論文 - 七島 篤志
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Kai K, Imamura N, Hiyoshi M, Hamada T, Uchise Y, Hatada H, Kawakami H, Mukai S, Kamoto T, Nanashima A
Asian Journal of Endoscopic Surgery 15 ( 1 ) 211 - 215 2022年1月
担当区分：最終著者, 責任著者 記述言語：英語 掲載種別：症例報告 出版者・発行元：Asian journal of endoscopic surgery
Pancreatic metastasis from renal cell carcinoma (RCC) is relatively rare. Surgical resection of the lesion is recommended if no residual tumor remains. Although there is no clear standard for surgical procedures, enucleation can be considered for small lesions. Lesion identification is important for enucleation, and contrast-enhanced ultrasound which takes advantage of the characteristics of hypervascular lesions was useful in a 68-year-old woman who underwent a left nephrectomy for RCC 11 years ago that was pathologically diagnosed as clear cell carcinoma. Recent computed tomography checkup showed a hypervascular tumor of 6 mm in the uncinated process and 10 mm in the pancreatic tail. Endoscopic ultrasonography-guided fine-needle aspiration was performed for the tail lesion, a diagnosis of clear cell carcinoma was made, and laparoscopic enucleation of the pancreatic tumors was performed aided by intraoperative contrast-enhanced ultrasound. The postoperative course was uneventful, and no pancreatic fistula occurred.
DOI： 10.1111/ases.12974
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An adult case of a retroperitoneal isolated enteric duplication cyst with the imaging changes over time.
Inomata M, Kai K, Ikeda T, Ichihara A, Masuda R, Kiwaki T, Tanaka H, Kataoka H, Nanashima A
Surgical case reports 7 ( 1 ) 258 2021年12月
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Nanashima A, Hiyoshi M, Imamura N, Yano K, Hamada T, Kai K, Nishida T, Uchise Y, Sakamoto R, Inomata M.
Annals of Hepato-Biliary-Pancreatic Surgery 25 ( 4 ) 477 - 484 2021年11月
担当区分：筆頭著者 記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Annals of Hepato-Biliary-Pancreatic Surgery
Backgrounds/Aims: It is known that preoperative nutritional status can influence patient outcomes after hepatectomy. Prognostic Nutritional Index (PNI) is a useful parameter to reflect patient outcomes undergoing gastro-intestinal surgery. The aim of this study was to retrospectively evaluate relationships of nutritional parameters, demographics, and surgical records with postoperative outcomes in a cohort study. Methods: Curative hepatectomy was performed for 182 patients at the University of Miyazaki between 2015 and 2018. Each preoperative level of albumin, prealbumin, lymphocyte, total cholesterol, or the comprehensively calculated Onodera’s PNI was examined as a nutritional parameter. Results: The mean PNI was 39.6 ± 5.1, with PNI below 40 observed in 91 (50.0%) patients. Nutritional parameters were not different among patients with various liver diseases. Serum albumin or prealbumin level was significantly correlated with each hepatic parameter (p < 0.01). Prealbumin and total cholesterol levels were significantly correlated with postoperative prothrombin activity (p < 0.05). Albumin or prealbumin levels and PNI were significantly lower in patients with posthepatectomy complications, particularly bile leakage in comparison those without such complications (p < 0.05). Multiple logistic analysis showed that albumin level was an independent risk factor for complications after hepatectomy (risk ratio [RR]: 1.33) and that lymphocyte count was an independent risk factor for bile leakage (RR: 1.28) (p < 0.05). The cut-off level of albumin was approximately 3.8 mg/dL and that of lymphocyte count was 1,320/mm3. Conclusions: Preoperative PNI reflected perioperative liver functional status. It was a predictive parameter for postoperative complications, particularly biliary leakage.
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悪性腫瘍との鑑別を要したS状結腸憩室炎による結腸膀胱皮膚瘻の1例 査読あり
市来伸彦，池田拓人，市原明子，濵田朗子，河野文耶，七島篤志
日本臨床外科学会雑誌 82 ( 11 ) 2023 - 2027 2021年11月
担当区分：責任著者 記述言語：日本語 掲載種別：研究論文（学術雑誌）
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Nanashima A., Hiyoshi M., Imamura N., Yano K., Hamada T., Kai K.
