論文 - 七島 篤志
-
腸間膜に穿通した空腸憩室症の1例 査読あり
市来伸彦，末田秀人，佐野浩一郎，真方寿人，樋口和宏，七島篤志
臨牀と研究 98 ( 1 ) 114 - 117 2021年1月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
-
Relationship between hepatic venous anatomy and hepatic venous blood loss during hepatectomy 査読あり
Nanashima A., Tanoue Y., Sakae T., Tsuneyoshi I., Hiyoshi M., Imamura N., Hamada T., Yano K., Nishida T., Ishii M., Nagayasu T., Nakamura K.
Surgery Today 51 ( 12 ) 1953 - 1968 2021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：Surgery Today
Purpose: Predicting increased blood loss based on anatomical intervascular relationships is essential in major hepatectomy. Methods: We assessed 63 consecutive patients undergoing anatomical hepatectomy exposing the hepatic vein (HV) trunk at two institutes. Correlations between anatomical alterations of the hepatic inferior vena cava (IVC), HV, hepatic IVC, or right atrium (RA) and the blood loss per standard weight (BLSW) or blood transfusion (n = 18) were analyzed. The results of IVC partial clamping (PC) were additionally examined. Results: The BLSW in type V-up anatomical morphology was significantly higher than that in straight type (p < 0.05). The parameters associated with an increased BLSW (> 13.5 mL/kg) were tumor size (> 4 cm), prothrombin activity (< 87%), CVP (> 7 mmHg), area of suprahepatic IVC (< 360 mm2), IVC-RA gap (> 28 mm), longitudinal angle of IVC (< 160°), and axial angle of the MHV (< 55°). A multivariate analysis revealed that a high IVC-RA gap was a significant independent risk factor (odds ratio; 4.32, p < 0.05). Among 25 patients undergoing IVC-PC, only three showed a remarkable decrease in hepatic venous bleeding. No other statistically significant differences in the surgical records were observed in most cases. Conclusion: The IVC-RA gap might be a promising novel predictive parameter reflecting increased blood loss leading to blood transfusion in anatomical hepatectomy.
-
Usefulness of Drain Lipase to Predict Postoperative Pancreatic Fistula After Distal Pancreatectomy 査読あり
Hiyoshi M., Wada T., Tsuchimochi Y., Hamada T., Yano K., Imamura N., Fujii Y., Nanashima A.
Indian Journal of Surgery 82 ( 5 ) 841 - 847 2020年10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：Indian Journal of Surgery
© 2020, Association of Surgeons of India. Postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) is a worrisome and life-threatening complication. The aim of this study was to clarify the risk factors and to find the early detective method of POPF after DP. From January 2010 through December 2014, 37 patients underwent DP and were enrolled in this study to examine the factors predictive of clinical POPF after DP. POPF was defined and classified according to the International Study Group of Pancreatic Surgery guideline 2016. Biochemical leakage occurred in 14 (37.8%) patients, grade B POPF in 16 (43.2%) patients, and no grade C POPF in any patient. Clinical POPF (grade B/C) occurred in 43.2% of patients. Multivariate analysis revealed pancreatic thickness ≥ 14 mm to be the independent preoperative risk factors predictive of POPF. Receiver operating characteristic curves showed that the drain lipase ≥ 800 IU/L on postoperative day 4 could distinguish clinical POPF from non-clinical POPF effectively. Sensitivity, specificity, and accuracy were 93.8%, 70.0%, and 80.6% respectively. Pancreatic thickness ≥ 14 mm was the independent preoperative predictive risk factors for POPF. A drain lipase level of ≥800 IU/L on POD 4 was useful to find clinical POPF after DP.
-
直腸間膜内リンパ節転移を来した神経内分泌分化型前立腺癌と同時性直腸癌重複の1例 査読あり
市原明子，池田拓人，長友謙三，七島篤志，寺田直樹，中村恵理子
日本消化器外科学会雑誌 53 ( 10 ) 817 - 825 2020年10月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
-
Kai K., Hamada T., Hiyoshi M., Imamura N., Yano K., Nagano M., Kai M., Hidaka T., Shimoda K., Haruyama Y., Kataoka H., Nanashima A.
