記述言語：日本語   出版者・発行元：(一社)日本神経学会  

医中誌

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The accuracy of lymph node (LN) dissection in robotic surgery for lung cancer remains controversial. We compared the accuracy of LN dissection in robot-assisted thoracic surgery (RATS) vs. video-assisted thoracic surgery (VATS). METHODS: The subjects of this retrospective analysis were 226 patients with cN0 primary lung cancer who underwent robot-assisted or video-assisted thoracic lobectomy with LN dissection, in our department, between April, 2016 and February, 2021. We compared the numbers of all LNs and mediastinal LNs dissected, the time required for LN dissection, complications, and upstaging rates of the N factor between the groups. Furthermore, we performed an inverse probability of treatment weighting-adjusted analysis to reduce potential bias between the groups. RESULTS: The number of dissected LNs was higher in the RATS group in both the unweighted and weighted analyses. The time required for lymph node dissection was also longer in RATS. There was no significant difference in complications or in the upstaging rate of the N factor between the groups. CONCLUSION: More LNs were dissected with RATS. Thus, the usefulness of robot-assisted surgery for LN dissection needs to be investigated further.

DOI： 10.1007/s00595-022-02578-5

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Abnormal expression of bicellular tight junction claudins, including claudin-2 are observed during carcinogenesis in human lung adenocarcinoma. However, little is known about the role of tricellular tight junction molecule angulin-1/lipolysis-stimulated lipoprotein receptor (LSR). In the lung adenocarcinoma tissues examined in the present study, expression of claudin-2 was higher than in normal lung tissues, while angulin-1/LSR was poorly or faintly expressed. We investigated how loss of angulin-1/LSR affects the malignancy of lung adenocarcinoma cell line A549 and normal human lung epithelial (HLE) cells. The EGF receptor tyrosine kinase inhibitor AG1478 prevented the increase of claudin-2 expression induced by EGF in A549 cells. Knockdown of LSR induced expression of claudin-2 at the protein and mRNA levels and AG1478 prevented the upregulation of claudin-2 in A549 cells. Knockdown of LSR induced cell proliferation, cell migration and cell metabolism in A549 cells. Knockdown of claudin-2 inhibited the cell proliferation but did not affect the cell migration or cell metabolism of A549 cells. The TGF-β type I receptor inhibitor EW-7197 prevented the decrease of LSR and claudin-2 induced by TGF-β1 in A549 cells and 2D culture of normal HLE cells. EW-7197 prevented the increase of cell migration and cell metabolism induced by TGF-β1 in A549 cells. EW-7197 prevented the increase of epithelial permeability of FITC-4kD dextran induced by TGF-β1 in 2.5D culture of normal HLE cells. In conclusion, downregulation of angulin-1/LSR induces malignancy via EGF-dependent claudin-2 and TGF-β-dependent cell metabolism in human lung adenocarcinoma.

DOI： 10.18632/oncotarget.27728

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出版者・発行元：南江堂  

DOI： 10.15106/j_kyobu76_246

CiNii Research

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Mullerian cyst in the posterior mediastinum is a rare disorder. We report on the case of a woman in her 40s with a cystic nodule which is located in the right posterior mediastinum next to the vertebra at the level of tracheal bifurcation. The tumor was suggested to be cystic by preoperative magnetic resonance imaging (MRI). The tumor was resected with robot-assisted thoracic surgery. Pathology by hematoxylin-and-eosin (H&E) revealed a thin-walled cyst lined by ciliated epithelium without cellular atypia. The diagnosis of Mullerian cyst was confirmed by immunohistochemical staining which showed the positive findings for estrogen receptor (ER) and progesterone receptor of the lining cells.

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出版者・発行元：南江堂  

DOI： 10.15106/j_kyobu76_9

CiNii Research

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

For a long time, lobectomy and lymph node dissection have been the standard surgery for treating non-small cell lung cancer. Recently, segmentectomy has been introduced as an alternative surgical procedure for treating early-stage lung cancer. Moreover, a growing number of segmentectomies are performed due to the increasing number of elderly patients, and the expansion of indications, including early- stage lung cancer with a ground glass nodule or peripheral nodule under 2 cm in diameter. However, the use of segmentectomy remains under debate. We have been performing thoracoscopic lung segmentectomy for malignant lung tumors since 2003. The number of surgeries has increased over the past few years, since robot-assisted lung resection of the right lobe became covered by health insurance in April 2018. In addition, lung segmentectomy is performed for lung metastases of malignant tumors in other organs. In deciding on the surgical approach, the increased technical difficulty of segmentectomy compared to lobectomy, owing to the anatomical complexity of the peripheral vessels and bronchi, needs to be considered, and novel surgical procedures and preoperative planning based on three-dimensional computed tomography( CT) images are necessary. We describe the preoperative management and surgical techniques used in approximately 250 lung segmentectomy procedures performed at our hospital up to May 2022, with no conversion to thoracotomy.

PubMed

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

触診が困難な小結節に対する肺部分切除術では，マーキングが有用である．近年，気管支鏡を用いたデジタルマーキング技術である，radiofrequency identification （RFID）が臨床応用された．RFIDマーキングは肺深部に存在する病変でも位置同定を可能とする．しかし，その合併症に関する報告はほとんどない．今回，気管支に留置されたRFIDタグが術中に変位する症例を経験したので報告する．患者は71歳，女性．転移性肺腫瘍疑い（左肺S10に8mm大の結節影）に対し，2箇所にRFIDタグを留置し，部分切除術を施行したところ，術中にタグの1つが気管支中枢側へ変位した．このタグを病変と一塊にして切除するため，結果的に切除肺の拡大を要した．原因として，鉗子の把持操作や自動縫合器による複数回のクランプが考えられた．部分切除では単一病変に対しタグ1つを末梢気管支に留置することを原則とし，留置部近傍での鉗子操作は避けるべきである．

DOI： 10.3919/jjsa.84.76

CiNii Research

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出版者・発行元：南江堂  

DOI： 10.15106/j_kyobu75_1088

CiNii Research

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

The subsuperior segment (S*) is not frequently observed between the superior (S6) and posterior basal segments (S10). We present a case of video-assisted thoracoscopic surgery of S6+S* segmentectomy for a primary lung cancer patient. A 71-year-old man with a 20-mm nodule on the right S6, suspected of primary lung cancer( cT1bN0M0, stageⅠA2), was admitted to our hospital. Three-dimensional chest computed tomography (CT) revealed a subsuperior segmental bronchus (B*), originating from the common trunk of the lateral basal segmental bronchus( B9) and posterior basal segmental bronchus (B10). In order to obtain enough surgical margin, we performed S6+S* segmentectomy. The pathological diagnosis was invasive adenocarcinoma( pT1cN0M0, stageⅠA3). S* segmentectomy was considered to be useful method to ensure sufficient surgical margin when the lesion is in S* or in segments adjacent to it.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.xjtc.2022.10.007

PubMed

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

医中誌

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Soft coagulation using the VIO soft coagulation system is used to treat minor lung air leaks during pulmonary resection in Japan. We previously reported that it has a similar effect as the air leak treatment with fibrin glue. We evaluated the efficacy of soft coagulation using the VIO soft coagulation system for lung air leakage during pulmonary resection. METHODS: Intraoperative air leaks from the interlobar lung parenchyma were observed in 42 of the 283 patients who underwent video-assisted thoracoscopic surgery lobectomy between 2016 and 2018. We retrospectively reviewed these 42 patients who were treated using the VIO soft coagulation system for air leaks. We classified the air leaks in to grades using the Macchiarini scale score and evaluated the surgical outcomes of air leak treatment. RESULTS: Air leaks from the interlobar lung parenchyma having Macchiarini scale scores 1, 2, and 3 occurred in 8, 17, and 17 patients, respectively. In all the 8 patients with score 1 air leaks (100%), the air leaks could be controlled using the VIO soft coagulation system alone, and none had delayed pneumothorax requiring intervention. Of the score 2 and 3 air leaks, 52.9% and 35.3% were controlled using the VIO soft coagulation system alone, respectively. CONCLUSIONS: Macchiarini scale score 1 air leaks from the interlobar lung parenchyma could be well controlled using the VIO soft coagulation system. Therefore, soft coagulation with this system may be an alternative method for treating minor air leaks during pulmonary resection surgery.

