nanashima, A., Hatachi, G., Tominaga, T., Murakami, G., Takagi, K., Arai, J., Wada, H., Nagayasu, T. and Shimada, Y.：
The Tohoku Journal of Experimental Medicine 238 ( 1 ) 9 - 16 2016年1月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Inamura Y., Honma K., Kimura D., Miyakoda M., Kimura K., Fukudome K., Nanashima A., Nagayasu T., Yui K.
Acta Medica Nagasakiensia 60 ( 2 ) 77 - 84 2016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：Acta Medica Nagasakiensia
© 2016, Nagasaki University School of Medicine. All Rights Reserved. The toll-like receptor 4 (TLR4)-mediated immune response is considered as one of the triggers of acute respiratory distress syndrome. The agonistic monoclonal antibody UT12 specific for the TLR4/MD2 complex induces immune activation in a manner distinct from lipopolysaccharide (LPS). In order to compare the effects of this differential TLR4 signaling activation, we examined immune cell recruitment to the lung following intratracheal inoculation with UT12 and LPS in mice. The increase in pulmonary neutrophils was much higher after LPS treatment compared with UT12 treatment, while CD11bhiCD11＋cells increased to similar levels following both treatments. These changes were MyD88-dependent and TRIF-independent. These differential effects on immune cell recruitment to the lung suggest distinct underlying mechanisms in response to TLR4 stimulation. These findings further indicate that TLR signaling can lead to different outcomes depending on the ligand and activation pathway, which may relate to the complex pathogenesis of inflammatory lung diseases.
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遠位肝外胆管原発腺扁平上皮癌の1例 査読あり
金丸 幹郎, 七島 篤志, 佐野 浩一郎, 末田 秀人, 内山 周一郎, 真方 寿人, 田中 弘之
日本臨床外科学会雑誌 77 ( 3 ) 625 - 630 2016年
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：日本臨床外科学会
肝外胆管原発の腺扁平上皮癌は，稀な疾患で通常の腺癌と比べ予後不良であると報告されている．症例は73歳の男性で，黄疸を主訴に近医を受診し，腹部CTで遠位肝外胆管に腫瘍を指摘された．精査加療目的で当科に紹介入院となった．腹部造影CTでは，遠位肝外胆管に造影効果のある約15mm大の腫瘍を認めた．ERCPを行い経乳頭的生検で腺癌と扁平上皮癌の両成分を認め，腺扁平上皮癌が疑われた．亜全胃温存膵頭十二指腸切除術およびD2リンパ節郭清術を施行した．病理組織学的に中分化型腺癌と高分化型扁平上皮癌が混在し腺扁平上皮癌と診断された．浸潤深部に扁平上皮癌成分を認めた．最終病期はT3a（panc），N0，M0，Stage IIAであった．術後3カ月目に肝転移を認め，術後6カ月目に誤嚥性肺炎による急性呼吸不全のため他病死された．
DOI： 10.3919/jjsa.77.625
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胆管癌に対するphotodynamic therapyの本邦ならびに海外における現状～胆道外科医の立場から～ 招待あり 査読あり
七島 篤志, 角田 順久, 永安 武, 磯本 一
胆道 30 ( 4 ) 699 - 708 2016年
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：日本胆道学会