International Journal of Surgery Case Reports 76 19 - 24 2020年9月
担当区分：最終著者 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
© 2020 The Author(s) Introduction: Gallbladder involvement in lymphoma is extremely rare, and only 68 cases have been reported in the English literature so far. We experienced a case of diffuse large B-cell lymphoma (DLBCL) of the gallbladder arising 8 years after DLBCL of the right testis. Presentation of case: A 68-year-old man underwent orchiectomy for malignant lymphoma of the right testis pathologically diagnosed as DLBCL 8 years ago. Systemic surveillance incidentally revealed a gallbladder tumour, and elective resection of the gallbladder bed of the liver was performed under a preoperative diagnosis of gallbladder cancer. The histopathological examination revealed DLBCL. At re-evaluation 3 months after surgery, he was diagnosed as having DLBCL involving the stomach. There had been no recurrence for 39 months after chemotherapy and radiation, but he suffered from a poor general condition due to protein-losing enteropathy and died of infection. Discussion: We compiled and analysed reported cases of malignant lymphomas involving the gallbladder in terms of background, symptoms, imaging findings, and prognosis. Compared to MALT lymphoma, DLBCL was significantly more involved in other organs simultaneously or heterochronously (p = 0.004). Conclusion: Gallbladder lymphoma should be added to the differential diagnosis of gallbladder tumours, especially when clinical findings are not consistent with the typical course of gallbladder carcinoma and cholecystitis.
-
Mai N.N.H., Yamaguchi Y., Choijookhuu N., Matsumoto J., Nanashima A., Takagi H., Sato K., Tuan L.Q., Hishikawa Y.
Acta Histochemica et Cytochemica 53 ( 4 ) 61 - 72 2020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 Histochemica et Cytochemica
© 2020 The Japan Society of Histochemistry and Cytochemistry. Photodynamic therapy (PDT) uses photosensitizer activation by light of a specific wavelength, and is a promising treatment for various cancers; however, the detailed mechanism of PDT remains unclear. Therefore, we investigated the anticancer effect of PDT using a novel phosphorus tetraphenylporphyrin (Ptpp) in combination with light emitting diodes (Ptpp-PDT) in the NOZ human biliary cancer cell line. Cell viability and apoptosis were examined by MTT assay, flow cytometry and TUNEL assay for 24 hr after Ptpp-PDT. MitoTracker and JC-1 were used as markers of mitochondrial localization and membrane potential. The levels of mitochondrial oxidative phosphorylation (OXPHOS) complexes, Bcl-2 family proteins, cytochrome c and cleaved caspase-3 were examined by western blotting and immunohistochemistry. The results revealed that Ptpp localized to mitochondria, and that Ptpp-PDT efficiently decreased cell viability in a dose-and time-dependent manner. JC-1 and OXPHOS complexes decreased, but apoptotic cells increased from 6 to 24 hr after Ptpp-PDT. A decrease in Bcl-xL and increases in Bax, cytochrome c and cleaved caspase-3 were also found from 6 to 24 hr after Ptpp-PDT. Based on these results, we conclude that Ptpp-PDT induces anticancer effects via the mitochondrial apoptotic pathway by altering the Bax/Bcl-xL ratio, and could be an effective treatment for human biliary cancer.
DOI： 10.1267/ahc.20-00002
-
Kubota K., Jang J.Y., Nakanuma Y., Jang K.T., Haruyama Y., Fukushima N., Furukawa T., Hong S.M., Sakuraoka Y., Kim H., Matsumoto T., Lee K.B., Zen Y., Kim J., Miyazaki M., Choi D.W., Heo J.S., Endo I., Hwang S., Nakamura M., Han H.S., Uemoto S., Park S.J., Hong E.K., Nanashima A., Kim D.S., Kim J.Y., Ohta T., Kang K.J., Fukumoto T., Nah Y.W., Seo H.I., Inui K., Yoon D.S., Unno M.