DOI： 10.1186/s13019-022-01948-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: To perform safe robot-assisted anatomical lung resections, the details of intraoperative complications need to be shared among thoracic surgeons. However, only limited data are available. METHODS: This retrospective, single-institutional study evaluated 134 patients who underwent robot-assisted anatomical lung resection. We examined the causes, management, and outcomes of all intraoperative complications. RESULTS: Of the 134 eligible patients, 118 (88%) underwent lobectomy and 16 (12%) underwent segmentectomy. Intraoperative complications occurred in 17 (12.7%) patients. These complications included pulmonary artery (PA) injuries in seven patients, pulmonary vein (PV) injuries in three, azygos vein (AV) injury in one, superior vena cava (SVC) injury in one, bronchial injuries in three, and lung injuries in four. Most PA injuries were at a distal side and controlled by pressure, fibrin sealant, or stapling of the proximal side. In the three PV injuries, right upper PV was sandwiched by robotic instruments, V6 was punctured by the tip of the Maryland bipolar forceps, and the distal side of V2t was injured during tunneling of a minor interlobar fissure. These were controlled the same way as the PA injuries. The AV injury occurred during hilar lymph node (LN) dissection and was controlled by suturing. The SVC injury was caused by interference of the robotic forceps and the suction tube outside the field of view during upper mediastinal LN dissection. The injury was controlled by continuous pressure while layering polyglycolic acid sheets and fibrin glue. In the three bronchial injuries, B10 was injured during subcarinal LN dissection, right main bronchus was injured during upper bronchus dissection and the stapling failure of the bronchus occurred by strong traction. They were all repaired by suturing. All lung parenchymal injuries were caused by manipulation of robotic instruments outside the field of view. The lung injuries were repaired by suturing with pledgets. No cases were converted to thoracotomy. The 30-day mortality rate was 0.7%. The cause of mortality was pneumonia. CONCLUSIONS: In robot-assisted anatomical pulmonary resection for lung cancer, most major intraoperative complications can be safely managed robotically without conversion to thoracotomy.

DOI： 10.21037/jtd-22-553

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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：南江堂  

DOI： 10.15106/j_kyobu75_674

CiNii Research

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Minimally invasive surgery is the standard treatment for early-stage thymoma. We compared the perioperative outcomes between robot-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) for thymoma. METHODS: Between April 2011 and August 2021, patients with thymoma who underwent thymectomy by RATS (n=20) or VATS (n=37) at our hospital were retrospectively reviewed. We evaluated the postoperative quality of life (QOL), surgical outcomes, complications, mortality, and pain grade. Postoperative QOL was assessed according to the time to achieve "B duration" and "CIII duration" based on the Nursing Dependency Score and Nursing Criteria, respectively. RESULTS: After the inverse probability of treatment weighting (IPTW), the B duration and CIII duration were significantly shorter with RATS than with VATS (P<0.001 and P=0.037, respectively). These superior results of RATS group compared to those of the VATS group were confirmed with logistic regression analysis (OR 0.25, 95% CI: 0.10-0.63, P=0.003; and OR 0.31, 95% CI: 0.12-0.76, P=0.011, respectively). After the IPTW, the VATS group had significantly fewer patients with epidural analgesia than the RATS group (P=0.018). In contrast, additional regular analgesics (including those for wound pain and neuralgia) were prescribed significantly more often during postoperative hospitalization in the VATS group (P=0.033). Patients in both groups had no myasthenic crisis or mortality. The postoperative pain grade at the first and second follow-ups did not significantly differ between the two groups after the IPTW (P=0.376 and P=0.109, respectively). CONCLUSIONS: RATS offered the advantages of improved postoperative QOL according to nursing care systems compared to VATS.

DOI： 10.21037/gs-22-333

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The subsuperior segmental bronchi (B*) forms the subsuperior segment (S*) between the superior (S6) and basal segment (S7, S8, S9, S10) of the lung. However, the anatomical planes of S* remains undefined. The present study clarified the anatomical features of S*. METHODS: We reviewed the anatomical patterns of pulmonary vessels and the left lung bronchus in 539 patients using three-dimensional computed tomography. We report the anatomic structure in S*. RESULTS: A total of 537 patients were analyzed. B* was observed in 129 (24.0%) patients. The intersegmental vein between S6 and S* was complete in all cases. The absence of intersegmental veins of S* was observed in 77 (14.3%) patients, reaching 59.7% of B* cases. Twenty-two (4.1%) cases of B* diverged from the trunk of the basal bronchus, and about half of the B* branched to the dorsolateral (n = 77, 14.3%) or dorsal (n = 2, 0.37%) direction. CONCLUSION: Our study revealed the branching patterns of B* and anatomical intersegmental veins of S*. Our results provide useful information regarding anatomical segmentectomy including or adjusting to the left S*.

DOI： 10.1007/s00595-021-02417-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The major advantages of robot-assisted surgery are the fine field of view provided by the high-precision three-dimensional (3D) images and the good operability provided by the robotic arms that enables precise movements. A growing number of retrospective studies have compared robotic-assisted thoracoscopic surgery (RATS) with video-assisted thoracoscopic surgery (VATS), but the number of cases is limited and the results are contradictory. METHODS: We studied the medical records of primary lung cancer patients who underwent lobectomy with lymph node dissection between 2017 and 2020. Four hundred and eleven patients fulfilled the inclusion criteria in this study (RATS: 103; VATS: 308). We compared the perioperative factors and postoperative results of the VATS and RATS groups. Further, we adjusted background factors using propensity score matching (PSM) then compared the results of 200 patients (100 patients in each group). In this study, we matched interlobar fissure completeness, which affects operative difficulty and operative time; however, this has been superficially compared in previous studies. RESULTS: After PSM, a significant difference was observed in the intraoperative blood loss (RATS: 53.3 mL, VATS: 120.3 mL, P=0.04). The rates of surgical complications were comparable between the groups (10.0% vs. 13.0%, P=0.66) with similar mean operation times (RATS: 215.0 min, VATS: 210.1 min, P=0.57). The mean postoperative stay in the RATS group was shorter than that in the VATS group (10.0 vs. 11.5 days, P=0.04). CONCLUSIONS: Initial experience of RATS had no obvious drawbacks when compared with that of VATS on propensity-matched analysis.

DOI： 10.21037/jtd-21-1696

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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）  

OBJECTIVE: We investigated the safety of a novel interlobar fissure division technique using the da Vinci vessel sealing system in robot-assisted pulmonary lobectomy. METHODS: The medical records of patients who underwent robotic pulmonary lobectomy with node dissection for primary lung cancer between 2018 and 2020 were reviewed. The inclusion criteria were fulfilled by 111 patients, whose perioperative factors and postoperative results were compared with those previously reported. Furthermore, the new robotic lung interlobar division technique using the da Vinci vessel sealing system without a robotic stapler was evaluated in patients with low-grade incomplete fissure. We considered the Craig and Walker classification of lung fissures grades 1 and 2 as a good adaptation for the vessel sealing system interlobar fissure division. RESULTS: The vessel sealing system group had shorter mean operative and console times (P = .03 and P = .01, respectively) and lesser median intraoperative blood loss (20 mL vs 50 mL; P = .01). The vessel sealing system group had lower surgical complication rates (2.2% vs 20.0%; P = .01). The incidence of persistent postoperative air leak was lower (0% vs 10.0%; P = .06), and fewer robotic stapler cartridges were used during surgery (3.4 vs 5.6; P < .001) in the vessel sealing system group than in the stapler group. CONCLUSIONS: We report the safety of using the da Vinci vessel sealing system as an alternative to the use of robotic staples for interlobar fissure division in robot-assisted pulmonary lobectomy. This technique seems easy and feasible though limited to the low-grade incomplete fissure.

DOI： 10.1016/j.xjtc.2022.02.019

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記述言語：英語  

Subsegmentectomy is an optional treatment for early primary lung cancer presenting without adequate surgical margins for wedge resection. There are no previous reports regarding a robotic single subsegmentectomy. We report a robotic single subsegmentectomy of the right anterior medial subsegment (S3b). The lung parenchyma was dissected with a Vessel Sealer Extend along the intersubsegmental veins for proper lung mobilization to solve the directional limitations of the robotic stapler. Additionally, we inserted the most ventral port from the subcostal region to increase the distance between the ports. Performing a robotic single subsegmentectomy is challenging. However, our techniques help to achieve a safe and effective operation.

DOI： 10.1510/mmcts.2022.027

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSES: The bronchopulmonary vascular bifurcation patterns in the upper lobe of the left lung are diverse. Therefore, it is important for general thoracic surgeons to understand the detailed anatomy of the pulmonary segments when performing thoracoscopic anatomical pulmonary resection. This study aimed to analyze the bronchovascular patterns of the left upper lobe and summarize the anatomical information associated with pulmonary anatomical pulmonary resection. METHODS: We reviewed the anatomical patterns of pulmonary vessels and the left lung bronchus of 539 patients using computed tomography imaging data including those obtained using three-dimensional computed tomography. We herein report the anatomic structure in the left upper lobe. RESULTS: Regarding the superior division bronchi, a pattern of trifurcation into B1+2, B3, lingular division bronchus was observed in nine patients (1.7%). A pattern of proximal bifurcation of B4 was found in eight patients (1.5%). Regarding the lingular veins (LV), patterns of LV drainage into the left lower pulmonary vein were observed in 22 patients (4.1%). Regarding the pulmonary artery, mediastinal lingular arteries (MLA) were found in 161 patients (29.9%). CONCLUSION: The bifurcation patterns of the bronchovascular region in the upper lobe of the left lung were clarified. These results should be carefully noted when performing anatomical pulmonary resection.

DOI： 10.1007/s00595-022-02471-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The surgical instruments used in robot-assisted thoracic surgery are flexible to enable the surgeon to approach the surgical field from any direction. However even in robot-assisted thoracic surgery subcarinal lymph node dissection requires a precise technique suitable for a small area surrounded by important organs. We present a method of subcarinal node dissection with solo robot-assisted thoracic surgery using a bronchial traction method and a metal basket suction device, the Dobon (Senko Medical Instrument Mfg, Tokyo, Japan).