Current Oncology 28 ( 5 ) 4067 - 4079 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：Current Oncology
The therapeutic and diagnostic modalities of light are well known, and derivative photodynamic reactions with photosensitizers (PSs), specific wavelengths of light exposure and the existence of tissue oxygen have been developed since the 20th century. Photodynamic therapy (PDT) is an effective local treatment for cancer-specific laser ablation in malignancies of some organs, including the bile duct. Although curability for extrahepatic cholangiocarcinoma is expected with surgery alone, patients with unresectable or remnant biliary cancer need other effective palliative therapies, including PDT. The effectiveness of PDT for cholangiocarcinoma has been reported experimentally or clinically, but it is not the standard option now due to problems with accompanied photosensitivity, limited access routes of irradiation, tumor hypoxia, etc. Novel derivative treatments such as pho-toimmunotherapy have not been applied in the field hepatobiliary system. Photodynamic diagnosis (PDD) has been more widely applied in the clinical diagnoses of liver malignancies or liver vascularization. At present, 5-aminolevulinic acid (ALA) and indocyanine green (ICG) dyes are mainly used as PSs in PDD, and ICG has been applied for detecting liver malignancies or vascularization. However, no ideal tools for combining both PDD and PDT for solid tumors, including hepatobiliary malignancies, have been clinically developed. To proceed with experimental and clinical trials, it is necessary to clarify the effective photosensitive drugs that are feasible for photochemical diagnosis and local treatment.
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胃穿孔による汎発生腹 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）
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Spontaneous common bile duct perforation due to choledocolithiasis accompanied with pancreaticobiliary maljunction in an adult: a case report. 査読あり
Sakamoto R, Kai K, Hiyoshi M, Imamura N, Yano K, Hamada T, Nishida T, Kawano F, Sakurahara D, Uchise Y, Yamamoto K, Kataoka H, Nanashima A
Surgical case reports 7 ( 1 ) 205 2021年9月
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Masuya R., Miyoshi K., Nakame K., Nanashima A., Ieiri S.
International Journal of Surgery Case Reports 86 106300 2021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：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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Case Series: Rare resected eight cases of duodenal adenocarcinomas 査読あり
Nanashima, A., Tanoue, Y., Imamura, N., Hiyoshi, M., Yano, K., Hamada, T., Nishida, T., Kai, K., Suzuki, Y., Sato, Y., Nakashima, K., Hosokawa A. and Nagayasu, T.
International Journal of Surgery Case Reports 86 Article 106384 2021年9月
担当区分：筆頭著者 掲載種別：研究論文（学術雑誌）
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Hiyoshi M., Nanashima A.
Journal of Japanese Society of Gastroenterology 118 ( 8 ) 736 - 741 2021年8月
担当区分：責任著者 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 Japanese Society of Gastroenterology
胆膵内視鏡にともなう重度合併症の際にわれわれ外科医が対応する場面として，消化管の損傷がある．近年は，消化管穿孔であってもまずは内視鏡での治療が試みられているが，これに固執して外科的治療を開始するタイミングが遅れてはならない．胆膵内視鏡，特にERCPによる十二指腸損傷は解剖学的な複雑性もあり，適切に判断や治療が行われないと死亡率が高くなる．ERCPによる十二指腸損傷の基本術式は腹腔ドレナージ，損傷部位の縫合閉鎖，triple tube ostomy（胆道ドレナージ，消化管の減圧，腸瘻造設）と考える．外科的治療は受傷後24時間を超えると救命率が低下するため，適切なタイミングで治療する必要があり，そのためにも各診療科やコメディカルスタッフとの連携が重要である．
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宮崎大学医学部附属病院におけるがんゲノム医療の現状と今後の課題 査読あり
西田卓弘，伊井美奈代，落合昂一郎，中島孝治，福島 剛，佐藤勇一郎，山口昌俊，七島篤志，細川 歩
宮崎県医師会医学会誌 2021年8月
掲載種別：研究論文（学術雑誌）
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A 3D quantitative MRC modeling images detected case of intrahepatic biliary stricture diseases 査読あり
Nanashima A., Komi M., Mavar M., Ferreira C., O'Donoghue P., Goldfinger M., Langford C., Imamura N.