Journal of Hepato-Biliary-Pancreatic Sciences 27 ( 9 ) 581 - 597 2020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：Journal of Hepato-Biliary-Pancreatic Sciences
© 2020 Japanese Society of Hepato-Biliary-Pancreatic Surgery Background: The prevalent location and incidence of intraductal papillary neoplasm of the bile duct (IPNB) and invasive carcinoma associated with them have varied markedly among studies due to differences in diagnostic criteria and tumor location. Methods: IPNBs were classified into two types: Type 1 IPNB, being histologically similar to intraductal papillary mucinous neoplasm of the pancreas, and Type 2 IPNB, having a more complex histological architecture with irregular papillary branching or foci of solid-tubular components. Medical data were evaluated. Results: Among 694 IPNB patients, 520 and 174 had Type 1 and Type 2, respectively. The levels of AST, ALT, ALP, T. Bil, and CEA were significantly higher in patients with Type 2 than in those with Type 1. Type 1 IPNB was more frequently located in the intrahepatic bile duct than Type 2, whereas Type 2 was more frequently located in the distal bile duct than Type 1 IPNB (P ' 0.001). There were significant differences in 5-year cumulative survival rates (75.2% vs 50.9%; P ' 0.0001) and 5-year cumulative disease-free survival rates (64.1% vs 35.3%; P ' 0.0001) between the two groups. Conclusion: Type 1 and Type 2 IPNBs differ in their clinicopathological features and prognosis. This classification may help to further understand IPNB.
DOI： 10.1002/jhbp.785
-
総合外科学講座の利点を最大限に活用した局所進行食道癌および下咽頭癌の重複癌に対する拡大サルベージ手術 査読あり
武野慎祐，七島篤志，前田 亮，石井廣人，古川貢之，中村都英
手術 70 ( 10 ) 1499 - 1504 2020年9月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
-
急性虫垂炎を契機に発見された石灰化を伴う14歳男児の結腸印環細胞癌の1例 査読あり
長友謙三，池田拓人，甲斐健吾，甲斐真弘，田中俊一，七島篤志
日本臨床外科学会雑誌 81 ( 9 ) 1838 - 1848 2020年9月
担当区分：最終著者, 責任著者 記述言語：日本語 掲載種別：研究論文（学術雑誌）
-
Kawano F., Yonekawa T., Yamaguchi H., Shibata N., Tashiro K., Ikenoue M., Munakata S., Higuchi K., Tanaka H., Sato Y., Hosokawa A., Takeno S., Nakamura K., Nanashima A.
Endocrinology, Diabetes and Metabolism Case Reports 2020 ( 1 ) 20-0064 - 6 2020年8月
担当区分：最終著者 記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Endocrinology, Diabetes and Metabolism Case Reports
© 2020 The authors. A 54-year-old woman was referred to our hospital with a cervical tumor. CT revealed a cervical tumor extending to the upper mediastinum, tracheal deviation and tumor infiltration in the cervical vessels. She was followed-up because no diagnosis of malignancy was made by cytology. However, 2 months later, a CT scan showed enlargement of the tumor and tracheal stenosis, and a surgical biopsy was performed and she was diagnosed with anaplastic thyroid cancer (ATC). The tracheal tube with tracheal stenosis could not be removed due to the rapid growth of the tumor, necessitating management by mechanical ventilation. Due to the difficulty of surgical resection, she was treated with lenvatinib. A lenvatinib solution was made and administered via a nasogastric tube. After lenvatinib treatment, the tumor volume decreased and the tracheal stenosis improved. The tracheal tube was removed and oral intake became possible. She was discharged and received ambulatory lenvatinib therapy. The tumor was significantly reduced in size, but gradually grew and was exposed through the cervical wound 6 months later. Esophageal perforation occurred 10 months after the start of treatment. Lenvatinib was re-administered via a nasogastric tube. Eleven months later, the patient died of massive bleeding from the exposed cervical tumor. Patients with advanced ATC may require management with mechanical ventilation for airway stenosis or with a nasogastric tube for esophageal stenosis and perforation. We experienced a case in which lenvatinib was safely administered via a nasogastric tube while performing mechanical ventilation.
DOI： 10.1530/EDM-20-0064
-
Hamada T., Yano K., Wada T., Imamura N., Hiyoshi M., Kondo K., Nanashima A.