DOI： 10.1016/j.athoracsur.2021.05.038

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出版者・発行元：南江堂  

その他リンク： https://search.jamas.or.jp/link/ui/2022066086

DOI： 10.15106/j_kyobu74_1051

CiNii Research

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

We report a rare case of a congenital pericardial defect that was incidentally found at thoracoscopic left upper lobe resection in a patient with lung cancer. A 75-year-old man with a left upper lobe lung cancer was referred to our hospital. We performed thoracoscopic left upper lobectomy and incidentally found a pericardial defect intraoperatively. Careful lymph node dissection was necessary to avoid injury of phrenic nerve and pulmonary artery. Surgery for lung cancer was completed without pericardial repair. After surgery, no complications associated with the pericardial defect has not been encountered.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

In robotic-assisted thoracoscopic surgery, surgeons may encounter bleeding issues requiring compression techniques and time to achieve hemostasis. During this time, surgeons cannot use the robot arm and may require an assistant to perform suction, thus increasing the cost of the procedure. This report describes an alternative suction device, Dobon (Senko Medical Instrument Mfg, Tokyo, Japan), which is usually used for pediatric cardiac surgery, for use in robotic-assisted thoracoscopic surgery. The report presents the technique for using this device and comments on the advantages, including decreased cost and an improved surgical visual field.

DOI： 10.1016/j.athoracsur.2021.03.019

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出版者・発行元：南江堂  

DOI： 10.15106/j_kyobu74_664

CiNii Research

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 42-year-old man presented with a one-month history of back pain. Chest computed tomography revealed a mass (7.6×5.7 cm) in the right upper lobe, suspicious of chest wall invasion. We performed right upper lobectomy combined with chest wall resection. Partial dissections of the second to sixth ribs and the third and fourth vertebral bodies were conducted. Postoperatively, motor paralysis of the right lower extremity was observed and a diagnosis of spinal infarction was made. After cerebrospinal fluid drainage and administration of edaravone with early rehabilitation, he was able to walk with a brace and was discharged from the hospital.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Ipsilateral recurrent laryngeal nerve paralysis is one of the rare complications during the superior mediastinal node dissection for lung cancer. However, very few reports of contralateral recurrent laryngeal nerve paralysis during the procedure are available. CASE PRESENTATION: Two women aged 74 and 80 years developed hoarseness after undergoing right upper lobectomy and right superior mediastinal node dissection for primary lung cancer. Postoperative laryngoscopy in the two patients confirmed left vocal cord paralysis. CONCLUSION: Node dissection is performed in the standard procedure for right upper lobe lung cancer. At this time, care must be taken not to cause damage not only to the recurrent laryngeal nerve on the ipsilateral side but also to the recurrent laryngeal nerve on the contralateral side.

DOI： 10.1186/s40792-021-01236-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Histone deacetylase (HDAC) inhibitors have a potential therapeutic role for non-small cell lung cancer (NSCLC). However, more preclinical studies of HDAC inhibitors in NSCLC and normal lung epithelial cells are required to evaluate their antitumor activities and mechanisms. The bicellular tight junction molecule claudin-2 (CLDN-2) is highly expressed in lung adenocarcinoma tissues and increase the proliferation of adenocarcinoma cells. Downregulation of the tricellular tight junction molecule angulin-1/LSR induces malignancy via EGF-dependent CLDN-2 and TGF-β-dependent cellular metabolism in human lung adenocarcinoma cells. In the present study, to investigate the detailed mechanisms of the antitumor activities of HDAC inhibitors in lung adenocarcinoma, human lung adenocarcinoma A549 cells and normal lung epithelial cells were treated with the HDAC inibitors Trichostatin A (TSA) and Quisinostat (JNJ-2648158) with or without TGF-β. Both HDAC inhibitors increased anguin-1/LSR, decrease CLDN-2, promoted G1 arrest and prevented the migration of A549 cells. Furthermore, TSA but not Quisinostat with or without TGF-β induced cellular metabolism indicated as the mitochondrial respiration measured using the oxygen consumption rate. In normal human lung epithelial cells, treatment with TSA and Quisinostat increased expression of LSR and CLDN-2 and decreased that of CLDN-1 with or without TGF-β in 2D culture. Quisinostat but not TSA with TGF-β increased CLDN-7 expression in 2D culture. Both HDAC inhibitors prevented disruption of the epithelial barrier measured as the permeability of FD-4 induced by TGF-β in 2.5D culture. TSA and Quisinostat have potential for use in therapy for lung adenocarcinoma via changes in the expression of angulin-1/LSR and CLDN-2.

DOI： 10.1007/s00418-021-01966-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The objective of this study was to analyze the efficacy of the LigaSureTM vessel sealing system for lung cancer resection with node dissection, as this has not been sufficiently evaluated. METHODS: From 2004 to 2018, 948 patients underwent anatomical pulmonary resection with node dissection for non-small cell lung carcinoma (NSCLC) via the video-assisted thoracoscopic surgery (VATS) approach. Medical records of these patients were reviewed retrospectively. Univariate and multivariate analyses were conducted to determine the risk factors for chylothorax and blood loss. RESULTS: Of the 948 patients, 318 (33.5%) who underwent anatomical lung resection with node dissection by conventional methods without vessel sealing system and 630 (66.5%) who underwent lung resection with node dissection with the vessel sealing system were included. The median intraoperative blood loss was 100 mL. Postoperative chylothorax occurred in 9 (2.8%) patients in the conventional method group with 2 (0.3%) patients in the vessel sealing system group (P=0.001). Patients in the vessel sealing group who developed chylothorax were cured by conservative treatment. Univariate and multivariate analyses identified male sex [odds ratio (OR) 2.053; 95% confidence interval (CI): 1.494-2.820; P<0.001] and the use of vessel sealing system (OR 0.342; 95% CI: 0.256-0.457; P<0.001) as independent predictors of intraoperative blood loss. The univariate and multivariate analyses identified the use of the vessel sealing system (OR 0.108; 95% CI: 0.023-0.504; P=0.005) as an independent predictor of chylothorax incidence. CONCLUSIONS: Vessel sealing system for lung cancer resection could decrease chest tube duration, amount of intraoperative bleeding, and incidence of chylothorax in patients who undergo lung resection with node dissection.

DOI： 10.21037/jtd-21-169

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

医中誌

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出版者・発行元：南江堂  

DOI： 10.15106/j_kyobu74_108

CiNii Research

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記述言語：日本語   出版者・発行元：北海道外科学会  

CiNii Research

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Several severe intraoperative complications of lung cancer surgery have been reported, but the incorrect transection of the main bronchus is a very rare and serious complication. We report a surgical case of a patient with left lower lobe lung cancer invading the inferior segment of the lingula, with fused interlobar fissure and dense pleural adhesion, in which the left main bronchus was mistaken for the left lower lobe bronchus and was transected. CASE PRESENTATION: A 64-year-old woman with lung adenocarcinoma was referred to our hospital for surgical treatment. Chest computed tomography (CT) scan showed a 30-mm nodule with a clear border and irregular margins in the center of the anterior (S8) segment of the lower lobe of the left lung and another similar 30-mm nodule in the lateral (S9) segment of the same lobe. Metastasis within the same lobe was suspected. A thoracoscopic left lower lobectomy was scheduled for the patient. As the patient had a moderately, fused fissure, dense pleural adhesion, and suspicious tumor invasion from the left S8 segment to the left S5 segment, and the interlobar node tightly adhered to the main PA at the site of basilar artery origin of the LLL, we performed left lower lobectomy and a left S5 segmentectomy using the fissureless fissure-last technique. During surgery, the left main bronchus was mistaken for the left lower lobe bronchus and was transected. After transecting the left main bronchus, we performed a sleeve bronchoplasty to prevent pneumonectomy. CONCLUSIONS: We experienced the rare and serious intraoperative complication of the incorrect transection of the main bronchus. There are few reports of this intraoperative complication, and it should not be overlooked by surgeons.

DOI： 10.1186/s40792-020-01073-8

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出版者・発行元：南江堂  

DOI： 10.15106/j_kyobu73_663

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A man was diagnosed with a left upper mediastinal mass. The mass was located near the left subclavian vein, phrenic nerve, vagus nerve, left subclavian artery, and left brachiocephalic vein. He underwent a robotic surgery without additional approaches such as cervical approach on transmanubrial approach. Robotic surgery enabled to remove the tumor safely due to the highly flexible robot forceps under a 3-dimensional visual field. Robotic surgery may be effective for tumors in the upper mediastinum, where important blood vessels and nerves are closely present.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To identify and clarify the comprehensive anatomic patterns in the left lower lobe (LLL). METHODS: Using computed tomography (CT) imaging data, including that obtained using three-dimensional CT, we reviewed the anatomic patterns of the pulmonary vessels and bronchi in the left lungs of 539 patients, focusing on the LLL. RESULTS: The two-stem type in A6 was observed in 131 (24.7%) patients and the three-stem type in A6 was observed in 11 (2.1%) patients. The independent two-stem type in B6 was observed in four (0.75%) patients. The B7 with independent branching from the basal bronchi was observed in 42 (7.9%) patients. B* was observed in 129 (24.0%) patients and B* was accompanied by A* in all patients. An extrapericardial common trunk of the left pulmonary veins was identified in five patients (0.93%). CONCLUSION: We identified various bronchovascular patterns in the LLL of a large number of patients. Our results provide useful information for anatomic pulmonary resection, especially segmentectomy.