Case Reports in Gastroenterology 15 ( 2 ) 680 - 688 2021年7月
担当区分：筆頭著者, 責任著者 記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Case Reports in Gastroenterology
In the future, the application of quantitative imaging and computational analysis will reduce the burden on radiologists. We herein report 8 pilot cases both with and without intrahepatic biliary stricture (IHBS) diseases which have been analyzed with the novel analytical system MRCP+ (Perspectum Ltd., Oxford, UK). The colored and well-visualized 3D models of the entire biliary trees could be obtained in all 8 cases. Three representative cases did not show dilated regions in the intrahepatic bile ducts. Cases diagnosed as a pancreatico-biliary maljunction showed slightly increased dilated visualization in the extrahepatic duct. Except in a case with severe stenosis resulting from hepatolithiasis, the number of visualized intrahepatic bile ducts tended to be decreased and the volume of biliary tree and the total length of stricture and dilatation were also decreased. However, the number of IHBS or dilatation was unchanged. The number of strictures obtained by MRCP+ and the subjective counts of stenosis from a radiologist was not found to be correlated. In a case of severe stenosis at the left lateral bile duct, the number of intrahepatic biliary dilatations was increased. The latest computerized 3D modeling technology was found to be useful in visualizing the alteration of intraluminal diameter of the entire biliary trees at a glance, which can provide the automatic diagnosis of IHBS diseases at an earlier phase.
DOI： 10.1159/000518020
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Kawano F., Tashiro K., Ikenoue M., Munakata S., Nakao H., Mizuno T., Mori H., Ikeda T., Takeno S., Furukawa K., Tomita M., Endo G., Ochiai H., Nakamura K., Nanashima A.
Surgery Today 51 ( 6 ) 1001 - 1009 2021年6月
担当区分：責任著者 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
© 2021, Springer Nature Singapore Pte Ltd. Purposes: Balancing scheduled surgery and trauma surgery is difficult with a limited number of surgeons. To address the issues and systematize education, we analyzed the current situation and the effectiveness of having a trauma team in the ER of a regional hospital. Methods: This retrospective study analyzed the demographics, traumatic variables, procedures, postoperative morbidities, and outcomes of 110 patients who underwent trauma surgery between 2012 and 2019. The trauma team was established in 2016 and our university hospital Emergency Room (ER) opened in 2012. Results: Blunt trauma accounted for 82% of the trauma injuries and 39% of trauma victims were transported from local centers to our institute. The most frequently injured organs were in the digestive tract and about half of the interventions were for hemostatic surgery alone. Concomitant treatments for multiple organ injuries were performed in 31% of the patients. The rates of postoperative severe complications (over Clavien–Dindo IIIb) and mortality were 10% and 13%, respectively. Fourteen (12.7%) of 24 patients who underwent damage-control surgery died, with multiple organ injury being the predominant cause of death. Conclusion: Systematic education or training of medical students and general surgeons, as well as the co-operation of the team at the regional academic institute, are necessary to overcome the limited human resources and save trauma patients.
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急性膵炎を契機に発見された男性の膵 mucinous cystic neoplasm の 1 切除例 査読あり
和田 敬，濵田朗子，今村直哉，旭吉雅秀，清水一晃，長友謙三，北村英嗣，濵田剛臣，矢野公一，七島篤志
日本消化器外科学会雑誌 54 ( 5 ) 328 - 336 2021年5月
担当区分：責任著者 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：Japanese Journal of Gastroenterological Surgery
A 50-year-old man was admitted to our hospital with a chief complaint of abdominal pain. Abdominal CT showed a 17-mm unilocular cystic lesion in the pancreatic tail and dilation of the main pancreatic duct distal to the lesion. The pancreatic parenchyma was swollen. The fat tissue density around the pancreas was increased and indicative of pancreatitis. There was no communication between the main pancreatic duct and the cystic lesion based on MRCP, and endoscopic ultrasound showed a unilocular cystic lesion with no solid components or septal structure. The patient was diagnosed as having a retention cyst and acute pancreatitis, and received conservative therapy. Because of recurrence of pancreatitis due to stenosis of the main pancreatic duct caused by the cystic lesion, laparoscopic-assisted distal pancreatectomy was performed. The lesion was a bilocular cyst, and histopathologically, ovarian-type stroma was observed in the cystic wall. Thus, the lesion was diagnosed as a mucinous cystic adenoma. Pancreatic mucinous cystic neoplasms in males are less frequent than in females, but if suspicious findings are found on imaging, this disease should be considered in the differential diagnosis.