World Journal of Surgery 44 ( 8 ) 2770 - 2776 2020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：World Journal of Surgery
© 2020, Société Internationale de Chirurgie. Background: The role of adjuvant hepatic intra-arterial infusion chemotherapy (HAI) is considered to be a promising option. Methods: We examined treatment effects of adjuvant HAI using cisplatin in 37 hepatocellular carcinoma (HCC) patients with portal vein infiltration (PVI) who underwent hepatectomy in comparison with those in 85 patients who did not. Results: PVI in 89 patients. Increased levels of aspartate transaminase, tumor markers, size and microvessel tumor infiltration (MVI) or cirrhosis, poorly differentiation, non-adjuvant HAI was associated with lower overall survival (p = 0.09). Poor differentiation, MVI and HAI were independently risk factors associated with tumor-free and overall survivals by the multivariate analysis (p < 0.05). Adjuvant HAI tended to show longer survivals in comparison with no-HAI (p = 0.08) and the multivariate analysis revealed significant efficacy of HAI for better prognosis. Conclusion: Adjuvant HAI showed effectiveness on prolonging tumor-free and patient survival in HCC with PVI and is a promising option in the daily clinical practice.
-
Kai K., Hidaka H., Nakamura T., Ueda Y., Marutsuka K., Ikeda T., Nanashima A.
Clinical Journal of Gastroenterology 13 ( 4 ) 538 - 544 2020年8月
担当区分：最終著者, 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
© 2019, The Author(s). An 86-year-old woman’s stool sample was positive for blood. Computed tomography (CT) showed wall thickening of the ascending colon at the hepatic flexure. Colonoscopy showed near-complete obturation by colon cancer. Since she was asymptomatic, elective surgery was planned. Laparoscopic right hemicolectomy was performed. Histopathological examination showed poorly differentiated carcinoma cells proliferating in a solid pattern with marked lymphocyte infiltration. The diagnosis was lymphoepithelioma-like carcinoma (LELC) associated with Epstein-Barr virus (EBV) infection; however, EBV-encoded small RNA–in situ hybridization was negative. Microsatellite instability was not assessed. The postoperative course was uneventful and she was discharged on the 15th postoperative day. She remains recurrence-free at 2 years after surgery. Past reports note that colorectal carcinomas with dense lymphoid stroma may be related to LELC or medullary carcinoma (MC). Gastrointestinal LELC is rare, with some reports on LELC of the esophagus and stomach. Reports on LELC of the large intestine are very rare. MC of the large intestine is relatively new concept, firstly described in the WHO Classification of Tumours of the Digestive System 3rd Edition in 2000. We herein present a case of lymphoepithelioma-like carcinoma of the ascending colon and relevant case reports about LELC and MC of the large intestine.
-
Hamada, T., Ishizaki, H., Haruyama, Y., Hamada, R., Yano, K., Kondo, K., Kataoka, H. and Nanashima, A.
Tohoku Journal of Experimental Medicine 251 ( 4 ) 303 - 311 2020年8月
担当区分：最終著者, 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：Tohoku Journal of Experimental Medicine
© 2020 Tohoku University Medical Press. Colorectal cancer is the fourth most common malignancy across the world, and over 50% of patients had colorectal liver metastases (CLM). Activated neutrophils and tumor-infiltrating lymphocytes (TILs) are considered to interrupt progression of primary colorectal cancer; however, immunological host reactions to CLM have not been fully elucidated. We thus aimed to explore the prognostic implication of neutrophil-to-lymphocyte ratio (NLR) in peripheral blood and TILs in resected metastatic cancer tissues of 29 patients with CLM who underwent hepatectomy. To evaluate local immunological responses in CLM, we examined the infiltration of CD66b+ neutrophils and TILs, such as CD8+ T cells, CD45RO+ T cells, and forkhead box P3+ (FOXP3+) T cells. The presence of fewer than 4 tumors (p = 0.0005), the absence of distant metastasis (p = 0.018), adjuvant anti-cancer chemotherapy (p = 0.0013), and elevated NLR over 4.1 (p = 0.026) were found to be significant parameters related to longer survival after hepatectomy. Further, high numbers of infiltrated CD45RO+ T cells in CLM were significantly associated with longer patient survival (p = 0.020). The numbers of CD45RO+ T cells were correlated with those of CD8+ T cells (p = 0.008). The numbers of peripheral blood neutrophils were negatively correlated with those of CD45RO+ T cells (p = 0.038) and of CD66b+ neutrophils (p = 0.008) in CLM. The present data indicate that elevated peripheral blood NLR and high numbers of intratumoral CD45RO+ T cells are predictive of longer CLM patient survival after hepatectomy among current biomarkers.
DOI： 10.1620/tjem.251.303
-
Takeno, S., Tanoue, Y., Hamada, R., Kawano, F., Tashiro, K., Wada, T., Ikenoue, M., Nanashima, A. and Nakamura, K.