DOI： 10.1007/s00595-020-01991-y

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 65-year-old woman was diagnosed with lung cancer on the left upper lobe. During thoracoscopic left upper lobectomy, the common trunk of pulmonary vein was mistaken for the left upper pulmonary vein and divided incorrectly. Instead of left pneumonectomy, we successfully performed pulmonary vein reconstruction. As a result of anticoagulant therapy for 1 month, postoperative course was uneventful.

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記述言語：日本語   出版者・発行元：北海道外科学会  

その他リンク： https://search.jamas.or.jp/link/ui/2020344974

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The aim of the present study was to evaluate the survival impact of surgical resection among patients with pulmonary metastases from bone and soft tissue sarcomas. A total of 34 consecutive patients with ≤5 pulmonary metastases from bone and soft tissue sarcomas were retrospectively reviewed. The patients included 19 men and 15 women, with a median age of 64.0 years and a median follow-up of 14.5 months. The oncological outcome was compared between patients who underwent surgical and non-surgical treatment. A total of 22 patients underwent surgery and 12 patients did not undergo surgery. The surgery group had 3- and 5 year overall survival rates of 62 and 53%, respectively. None of the patients in the non-surgery group survived to 3 years. Compared with the non-surgery group, surgery achieved significantly better 3- and 5 year overall survival rates. Pulmonary metastasectomy was associated with significantly improved survival among patients who were aged <64 years (P=0.0155), as well as those who were aged ≥64 years (P=0.0444), which indicated that age was not associated with a difference in survival between the two groups. Therefore, pulmonary metastasectomy may improve the prognosis of patients with pulmonary metastases from bone and soft tissue sarcomas.

DOI： 10.3892/mco.2020.2009

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Primary soft tissue sarcomas (STSs) involving the chest wall are uncommon. The aim of this study was to identify factors that influence the prognosis of patients with primary chest wall STS. METHODS: The records of 38 patients (23 men and 15 women) who were treated at our institutions during 2002 to 2018 were reviewed. The following variables were evaluated as potential prognostic factors: sex, tumor size, chemotherapy, and completeness of surgical margins. Multivariate analysis was conducted to identify predictors of overall survival (OS) and disease-free survival (DFS). RESULTS: Of the 38 included patients, 5 had low-grade tumors and 33 had high-grade tumors. Five patients required chest wall reconstruction including rib resection. Thirty patients (79%) underwent R0 resection. The 5-year OS and DFS rates were 45% and 27%, respectively. Local recurrence developed in 7 patients. Multivariate analysis identified tumor size (hazard ratio [HR]: 4.13; 95% confidence interval [CI]: 1.05-16.24; P = .04) and R1/2 resection (HR: 3.92; 95% CI: 1.12-13.66; P = .03) as predictors of OS. CONCLUSIONS: Prognostic factors for survival included tumor size and completeness of surgical margins. Complete tumor excision is desirable, particularly in cases of early detection.

DOI： 10.1002/jso.25708

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Aim of this study was to elucidate an alteration of quality of life (QOL) score before and after video-assisted thoracoscopic surgery (VATS) for non-small cell lung cancer (NSCLC) patients using the 5-level EuroQol-5D questionnaire (EQ-5D-5L). We also investigated how the preoperative QOL scores affected the postoperative clinical outcome prospectively. METHODS: Between July 2018 and December 2018, 24 consecutive NSCLC patients who underwent VATS were recruited. The EQ-5D-5L for Japanese was used with face-to-face interviews to estimate the utility values of QOL. RESULTS: QOL scores were significantly declined after surgery (0.81 ± 0.19 vs. 0.74 ± 0.11: P = 0.049). The levels of EQ-5D-5L questionnaire were not significantly different before and after surgery except Q4 (pain control). The levels of Q4 were significantly worsened after surgery (1.33 ± 0.56 vs. 1.88 ± 0.61, P < 0.001). Operation time and bleeding in the preoperative low-QOL score group (N = 13) was longer (215.4 ± 52.3 min. vs. 173.5 ± 42.3 min., respectively: P = 0.045) and more (116.2 ± 152.7 ml vs. 22.7 ± 20.1 ml, respectively: P = 0.049) than those in the high-QOL score group (N = 11). CONCLUSIONS: QOL survey for lung cancer patients using EQ-5D-5L is simple and useful to identify the issue facing at the medical team. Preoperative low QOL score could be a predicting factor for the longer operation time and more bleeding.

DOI： 10.1007/s11748-019-01136-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Persistent left superior vena cava (PLSVC) is the most common anomalous thoracic venous drainage. A PLSVC usually drains into the right atrium through a dilated coronary sinus. It is rare that a PLSVC flows directly into the left atrium, and even rarer that it connects to the left upper pulmonary vein (LUPV). We report a case, wherein the LUPV connected to both the PLSVC and the left atrium.

DOI： 10.1007/s11748-018-1018-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: MCL1 is an anti-apoptotic BCL2 family member that is highly expressed in various malignant tumors. However, little is known about the role of MCL1 in KRAS-mutant lung adenocarcinomas. In this study, we aimed to clarify whether MCL1 could be a therapeutic target in KRAS-mutant lung adenocarcinomas for which no effective molecular targeted drugs are available. MATERIALS AND METHODS: We examined to what extent MCL1 knockdown either alone or in combination with MEK inhibitor trametinib suppressed growth or induced apoptosis in the KRAS-mutant lung adenocarcinoma cell line H441 and EGFR-mutant lung adenocarcinoma cell line H1975. Furthermore, we investigated the therapeutic effects of dual inhibition of MCL1 and Bcl-xL, another anti-apoptotic BCL2 family member, in these two cell lines. RESULTS: MCL1 knockdown alone did not induce apoptosis in H441 or H1975 cells. However, MCL1-depleted H441 and H1975 cells underwent apoptosis and decreased in number in the presence of trametinib. We also confirmed that combined therapy by MCL1 knockdown and trametinib almost completely suppressed the growth of H441 cells in vivo. Moreover, dual knockdown of MCL1 and Bcl-xL induced extensive apoptosis in H441 and H1975 cells. CONCLUSION: These findings suggest that combined treatments of MCL1 knockdown and trametinib or dual inhibition of MCL1 and Bcl-xL would be effective therapies for lung adenocarcinomas including the KRAS-mutant subtype.

DOI： 10.1016/j.lungcan.2019.05.014

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Completion lobectomy long after segmentectomy in the same lobe is extremely difficult because of severe adhesions around hilar structures, especially in cases involving video-assisted thoracoscopic surgery (VATS) completion lobectomy. We report and compare the surgical outcomes of patients who underwent VATS or thoracotomy completion lobectomy long after radical segmentectomy for lung cancer. METHODS: We retrospectively evaluated the surgical outcomes of completion lobectomies performed at our institute long after radical segmentectomies for lung cancer in the same lobe. The efficacy and safety of VATS completion lobectomy was compared to that of thoracotomy completion lobectomy. RESULTS: Ten of 228 patients who underwent radical segmentectomy for lung cancer between 2009 and 2018 underwent completion lobectomy at least a month after segmentectomy; five patients underwent VATS completion lobectomy. None of the patients underwent VATS left upper completion lobectomy, and conversion to thoracotomy was required in one patient. There were no significant differences between VATS and thoracotomy completion lobectomies in the median operative times (VATS 295 min, thoracotomy 339 min, p = 0.55), intraoperative blood loss volumes (VATS 350 mL, thoracotomy 500 mL, p = 0.84), intervals between initial segmentectomy and completion lobectomy (VATS 40 months, thoracotomy 48 months, p = 0.55), and number of patients with pulmonary artery injury (VATS 1, thoracotomy 2, p = 0.49). There was no operation-related mortality. CONCLUSIONS: VATS completion lobectomy long after segmentectomy for lung cancer could be performed without fatal complications unless severe adhesions are observed around each main pulmonary artery.

DOI： 10.1186/s13019-019-0941-8

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出版者・発行元：南江堂  

DOI： 10.15106/j_kyobu72_344

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Paraffin had been used for pleural plombage in the treatment of tuberculosis. However, paraffin use has been reported to cause late postoperative complications. A 79-year-old man was presented with an extramedullary tumor and spinal paralysis. Forty-seven years ago, he had undergone pleural plombage using paraffin for the treatment of pulmonary tuberculosis. Since the extramedullary tumor was found to be paraffinoma, paraffin in the vertebral canal and thoracic cavity was removed surgically. All the paraffin in the vertebral canal and thoracic cavity was removed. After surgery, the patient remains well, without spinal paralysis.