胆管癌における唯一の有効な治療手段は外科的切除であり，治癒切除で良好な予後が期待できる．しかしながら高度な局所進展により胆管切離縁の癌浸潤陽性で治癒切除に至らない症例も少なくなく，治療後の予後に大きな影響を与える．また全身状態や臓器機能障害により切除を行えない症例や術後胆管再発症例も認められる．現状では化学療法や放射線治療による治療が行われているが，高いエビデンスある局所制御効果は認められていない．光線力学的療法は2000年以降欧州のランダム化比較試験などにより切除不能胆管癌で高い局所制御効果や生存期間延長が示され，それ以降も現在までに新たな光増感剤開発によって切除不能胆管癌におけるエビデンスある治療成績が報告されているがその一方，本邦での普及には至っていない現状がある．胆道外科医の立場から，PDTの実際の手技，本邦並びに海外の光線力学的療法の現状と，新たな研究開発と将来について総説する．
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肉眼的に明らかな腫瘤性病変を認めなかった陰窩腺由来肛門管癌のPagetoid spreadの1例 査読あり
土屋 和代, 春山 幸洋, 石崎 秀信, 南 史朗, 柴田 直哉, 池田 拓人, 七島 篤志
日本大腸肛門病学会雑誌 69 ( 1 ) 20 - 26 2016年
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：The Japan Society of Coloproctology
症例は79歳女性．肛門部掻痒感，肛門部出血，肛門周囲皮膚の浸潤性紅斑を認め，肛門周囲Paget病を疑われた．肛門部皮膚生検の免疫染色結果，Paget様進展（pagetoid spread，PS）が疑われ，下部消化管内視鏡検査と腰椎麻酔下に十分な肛門視診も行ったが，肉眼的に明らかな腫瘤性病変は認めなかった．このため再度皮膚深層生検を行ったところ表皮内にはPaget様細胞の増殖と，真皮内には腫瘍性腺管を認め腺癌と診断された．免疫染色でCK7，CK20，CDX2が陽性，GCDFP-15が陰性であり肛門管癌のPSと診断され，手術は腹腔鏡下腹会陰式直腸切断術，両側側方郭清（D3）を施行した．切除標本病理では陰窩腺原発肛門管癌のPSと診断され，根治切除を行い得た．肛門管内に肉眼的に明らかな腫瘤性病変を認めない場合でも，肛門管癌のPSを念頭に置く必要があると思われた貴重な1症例であった．
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初回手術21年後に肝転移・局所再発を来した膵Solid pseudopapillary neoplasmの1切除例
濱田 剛臣, 今村 直哉, 土持 有貴, 矢野 公一, 旭吉 雅秀, 大内田 次郎, 藤井 義郎, 春山 幸洋, 片岡 寛章, 七島 篤志
膵臓 31 ( 4 ) 662 - 669 2016年
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：日本膵臓学会
膵Solid pseudopapillary neoplasm（SPN）の初回膵切除から21年目に局所再発および肝転移を来し，再切除を行った1例を経験したので報告する．61歳の女性．1993年に膵腫瘍に対し，脾温存尾側膵切除術を受けた．5年間の経過観察中は無再発であり，以後は経過観察されていなかった．2014年，健康診断で肝内に腫瘍を指摘され，造影CTで残膵体部の腫瘍と多発する肝腫瘍を認め，当科紹介となった．残膵の腫瘍は画像診断では嚢胞成分と充実成分が混在していた．肝腫瘍の針生検の結果，膵SPNの肝転移と診断し，残膵体部切除術，肝部分切除術を施行した．21年前の膵腫瘍と今回の腫瘍は病理組織学的に類似し，免疫染色の結果も同様であったため，膵SPNの残膵局所再発および肝転移と診断された．免疫染色のCD99染色が膵SPN再発・転移の鑑別に有用であった．治療切除後の膵SPNは予後良好な腫瘍であるが，術後長期間経過しても今回の様に再発例を認めるため，長期間の経過観察が必要と考えられる．
DOI： 10.2958/suizo.31.662
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先天性胆道拡張症に対する胆管嚢腫消化管吻合術後43年目に発症した肝門部領域胆管癌の1切除例 査読あり
富永 哲郎, 七島 篤志, 村上 豪志, 飛永 修一, 阿保 貴章, 角田 順久, 木下 直江, 永安 武
胆道 30 ( 5 ) 876 - 882 2016年
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：日本胆道学会
症例は59歳女性．15歳時に先天性胆道拡張症に対して拡張胆管・空腸吻合術を施行された．上腹部痛の精査で肝内結石を指摘され当院へ紹介された．内視鏡検査では，左肝管の不整な狭窄を認め左肝管入口部と胆管空腸吻合部に粘膜の発赤と不整がみられ，生検で中分化型腺癌と診断された．拡張胆管・空腸吻合術後の拡張胆管に発生した肝門部領域胆管癌に対し肝左葉・尾状葉切除，肝外胆管＋吻合部空腸切除および胆道再建術を施行した．病理組織所見で，胆管内に結節浸潤型の高分化型腺癌を認め，T1bN0M0，Stage IでR0切除であった．現在術後2年3カ月，無再発生存中である．先天性胆道拡張症に対する拡張胆管・空腸吻合術は発癌の高リスクであり，発癌後の予後は不良といわれている．小児期に本症例のような内瘻術を受け，定期的なサーベイランスがなされず経過している症例がいることを念頭に，そのような症例では肝内結石などの発生時に遺残胆管の癌合併も考慮した精査が重要である．