Surgical Endoscopy 34 ( 8 ) 3479 - 2486 2020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：Surgical Endoscopy
Background: This study aimed to assess the surgical difficulty of minimally invasive esophagectomy in the left lateral decubitus position for patients with esophageal cancer from the perspective of short-term outcomes, including operation time, blood loss, and morbidity. Materials and methods: The initial 44 consecutive patients with esophageal cancer who underwent minimally invasive esophagectomy were statistically analyzed retrospectively. Thoracic cage area was measured from preoperative computed tomography as a factor affecting the surgical difficulty of minimally invasive esophagectomy, as well as other patient characteristics. Correlations with short-term outcomes including chest operation time, blood loss, and morbidity rate were then examined. Results: In univariate analyses, smaller area of the upper thoracic cage width correlated with prolonged thoracic procedure time (p = 0.0119) and greater blood loss during thoracic procedures (p = 0.0283), but area of the lower thoracic cage showed no correlations. History of respiratory disease was associated with thoracic procedure time (p < 0.0001), but not blood loss. In multivariate analysis, small area of the upper thoracic cage was independently associated with prolonged thoracic procedure time (p = 0.0253). Small upper thoracic cage area was not directly correlated with morbidity rate, but prolonged thoracic procedure time was associated with increased blood loss (p < 0.0001) and morbidity rate (p = 0.0204). Empirical time reduction (p = 0.0065), but not blood loss, was associated with thoracic procedure time. However, area of the upper thoracic cage did not correlate with empirical case number. In multivariate analysis, area of the upper thoracic cage (p = 0.0317) and empirical case number (p = 0.0193) correlated independently with thoracic procedure time. Conclusion: A small area of the upper thoracic cage correlated significantly with prolonged thoracic procedure time and increased thoracic blood loss for minimally invasive esophagectomy in the left lateral decubitus position, suggesting the surgical difficulty of minimally invasive esophagectomy in the left lateral decubitus position.
-
Yamashita Y.i., Aishima S., Nakao Y., Yoshizumi T., Nagano H., Kuroki T., Takami Y., Ide T., Ohta M., Takatsuki M., Nanashima A., Ishii F., Kitahara K., Iino S., Beppu T., Baba H., Eguchi S.
Hepatology Research 50 ( 7 ) 863 - 870 2020年7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：Hepatology Research
© 2020 The Japan Society of Hepatology Aim: Combined hepatocellular cholangiocarcinoma (cHCC-CCA) is a very rare subtype of primary liver carcinoma; therefore, its clinicopathological characteristics have not yet been elucidated in detail. The aim of the study was to reveal the clinicopathological characteristics and prognostic factors of cHCC-CCA after hepatic resection (HR). Methods: A total of 124 patients who underwent curative HR for cHCC-CCA between 2000 and 2016 were enrolled in this multi-institutional study conducted by the Kyushu Study Group of Liver Surgery. Clinicopathological analysis was performed from the viewpoint of patient prognosis. Results: A total of 62 patients (50%) had early recurrence within 1.5 years after HR, including 36 patients (58%) with extrahepatic recurrence. In contrast, just four patients (3%) had late recurrence occurring >3 years after HR. The independent predictors of early recurrence were as follows: des-gamma carboxyprothrombin >40 mAU/mL (odds ratio 26.2, P = 0.0117), carbohydrate antigen 19–9>37 IU/l (odds ratio 18.0, P = 0.0200), and poorly differentiated HCC or CCA (odds ratio 11.2, P = 0.0259). Conclusions: Half of the patients with cHCC-CCA had early recurrence after HR. Preoperative elevation of des-gamma carboxyprothrombin or carbohydrate antigen 19–9 and the existence of poorly differentiated components of HCC or CCA in resected specimens are predictors of its early recurrence.