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出版者・発行元：南江堂  

その他リンク： https://search.jamas.or.jp/link/ui/2019196318

DOI： 10.15106/j_kyobu72_209

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記述言語：日本語  

A 46-year-old woman with cervical cancer with multiorgan metastasis visited our hospital. She underwent a total gastrectomy, splenectomy, distal pancreatectomy, left adrenalectomy, and left partial diaphragmatic resection. Postoperatively, she developed pleural effusion with high level of amylase secondary to a pancreatic fistula, consequently causing left-sided empyema. She developed acute respiratory distress syndrome. Urgent surgical treatment was scheduled, and left lower lobectomy, with diaphragmatic partial resection were performed under the venovenous extracorporeal membrane oxygenation. After surgery, intensive care for 45 days was necessary and she was discharged home 6 months post operatively.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

This report describes a case of thoracoscopic right basilar segmentectomy after upper lobectomy. A 76-year-old man who underwent right upper lobectomy for lung tuberculosis 50 years earlier had a diagnosis of squamous cell carcinoma, stage IB (T2a N0 M0), in the right lower lobe and underwent right basilar segmentectomy for limited resection. The postoperative course was uneventful. The patient showed no recurrence clinically, and the 1-year postoperative chest computed tomographic scan showed adequate volume of the middle and residual right lower lobe without emphysematous changes.

DOI： 10.1016/j.athoracsur.2018.06.041

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本呼吸器外科学会  

Solitary fibrous tumor（SFT）は，間葉系細胞由来の稀な腫瘍である．今回，特異な病態を呈した3例を経験した．症例1は76歳男性，右肺上葉中枢側に60 mm大の腫瘤影を認め，原発性肺癌の疑いで右上葉切除を行った．病理診断は肺原発SFTであった．症例2は46歳女性，右下葉肺原発悪性SFTに対する下葉切除術後4年目に右中葉肺転移，胸膜播種をきたした．このため中葉切除と胸膜播種巣切除術，胸腔内化学療法を行った．その後，再発し初回手術から77ヵ月後に原病死した．症例3は63歳女性，CTで右胸腔に190 mm大の一部石灰化と血管新生を伴う巨大な腫瘤を認め，Chronic Expanding Hematomaの疑いで手術目的に当科紹介となった．術中出血低減目的に肋間動脈，内胸動脈塞栓術を施行した後手術を行い，病理診断はSFTであった．

その他リンク： https://search.jamas.or.jp/link/ui/2019127197

DOI： 10.2995/jacsurg.33.37

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.22603/ssrr.2018-0049

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本肺癌学会  

<b>背景．</b>異時性多発肺癌に対する3回以上の解剖学的肺切除や，片肺全摘後の残肺解剖学的切除例の報告はいまだ少ない．<b>症例．</b>66歳男性．50歳時に左上葉肺癌（肺癌取扱い規約第8版：微小浸潤性腺癌，stage IA1）に対して左上葉切除術，61歳時に左下葉異時性多発肺癌（微小浸潤性腺癌，stage IA1）に対して左下葉切除術の既往があった．定期検診で胸部異常陰影を指摘された．術前残存肺呼吸機能は肺活量2.32 <i>l</i>，1秒量1.59 <i>l</i>であった．組織学的な確定診断は得られなかったが，CT所見から原発性肺癌が強く疑われたため，体外式肺補助（ECLA）下に胸腔鏡下右S⁶区域切除を施行した．術後合併症はなく，術後14日目に退院した．組織学的診断は上皮内腺癌であった．<b>結論．</b>ECLAの使用により，左肺全摘後，右肺に出現した異時性肺癌（3重癌）に対し，安全に胸腔鏡下区域切除を施行することが可能であった．

その他リンク： https://search.jamas.or.jp/link/ui/2019010655

DOI： 10.2482/haigan.58.298

DOI： 10.2995/jacsurg.34.746_references_DOI_YSb6HuZxGp1gacqXpWN5ICzLTq3

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Combined resection of a phrenic nerve is occasionally required in T3 primary lung carcinomas invading the phrenic nerve to completely remove a malignant tumour, resulting in diaphragmatic paralysis. We describe the first case of thoracoscopic lobectomy and diaphragmatic plication as a one-stage surgery for lung cancer invading the phrenic nerve. CASE PRESENTATION: A 56-year-old woman with a T3N0M0 primary adenosquamous carcinoma in the left upper lobe presented with suspicious invasion to the anterior mediastinal fat tissue and left phrenic nerve and underwent left upper lobectomy, node dissection, and partial resection of the anterior mediastinal fat tissue with the left phrenic nerve. Furthermore, thoracoscopic diaphragmatic plication was performed as a concomitant procedure. The patient's postoperative course was favourable, without any complications, and respiratory function was preserved for 1 year postoperatively. CONCLUSIONS: Thoracoscopic one-stage lobectomy and diaphragmatic plication for T3 lung cancer invading the phrenic nerve is effective for preservation of postoperative pulmonary function.

DOI： 10.1186/s13019-018-0766-x

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出版者・発行元：南江堂  

その他リンク： https://search.jamas.or.jp/link/ui/2018316114

DOI： 10.15106/j_kyobu71_547

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Immunohistochemical staining is important for the differential diagnosis of basaloid squamous cell carcinoma(BSC)and other similar carcinomas, such as small-cell carcinomas and large-cell neuroendocrine carcinomas. p40 is a useful marker of squamous cell carcinoma that can be used for the diagnosis of BSC. We present the case of a 64-year-old man who was referred to our hospital for investigation of an abnormal shadow revealed on chest radiography. Computed tomography(CT) revealed a 16×11 mm nodule in the left lung(S1+2), and a thoracoscopic left upper lobectomy was performed. Histologically, lobular pattern with peripheral palisading was observed and the immunohistochemical staining revealed the tumor cells to be positive for p63 and negative for both p40 and neuroendocrine markers, leading to the diagnosis of BSC.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.athoracsur.2018.01.049

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記述言語：日本語   出版者・発行元：北海道外科学会  

その他リンク： https://search.jamas.or.jp/link/ui/2018299769

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記述言語：英語  

DOI： 10.1093/ejcts/ezx425

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSES: Acute exacerbation of interstitial pneumonia (AEIP) is a leading cause of death after lung cancer resection in patients with interstitial lung disease. METHODS: We retrospectively analyzed 1763 patients with non-small cell lung cancer with a clinical diagnosis of interstitial lung disease (ILD) who underwent lung cancer resection between 2000 and 2009 at 61 hospitals in Japan. AEIP occurred in 164 of 1763 (9.3%) patients with a mortality rate of 43.9% (72/164). Univariate and multivariate analyses were carried out to identify possible risk factors of fatal AEIP. We then analyzed the 164 patients who developed postoperative AEIP and identified the preoperative and postoperative risk factors. RESULTS: A multivariate regression analysis identified that the sex, percent vital capacity, neoadjuvant radiation, preoperative history of AEIP, preoperative use of steroids, usual interstitial pneumonia pattern on CT, and surgical procedures were independent preoperative risk factors for death due to AEIP. ILD patients with emphysema somehow showed a lower risk of fatal AEIP than those without emphysema in this study. CONCLUSIONS: This study revealed eight risk factors for fatal AEIP.

DOI： 10.1007/s00595-017-1605-8

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記述言語：英語  

We present a case series of four siblings with hereditary hemorrhagic telangiectasia (HHT) and pulmonary arteriovenous malformations (PAVM). The patients' mother has HHT. Case 1: A 22-year-old man developed dyspnea and epistaxis. CT revealed a large PAVM, treated by segmentectomy. Case 2: A 27-year-old woman developed epistaxis and dyspnea. CT revealed three PAVMs, treated by partial resection. Case 3: A 20-year-old woman developed dyspnea. CT revealed multiple PAVMs, treated with endovascular occlusion of the largest one. Case 4: A 12-year-old woman developed epistaxis. CT revealed multiple PAVMs, observed without treatment. Genetic testing identified a new mutation, ENG c.1517T>C (p.Leu506Pro), in all patients and their mother. We suspect that HHT in these patients may be associated with this ENG mutation.

DOI： 10.1016/j.rmcr.2018.07.001

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Mediastinal node dissection (MND) is an integral component of the surgical treatment for non-small cell lung cancer (NSCLC). Although video-assisted thoracoscopic surgery (VATS) has been used increasingly for lung cancer treatment, the accuracy of by VATS MND still remains controversial. We reviewed the surgical results of VATS MND for NSCLC. METHODS: A systematic review of literature was performed, and articles that fully described the surgical procedure, devices, and results of VATS MND were selected to compare the efficacy of MND by VATS and thoracotomy. RESULTS: Various techniques and equipments have been shown to perform adequate MND, but there is an argument as to the method of estimation of the accuracy of MND. Most of the recent studies showed that the nodal upstaging and number of dissected nodes are significantly lower by VATS than after thoracotomy. Oppositely, some studies showed VATS noninferiority in these issues. Complications such as chylothorax, pleural effusion, bleeding, and nerve damage were similar in both groups. CONCLUSIONS: Although ND by VATS remains controversial, VATS MND is becoming easier and more feasible owing to the development of more advanced endoscopic cameras and equipments. We should learn further to become more adept at performing adequate ND by VATS.