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Otsuka I., Kida K., Terada N., Kiwaki T., Nanashima A., Kamoto T.
International Journal of Surgery Case Reports 81 105763 2021年4月
記述言語：英語 掲載種別：症例報告 出版者・発行元：International Journal of Surgery Case Reports
Introduction: Pheochromocytoma surgery is generally challenging for surgeons and anesthesiologists for cardiovascular complications. Presentation of case: A 54-year-old Japanese man was found to have a large right pheochromocytoma infiltrating the posterior part of his liver and vena cava and multiple lung metastases. After retroperitoneal laparoscopic dissection of the dorsal side of the tumor and ligation of the feeding vessels, total resection of the primary tumor, extended posterior sectional hepatectomy, and partial vena cava resection were performed by open surgery via a thoracoabdominal approach. Abundant congestive bleeding with instability of vital signs occurred during transection. It could be finally controlled by dissect the remnant feeding artery in the inmost space. Prior control of arterial in-flow enabled successful completion of the planned surgical procedure. The patient has now survived for 27 months since resection of the primary lesion. Conclusion: Ligation of the feeding arteries to this hypervascular catecholamine-releasing tumor via a retroperitoneal laparoscopic approach prior to performing combined organ resection facilitated successful excision of this large malignant pheochromocytoma.
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Tashiro K., Takeno S., Kawano F., Kitamura E., Hamada R., Ikenoue M., Munakata S., Nanashima A., Nakamura K.
Endoscopy 53 ( 3 ) 288 - 292 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：Endoscopy
© 2020. Thieme. All rights reserved. Background Treatment of anastomotic leakage in reconstruction after esophagectomy remains challenging. This report presents a new endoscopic filling method for persistent fistula after failure of conservative treatment of leakage caused by anastomotic insufficiency. Methods 10 of 14 patients, in whom post-esophagectomy leakage had failed to resolve after 2 weeks of conservative treatment, underwent endoscopic filling with polyglycolic acid (PGA) sheet and fibrin glue into the anastomotic leakage site, using a delivery tube and endoscopic catheter, respectively. Results Each patient underwent jejunostomy, to secure nutrition. The leakage was resolved in all 10 patients. The mean number of PGA - fibrin glue procedures was 1.7.The mean period from the first application to the resumption of oral intake was 31.6 days, from the final application it was 14.7 days. Conclusions The reported filling method offers a new endoscopic approach for persistent fistula after esophagectomy when conservative treatment of leakage has failed.
DOI： 10.1055/a-1200-8199
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Nanashima A., Imamura N., Hiyoshi M., Yano K., Hamada T., Nishida T., Sakurahara D., Sakamoto R., Uchise Y., Wada T., Nagatomo K.