DOI： 10.1111/hepr.13507
-
腹腔鏡下修復術を行った左傍十二指腸ヘルニアの1治療経験：術後炎症性浮腫に伴う腸管通過障害に対してステロイド治療が奏効した1例 査読あり
中尾大伸，河野文彰，田代耕盛，武野慎祐，池田拓人，中村都英，峯 一彦，七島篤志
日本腹部救急医学会雑誌 40 ( 7 ) 905 - 908 2020年7月
担当区分：最終著者, 責任著者 記述言語：日本語 掲載種別：研究論文（学術雑誌）
-
直腸憩室炎による膀胱瘻に対する腹腔鏡下根治術の1例 査読あり
濵田朗子，池田拓人，西田卓弘，河野文彰，武野慎祐，七島篤志
日本内視鏡外科学会雑誌 25 ( 3 ) 157 - 162 2020年5月
担当区分：最終著者, 責任著者 記述言語：日本語 掲載種別：研究論文（学術雑誌）
-
AirSeal was useful in laparoscopic surgery for perforated appendicitis during pregnancy 査読あり
9. Kai, K., Ikeda, T., Ichihara, A., Hamada, R., Nagatomo, K., Matsuzawa, S., Ushijima, J., Sameshima, H. and Nanashima, A.
Case Reports from Society of Laparoendoscopic Surgeons e2020.00008 2020年5月
担当区分：最終著者 記述言語：英語 掲載種別：研究論文（学術雑誌）
-
Nanashima A, Imamura N, Hiyoshi M, Hamada T, Yano K, Wada T, Kawakami H, Ban T, Kubota Y, Sato Y, Harada K.
Clinical Journal of Gastroenterology 13 ( 2 ) 233 - 239 2020年4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
Intraductal papillary neoplasm of the bile duct (IPNB) is defined as a non-invasive malignancy; however, since there are disparities in its histological diagnosis, the operative strategy for typical IPNB has not yet been established. A 69-year-old male was diagnosed with a bile duct mass lesion at the confluence of the cystic duct by ultrasonography without clinical symptoms. Liver functional parameters and tumor markers were within normal ranges. Computed tomography showed an enhanced tumor with no findings of ductal invasion or node metastasis. The tumor was exposed in the hepatic duct lumen and biopsy via SpyGlass DS cholangiography revealed that it was a low-grade papillary lesion, indicating type 1 IPNB. Under preoperative diagnostic modalities, limited resection of the extrahepatic bile duct with D2 lymphadenectomy was planned and R0 resection was achieved. The postoperative histological diagnosis was type 1 IPNB without node metastasis. The postoperative course was uneventful and a good prognosis is expected at this stage. In the field of biliary surgery, although extended resection is generally performed for bile duct carcinomas, satisfactory limited surgical resection is possible for type 1 IPNB with lower malignant behavior.
-
Nanashima A., Hiyoshi M., Imamura N., Yano K., Hamada T., Wada T., Nishimuta M., Shimizu I., Mizutani Y.
Nuclear Medicine Communications 41 ( 4 ) 320 - 326 2020年4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：Nuclear Medicine Communications
© 2020 Wolters Kluwer Health, Inc. All rights reserved. Background The indocyanine green retention rate at 15 min (ICGR15) is a gold standard parameter of liver function when deciding on the extent of hepatectomy. However, ICGR15 is influenced by several hepatic conditions. To evaluate auxiliary preoperative liver functional reserve, we examined the clinical significance of modified parameters by blood tests and technetium-99m galactosyl human serum albumin (99mTc-GSA) scintigraphy. Methods We measured liver function parameters, including the hepatic uptake ratio (LHL15) and the blood pool clearance index (HH15) of 99mTc-GSA and their modified formulae [LHL/HH15, LHL minus HH15, and converted ICGR15 (cICGR15) from a preliminary study] in 229 patients, including 18 with biliary obstruction. Results The mean values of LHL15/HH15, LHL minus HH15, and cICGR15 were 1.646 ± 0.295, 0.347 ± 0.116, and 13.2 ± 5.3%, respectively. These parameters correlated significantly with other liver functions measured by blood tests except for the bilirubin level (P < 0.05) although the actual ICGR15 level correlated positively with the bilirubin level. The difference of ICGR15 (ICGR15 minus cICGR15) in patients with biliary obstruction tended to be higher in comparison with that in patients without biliary obstruction (P = 0.044). Values of LHL/HH15, LHL minus HH15, and the cICGR15 were not significantly associated with postoperative complications. Conclusion The modified parameters of 99mTc-GSA were useful for evaluating hepatic function in patients with high bilirubinemia due to biliary obstruction. However, it remains difficult to establish a more reliable parameter as a standard hepatic function test instead of ICGR15.