DOI： 10.1007/s00595-017-1494-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A cell-cell adhesion protein, junctional adhesion molecule-A (JAM-A), has been shown to be involved in neoplasia of various organs. However, the fundamental role of JAM-A in tumorigenesis is still under debate because dysregulated expression of this protein has distinct effects, playing opposite roles in carcinogenesis depending on the target tissues. In the present study, we found elevated levels of JAM-A expression in lung adenocarcinoma and its preinvasive lesions, including atypical adenomatous hyperplasia and adenocarcinoma in situ by immunohistochemistry. We also showed that suppression of constitutive JAM-A expression conferred target cells with increased susceptibility to apoptosis in lung adenocarcinoma cells. Consequently, inhibition of JAM-A activity decreased colony-forming capability in vitro and tumorigenicity in vivo. The transformed phenotype following suppression of JAM-A expression was sufficient to reduce motile and invasive capacities. Importantly, knockout of JAM-A had striking effects on cells. Our observations suggest that increased expression of JAM-A promotes neoplasia of lung adenocarcinoma. In addition, an anti-JAM-A antibody efficiently reduced cell proliferation and provoked apoptosis, indicating the potential feasibility of JAM-A-inhibitory cancer therapy.

DOI： 10.1111/cas.13385

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Spontaneous pneumothorax (SP) results from the rupture of blebs or bullae. It has been suggested that changes in weather conditions may trigger the onset of SP. Our aim was to examine the association between the onset of primary SP with weather changes in the general population in Sapporo, Japan. METHODS: From January 2008 through September 2013, 345 consecutive cases with a diagnosis of primary SP were reviewed. All cases of primary SP developed in the area within 40 km from the Sapporo District Meteorological Observatory. Climatic measurements were obtained from the Observatory, which included 1-h readings of weather conditions. Logistic regression model was used to obtain predicted risks for the onset of SP with respect to weather conditions. RESULTS: SP occurred significantly when the atmospheric pressure decreased by - 18 hPa or less during 96 h before the survey date (odds ratio = 1.379, P = 0.026), when the pressure increased by 15 hPa or more during 72 h before the survey date (odds ratio = 1.095, P = 0.007) and when maximum fluctuation in atmospheric pressure over 22 hPa was observed during 96 h before the survey date (odds ratio = 1.519, P = 0.001). Other weather conditions, including the presence of thunderstorms, were not significantly correlated with the onset of pneumothorax. CONCLUSIONS: Changes in atmospheric pressure influence the onset of SP. Future studies on the relationship between the onset of SP and weather conditions on days other than before the onset and with large number of patients may enable us to predict the onset of SP in various regions and weather conditions.

DOI： 10.1093/ejcts/ezx128

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Pulmonary thromboembolism is a fatal perioperative complication in general thoracic surgery. There is a report on its incidence of 2.68 cases out of 10,000 general thoracic surgeries. To prevent pulmonary thromboembolism, risk evaluation of an individual case and steady implementation of recommended preventive techiques are required. Because of the prevalence of guidelines for prevention, the incidence of pulmonary thromboembolism in the perioperative period is reducing. However, maximum prevention of deep vein thrombosis(DVT), which can lead to pulmonary thromboembolism, is impossible even if preventive measures are strictly implemented in the perioperative period. Mindful of potential DVT postoperatively, it is crucial to speculate perioperative acute pulmonary thromboembolism when sudden sensation of postoperative dyspnea occurs. For lifesaving measures, treatment along with diagnosis is necessary. In the presence of shock, pulmonary endarterectomy is recommended with percutaneous cardiopulmonary support, while in the absence of shock, treatment depends on a patient's condition.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive interstitial lung disease of unknown cause. IPF has a distinct histopathological pattern of usual interstitial pneumonia in which fibroblastic foci (FF) represent the leading edge of fibrotic destruction of the lung. Currently there are three major hypotheses for how FF are generated: (1) from resident fibroblasts, (2) from bone marrow-derived progenitors of fibroblasts, and (3) from alveolar epithelial cells that have undergone epithelial-mesenchymal transition (EMT). We found that FF dissociated capillary vessels from the alveolar epithelia, the basement membranes of which are fused in normal physiological conditions, and pushed the capillaries and elastic fibers down ~100 μm below the alveolar epithelia. Furthermore, the alveolar epithelial cells covering the FF exhibited a partial EMT phenotype. In addition, normal human alveolar epithelial cells in vitro underwent dynamic EMT in response to transforming growth factor-β signaling within 72 h. Because it seems that resident fibroblasts or bone marrow-derived cells cannot easily infiltrate and form FF between the alveolar epithelia and capillaries in tight contact with each other, FF are more likely to be derived from the epithelial-to-mesenchymal transitioned alveolar epithelia located over them. Moreover, histology and immunohistochemistry suggested that the FF formed in the lung parenchyma disrupt blood flow to the alveolar septa, thus destroying them. Consequently, collapse of the alveolar septa is likely to be the first step toward honeycombing in the lung during late stage IPF. On the basis of these findings, inhibition of transforming growth factor-β signaling, which can suppress EMT of the alveolar epithelial cells in vitro, is a potential strategy for treating IPF.

DOI： 10.1038/labinvest.2016.135

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本肺癌学会  

<b>背景．</b>高齢者に対する気管切除・再建術の報告はいまだ少ない．<b>症例．</b>84歳女性．検診で胸部異常陰影を指摘された．胸部CT検査で胸部中部気管前壁の結節性病変を認めた．前医で行われた経気管支鏡生検で腺様嚢胞癌の診断であった．胸骨正中切開で気管管状切除・再建術を施行した．術後合併症はなく，術後33日目に退院した．<b>結論．</b>80歳代女性患者の気管原発腺様嚢胞癌に対して気管切除・再建術を施行した．切除後12か月無再発生存中である．

その他リンク： https://search.jamas.or.jp/link/ui/2018135703

DOI： 10.2482/haigan.57.870

DOI： 10.2995/jacsurg.35.687_references_DOI_FwXyBs0UR0OmxLC7jslD5qKShED

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記述言語：日本語   出版者・発行元：一般社団法人 日本外傷学会  

症例は19歳女性，交通事故で頭部，顔面挫創，両肺挫傷，両側気胸，両側多発肋骨骨折，肝損傷と腸骨開放骨折を受傷．来院後，気道緊急のため気管挿管施行し人工呼吸管理とした．CTで左第９肋骨骨折端と下行大動脈の距離が12mmと近接しており経過観察としていたが，受傷後５日には４mmと近接したため，胸腔鏡下に肋骨骨折端摘除術を施行した．左下後部肋骨骨折による遅発性の下行大動脈損傷は稀ではあるが発生すると致命的である．本症例は予防的に肋骨骨折端を摘除することにより下行大動脈損傷を予防することができた．

DOI： 10.11382/jjast.30.23

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Pulmonary carcinoid tumor with Cushing's syndrome is comparatively rare disease. It is difficult to make an early diagnosis due to small size lesion in its early stage. We report a case of pulmonary carcinoid tumor with Cushing's syndrome successfully localised by positron emission tomography/computed tomography and was resected in the early stage. The levels of serum cortisol and adrenocorticotropic hormone( ACTH) decreased immediately after surgery, and the symptoms of Cushing's syndrome were relieved.