International Surgery 105 ( 1-3 ) 659 - 666 2021年3月
担当区分：筆頭著者 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：International Surgery
Background: Relationship between outcomes of major hepatectomy and the mortality rate predicted by National Clinical Database Risk Calculator (NCD-RC) was examined. Methods: Patient demographics and postoperative morbidity and mortality were compared between 30-day and in-hospital mortality rates among 55 patients who underwent major hepatectomies. The cutoff value for high-risk mortality was set at 5%. Patients were divided into 4 groups: (1) no severe complications and low predictive mortality rate (woML), (2) severe complications or mortality, and low mortality rate (wML), (3) no severe complications and high mortality rate (woMH), and (4) severe complications or mortality, and high mortality rate (wMH). Results: Morbidity higher than Clavien Dindo III occurred in 17 patients (28%) and 30-day and in-hospital mortality in none and 2 (3%), respectively. The in-hospital mortality rate was significantly higher for male patients (P , 0.01). Age, elderly patients, diseases, and comorbidity did not significantly differ among groups. Although bile leakage was common in group wML, there were no in-hospital deaths. All surgical procedures performed in group wMH were right hepatectomy with bile duct resection (RH-BDR) for biliary malignancy, and 2 died of hepatic failure; however, the incidence of RH-BDR was not significantly higher than those in other groups. Conclusions: Preoperative mortality rate predicted by NCD-RC was not always consistent with outcomes in actual clinical settings and further improvements are needed. In case of RH-BDR for biliary malignancy with high predictive mortality rate, careful decision making for liver function and perioperative management are required.
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切除可能性分類に基づいた膵癌の当院での治療成績の検討 査読あり
今村直哉，七島篤志，濵田剛臣，矢野公一，旭吉雅秀
宮崎県医師会医学会誌 45 ( 1 ) 1 - 7 2021年3月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
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A rare case of intrahepatic cholangiocarcinoma with tumor thrombus in the bile duct 査読あり
Nanashima A., Tominaga K., Yonei A., Sekiya R., Oshikawa S., Sato Y., Wake N., Akiba J.
Clinical Journal of Gastroenterology 14 ( 1 ) 275 - 282 2021年2月
担当区分：筆頭著者, 責任著者 記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Clinical Journal of Gastroenterology
© 2020, Japanese Society of Gastroenterology. Intrahepatic cholangiocarcinoma (ICC) is a refractory liver malignancy; however, as its histological characteristics have been clarified, a good operative strategy for the subtypes of ICC can be expected. A 72-year-old woman was diagnosed with a large primary liver cancer with biliary tumor thrombus (BTT) and obstructive jaundice. An enhanced imaging modality showed hypervascular ICC or combined hepatocellular carcinoma (HCC). As her liver functional parameters permitted major hepatectomy, preoperative biliary drainage was performed, followed by a radical left hepatectomy accompanied by tumor thrombectomy with D2 lymphadenectomy. During the operation, the BTT was found to have widely spread into the right hepatic duct and the common bile duct and was histologically diagnosed as an adenocarcinoma. As ductal cancer invasion was not macroscopically observed, the planned operation was completed. The postoperative histological diagnosis was determined by discussion to be a rare mass-forming ICC with BTT. Her postoperative course was uneventful, and a 1-year survival without tumor relapse was observed with adjuvant chemotherapy. In the field of biliary surgery, although advanced ICC still has a poor prognosis, curable surgical intervention is possible for specific findings, such as BTT and HCC with BTT.
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Yonezawa E., Kawakami H., Miike T., Sakamoto K., Noda T., Suzuki S., Yamamoto S., Kawano F., Nanashima A., Takeno S.
Gastroenterological Endoscopy 63 ( 1 ) 31 - 37 2021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：Gastroenterological Endoscopy
A 40-year-old man presented to the emergency room of our hospital with precordial pain after eating chicken for dinner. Computed tomography showed a high-density linear shadow of 40 mm in length in the lower esophagus. Mediastinal emphysema was noted around the mediastinal tip of the foreign body. The patient was diagnosed with bilateral perforation of the lower esophagus by chicken bone, and was referred to our department. After making preparations for on-site surgical backup, endoscopic removal of the foreign body was attempted. Upper endoscopy showed bilateral perforation of the side walls of the lower esophagus. We attempted to remove the foreign body, which was adjacent to the descending aorta, with a grasping forceps from the left side. The foreign body was pulled into the attachment and extracted without aortic injury. Esophageal perforation was managed conservatively and curatively. The patient was discharged 20 days after endoscopic extraction without surgery. Esophageal perforation may cause severe or fatal complications. A foreign body in the esophagus is often removed surgically. Furthermore, in the case of esophageal perforation by a sharp foreign object, severe bleeding may occur during endoscopic extraction. Therefore, it is necessary to devise a technique for endoscopic extraction.
DOI： 10.11280/gee.63.31