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

医中誌

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記述言語：日本語   出版者・発行元：北海道外科学会  

その他リンク： https://search.jamas.or.jp/link/ui/2015044670

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記述言語：日本語   出版者・発行元：北海道外科学会  

その他リンク： https://search.jamas.or.jp/link/ui/2015044672

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出版者・発行元：南江堂  

その他リンク： https://search.jamas.or.jp/link/ui/2014106930

DOI： 10.15106/j00349.2014106930

CiNii Research

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Between 1992 and 2011, 22 patients underwent surgery of reconstruction of thoracic wall with curved metal plates for multiple rib fracture and resection of thoracic wall tumor. They were divided into 2 groups according to original disorders. Twelve cases of group A accepted surgical stabilization of traumatic multiple rib fractures with the metal plates fixed on the fractured ribs as an external brace. Ten patients of group B were suffered from thoracic wall tumors, including 1 fibrous dysplagia, 1 chondroma, 5 invasive lung cancer, 2 rib metastases and 1 primary chest wall cancer. After the resection of tumors, an average of 3.2 ribs were removed, the defects of full thickness chest wall were reconstructed using a combination of a polypropylene mesh and the metal plates. In both groups, there were no displacement of the plates and allergic reaction. Only 2 patients needed removal of the fixed plates due to pyothorax caused by pneumonia after crushing thoracic injuries. The long metal reconstruction plates with many perforations were very useful for reconstruction of chest wall because they were long enough to cover the whole length of widely resected chest defects and moderately soft enough to be appropriately bent or twist by hand at the time of operation. Moreover long-term result of the reconstructed chest wall was safe and satisfactory without severe complication.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 72-year-old man had underwent left lower lobectomy for squamous cell carcinoma in our hospital in 2008. Postoperative stage was I A (T1N0M0). In 2010, follow-up chest computed tomography (CT) images showed similar cavitary nodules in segments 2 and 8 of the right lung with positive uptake on fluorodeoxyglucose-positron emission tomography (FDG-PET) images. Physical examination, blood tests, and levels of serum tumor markers showed no abnormality. Transbronchial lung biopsy revealed the absence of malignant cells. Segment 8 of the right lower lobe with the nodule was partially resected, and pathological examination demonstrated lung abscess. He was discharged but was hospitalized in another hospital for purpuric rash, fever, and arthralgia. Microscopic albuminuria was noted, and renal biopsy revealed nephritis with immunoglobulin A( IgA)deposition. He was made a diagnosis of Henoch-Schönlein purpura. Oral steroid therapy( prednisolone 60 mg/d) was initiated, resulting in the improvement of symptoms and disapearance of the cavitary nodule in the right lung segment 2.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Total thoracoscopic segmentectomy is an appealing concept in terms of providing a parenchyma-sparing treatment. We describe our technique of two seperate total thoracoscopic segmentectomies by using a vessel sealing system (VSS). A 76-year old female with four gradually enlarging ground glass lesions on the right segment 2 (10 and 3 mm) and segment 6 (8 and 3 mm) was admitted to our institute for surgical diagnosis and treatment. Preoperative three-dimensional computed tomography showed that the A2 is composed of descending A2 and ascending A2, branch of V6 coursed to V2 and B1a originated from B2 and B1b from B3. Two separate segmentectomies were subsequently scheduled. Pulmonary vessel division was performed with VSS after proximal ligation. Intersegmental division by VSS and electrocautery was performed with the use of inflation-deflation demarcation line and the pulmonary veins along the intersegmental plane (V2a and V2c for segment 2 and V6b and V6c for segment 6) as guides to confirm the intersegmental plane after pulmonary artery and bronchial divisions. The intraoperative frozen-section examinations revealed adenocarcinoma in situ. Two separate segmentectomies were successfully completed, with a total operative time of 240 min and blood loss of 30 ml. VSS is a very useful and safe device for intersegmental division and pulmonary vessel division.

DOI： 10.1093/ejcts/ezr332

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

In lung cancer, mediastinum lymphatic spread occurs. We review our technique and experience of thoracoscopic mediastinal lymphnode dissection (MLND). Between 1997 and 2011, 992 patients with primary lung cancer underwent thoracoscopic major pulmonary resection with MLND. Initially we used a combination of electrocautery and clips to divide blood vessels and lymphatic channels; our current technique relies on a vessel sealing system (VSS) which is expeditious and leads to less lymphorrhea. Furthermore, dissection of station 7 nodes is performed after each main bronchus or right intermediate bronchus is taped with a 0 silk suture, which is then brought out of the thorax through the access incision for antero-lateral retraction of the tracheal carina. We dissect between 3 and 4 N2 lymph node stations and a total of approximately 20 N2 lymph nodes. Postoperative complications related to MLND occurred in 35 of 992 patients (3.5%), 15 (1.5%) for recurrent laryngeal nerve injury, 3 (0.3%) for bilateral vagal injury, 14 (1.4%) for chylothorax and 3 (0.3%) for airway injury. However, none were lethal. Thoracoscopic mediastinal dissection is safe and feasible in treating lung cancer. We believe our technique and VSS are very useful for thoracoscopic MLND.

DOI： 10.1053/j.semtcvs.2012.03.002

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Pneumothorax associated with chronic graft-versus-host disease (cGVHD) after stem cell transplantation is a rare complication. Autologous blood has been used successfully for pleurodesis, which was less toxic than chemical agents. However, when pneumothorax is resistant to pleurodesis, no other procedure is more effective and conservative. Here, we describe a case of myelodysplastic syndromes complicated with cGVHD-related pneumothorax. His pneumothorax has been resistant to pleurodesis using autologous blood and was treated successfully with fibrin glue sealant. In our limited experience, we believe the best success could be achieved when this method is used to treat persistent pneumothorax with cGVHD.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 69-year-old woman with a pulmonary nodule in anterior basal segment of the right lower lobe (RS8) was referred to our department. The diameter of the tumor was 12 mm, and it had increased over a few months. First, video-assisted thoracoscopic lung surgery (VATS) biopsy of the pulmonary nodule was carried out. Frozen section examination of this nodule confirmed the diagnosis of bronchioloalveolar carcinoma (BAC). Segmentectomy of RS8 with lower mediastinal node dissection (ND2a-1) was performed. The intersegmental plane was identified using the intersegmental veins as landmarks and the demarcation between the resected (inflated) and preserved (collapsed) lungs. Electrocautery at 70 watts was used to divide the intersegmental plane. A vessel sealing system was used to seal and cut the pulmonary arteries. Postoperative histopathological examination revealed that the tumor was T1aN0M0 BAC, and the minimal distance between the surgical margin and the tumor edge was 15 mm. The patient was discharged from hospital on postoperative day 5 without any complications.

DOI： 10.1186/1749-8090-6-115

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Mouse renal allografts have a remarkable ability to promote acceptance across full major histocompatibility complex incompatibilities in certain strain combinations without immunosuppression. The mechanism is unknown but is believed to involve immunoregulation. This study tests whether Foxp3(+) T-regulatory cells are responsible in the early phase of graft acceptance, using B6.Foxp3(DTR) mice that express diphtheria toxin receptor (DTR) in Foxp3(+) cells. The administration of DT to B6.Foxp3(DTR) recipients with accepted DBA/2 kidneys, 3 weeks to 3 months after transplantation, caused a marked depletion of Foxp3 cells and triggered acute cellular rejection, manifested by a sudden increase in blood urea nitrogen within a week. None of the controls showed an increase in blood urea nitrogen, including DT-treated B6 wild-type recipients of DBA/2 kidneys or B6.Foxp3(DTR) recipients of isografts. Accepted DBA/2 allografts showed prominent lymphoid sheaths around arteries containing numerous CD3(+)Foxp3(+) cells, CD4(+) cells, dedritic cells, and B cells, which was independent of CCR4. The lymphoid sheaths disintegrate after Foxp3 depletion, accompanied by widespread CD8 interstitial mononuclear inflammation, tubulitis, and endarteritis. The Foxp3 depletion caused an increased frequency of donor-reactive cells in the spleen by interferon (IFN) γ enzyme-linked immunosorbent spot (ELISPOT) assays and increased expression of the maturation markers, CD86 and IA(b), on dendritic cells in the spleen and kidney. We conclude that Foxp3(+) cells are needed to maintain acceptance of major histocompatibility complex-incompatible renal allografts in the first 3 months after transplantation and may act by inhibiting DC maturation.

DOI： 10.1016/j.ajpath.2010.12.024

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Dendritic cell (DC) maturation results in changes in antigen processing and presentation, governing the fate of adaptive immunity. Understanding the intracellular signaling pathways governing DC maturation is therefore critical. In this study, we observed that the kinase, GSK-3β, is present in its active form in resting immature DCs isolated from the spleen and bone marrow of mice. Induction of DC maturation using GM-CSF, IL-4 and TNF-α resulted in GSK-3β inhibition, as reflected by increased phosphorylation of Serine 9 on the kinase, and concomitant stabilization of its substrate, β-catenin. Treatment of immature DCs with a GSK-3β inhibitor increased cell surface expression of CD80, CD86 and CD40 on DCs, enhancing their ability to present antigen and activating IL-2 secretion by T cells. GSK-3β inhibition also parallels dendritic cell maturation in vivo. Our results show that GSK-3β signaling controls DC maturation and suggest that this kinase could be manipulated to modulate adaptive immunity.

DOI： 10.1016/j.cellimm.2011.04.007

PubMed

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本呼吸器外科学会  

患者は59歳，女性．2000年に他院で胸部下行大動脈瘤に対して人工血管置換術を受けた．しかし，術後膿胸を合併したため胸腔内洗浄を施行され軽快退院した．2010年4月に喀血を主訴に他院へ救急搬送された．血管造影検査にて体動脈から左肺下葉内に流入する血管が数本造影され，CTで中枢側吻合部仮性瘤が認められた．2010年6月に再度喀血を生じて当院に搬送された．開胸手術にて左肺下葉切除術を行った．肺組織に至るまでの結合組織には新生血管が豊富にあり動脈性出血の止血に難渋した．術後8日目に独歩退院した．また，仮性動脈瘤については1ヵ月後にステントグラフト内挿術で治療された．膿胸による慢性炎症によって胸壁から肺内に向かう血管が新生され，体動脈肺静脈瘻が形成され喀血に至ったと考えられた．血管新生に対する考察を加えて報告する．

DOI： 10.2995/jacsurg.25.497

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本呼吸器外科学会  

画像所見で肋骨腫瘍が疑われ，胸腔鏡補助下に肋骨切除術を行った1例を経験した．症例は74歳，男性で2010年に右側胸部痛があり近医整形外科を受診した．右第4肋骨背側に3cm超の腫瘤があり，全身精査の為に当院を紹介され受診した．CTにて肝臓S6に4cmの腫瘤影があり，肋骨部の腫瘤が肝細胞癌転移の可能性があるため，診断および切除目的に手術となった．胸腔鏡補助下に第4肋骨と第5肋骨を合併切除した．病理診断の結果は肝細胞癌の肋骨転移であった．肋骨腫瘍に対して胸腔鏡補助下の切除術を行うことで，皮膚および胸壁筋切開範囲を縮小し，同部への損傷を少なくすることが可能であった．

DOI： 10.2995/jacsurg.25.621

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We present the case of a patient with postinfarction ventricular septal rupture (VSR) who underwent delayed repair using a modified infarction exclusion technique. The patient was taken to the operating room 21 days after the first incidence of acute myocardial infarction because the intra-aortic balloon pump maintained a stable circulatory condition without cardiogenic shock. In our procedure, a Dacron patch was sutured to the healthy endocardium to exclude the infarcted septum, and the VSR was subsequently closed with another Dacron patch. After three years of postoperation, the patient's condition remains normal with good ventricular kinesis and no residual shunt. We describe herein a novel procedure for repairing postinfarction VSR by using two Dacron patches.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: c-Jun N-terminal kinase (JNK) is reported to play crucial roles in T-cell activation and differentiation, and SP600125 is a small molecule that inhibits JNK. The aim of this study was to examine immunosuppressive action of this compound. METHODS: Rat heterotopic heart transplantation, popliteal lymph node (PLN) hyperplasia bioassay and lymphocyte proliferation assay. RESULTS: SP600125 treatment reduced histological rejection, and dose-dependently extended median survival time of cardiac allografts from 7 days (vehicle) up to 20 days (40 mg/kg/day). Alloantigen-induced PLN hyperplasia was also inhibited by SP600125 in a similar fashion. SP600125 suppressed mixed lymphocyte reaction and OX52-positive lymphocyte proliferation (IC50: 1.5-5.7 microM). Thus, SP600125 inhibits both T-lymphocyte expansion in vitro and T-cell-mediated alloimmune responses in vivo. In addition, SP600125 interacted with cyclosporine additively to prolong cardiac allograft survival. CONCLUSION: Our data provide the first evidence indicating the potential for JNK as a therapeutic target to inhibit the alloimmune response.

PubMed

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出版者・発行元：南江堂  

その他リンク： https://search.jamas.or.jp/link/ui/2007020971

DOI： 10.15106/j00349.2007020971

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

In the thoracolumbar region, it is well known that the great anterior medullary artery (the artery of Adamkiewicz: AKA) is the dominant feeder of the spinal cord. During surgery for posterior mediastinal tumor adjacent to the lower thoracic aorta, perioperative distortion of the spinal cord blood supply could lead to neurological complication. To avoid postoperative paralysis, it would be useful to know the level of the intercostal artery from which the AKA originates. Recently, we have attempted to identify the AKA preoperatively using magnetic resonance angiography (MRA).

PubMed

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A rare case of native valve endocarditis affecting both the normal mitral and tricuspid valves is presented. A 25-year-old woman with an acute ischemic stroke was found to have vegetation secondary to infective endocarditis as the embolic source. One month after the onset of embolic cerebrovascular intervention, a valve repair with the implantation of artificial chordae, sliding commissuroplasty, and ring annuloplasty resulted in a complete recovery.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

There has been a decline in the number of medical students applying for thoracic surgery training programs. We obtained knowledge of medical students' views on thoracic surgery residency programs. After completion of thoracic surgery clerkship, 17 students were asked to fill out questionnaires on first-year thoracic surgery residency programs. The majority of students considered thoracic surgery to be held in high regard by the general public, and felt that the salary was sufficient. However, only one student chose a thoracic surgery training program. The main reason for not applying for thoracic surgery residency was lifestyle issues. The factors in determining career choice included quality of education and work hours. Medical students are likely to select specialties other than thoracic surgery. Since the main factor influencing medical students' career is the quality of education in a residency program, efforts should be made to improve the quality of education.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Two high-risk patients underwent a graft replacement for descending thoracic or thoracoabdominal aortic aneurysms without the reconstruction of any intercostal and lumbar arteries. The first patient was an 81-year-old woman with asthma and renal dysfunction who was diagnosed to have a descending thoracic aortic aneurysm extending from the Th8 to Th12 level. Contrast magnetic resonance angiography (MRA) demonstrated the Adamkiewicz artery to originate from the left second lumbar artery. The second patient was a 59-year-old man with left ventricular dysfunction due to aortic and mitral stenoses who was diagnosed to have a Crawford type IV thoracoabdominal aortic aneurysm. Contrast MRA showed the Adamkiewicz artery to originate from the left ninth intercostal artery. In general, the reestablishment of the spinal cord's blood supply, whenever possible, is generally considered to be necessary in such patients to prevent spinal cord injury. However, the reimplantation of intercostal vessels is the most complex aspect of this surgical modality, and therefore, it may cause a substantial increase in the cardiopulmonary bypass time. However, at least in some cases, such as the two cases presented herein, the use of contrast MRA was found to reduce the risk in surgery for descending thoracic or thoracoabdominal aortic aneurysms by eliminating the need for any intraoperative management of the intercostal and lumbar arteries.

PubMed

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

CiNii Research

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

CiNii Research

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

医中誌

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出版者・発行元：金原出版  

DOI： 10.18888/se.0000002023

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

医中誌

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出版者・発行元：南江堂  

その他リンク:： https://search.jamas.or.jp/link/ui/2021001362

DOI： 10.15106/j_kyobu73_590

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出版者・発行元：南江堂  

その他リンク:： https://search.jamas.or.jp/link/ui/2017355971

DOI： 10.15106/j00349.2017355971

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出版者・発行元：南江堂  

その他リンク:： https://search.jamas.or.jp/link/ui/2015390529

DOI： 10.15106/j00349.2015390529

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出版者・発行元：南江堂  

その他リンク:： https://search.jamas.or.jp/link/ui/2013305781

DOI： 10.15106/j00349.2013305781

CiNii Research

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.33.special_s184_1

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本心臓血管外科学会  

症例は70歳，男性．4年前に回旋枝領域の急性心筋梗塞後に発症した左室自由壁破裂に対してフェルトによる直接縫合閉鎖術が施行された．今回，鎖骨骨折で入院した際に施行されたCTにて偶然左室後壁に8×4 cmの腫瘤が認められた．心臓エコー検査にて左室内腔と腫瘤との間に交通孔を認め，左室仮性瘤と診断した．画像所見より仮性瘤が左室後壁に存在することから左開胸で再手術を行い，部分体外循環下に直腸温28度で心室細動として仮性瘤を切開した．左室との交通孔をダクロンパッチで閉鎖し，修復部を瘤化した心膜にてラッピングして手術を終了した．術後経過は良好で術後18日目に鎖骨骨折治療目的に整形外科に転科となった．左心破裂修復後の仮性瘤は遠隔期の合併症としては非常にまれであり，調べえる限りでは本邦で2例の報告があるのみである．急性心筋梗塞後の左室自由壁破裂術後は仮性瘤の発症の可能性を考え，CT，エコーなどの画像診断を含めた定期的な経過観察が必要であると考えられた．

DOI： 10.4326/jjcvs.38.361

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本心臓血管外科学会  

症例は64歳，男性で，平成12年より間質性肺炎，肺気腫の既往があり，平成15年6月30日他院で肺癌のため VATS 左上葉と下葉の区域切除を受けた．8月14日退院し在宅酸素療法を受けていた．平成15年9月11日突然胸痛を自覚し救急外来を受診した．来院時血圧は90mmHg台で意識混濁，その後ショック状態になり心エコーでエコーフリースペースを認め，ただちに心嚢穿刺を施行した．心嚢液は血性でドレナージにより意識，血圧は回復した． CT で左胸水と心タンポナーデを認めたが大動脈に解離は認めなかった．血性心嚢液が持続するためただちに緊急手術となった．体外循環を開始し血腫を取ると心嚢内に左胸腔と通じる小さな穴とそれに接する回旋枝に出血点を認めた．心タンポナーデの原因を VATS 手術後慢性期の冠動脈破裂と診断して心停止下に回旋枝の出血点を心膜プレジェット付き7-0プロレン糸のマットレス縫合で止血した．術後は血行動態が安定し IABP を必要としなかった．その後は順調に回復し10月6日退院した．

DOI： 10.4326/jjcvs.37.65

DOI： 10.1093/ehjcr/ytab484_references_DOI_UdPGRu5CJR8RKag7Bo9hamPky5U

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本心臓血管外科学会  

症例は24歳，男性．既往歴は10年前よりSLE，ループス腎炎，ネフローゼ症候群の診断でプレドニンを長期服用していた．平成17年12月6日，突然の胸痛を訴え，造影CTでは弓部に最大径63mmの弓部大動脈瘤と前縦隔に血腫を認め，弓部大動脈瘤破裂（oozing type）と診断した．下行大動脈も5cmに拡大していた．降圧療法後，12月8日に脳分離併用上行弓部全置換術を施行した．術後11日目より縦隔ドレーン液が混濁し，13日目正中創および胸骨が離開した．その間37度台の微熱が継続し，WBC 14,200/<i>μ</i>l，CRP14.6mg/dlに上昇したが，2回の縦隔ドレーンの細菌培養は陰性であった．1週間創開放洗浄し WBC 7,900/<i>μ</i>l，CRP1.8mg/dlに低下し，12月29日大網充填創閉鎖を施行した．その後は順調に経過し，1月25日退院した．平成18年6月9日朝，突然左胸痛を訴え入院，下行大動脈が60mmに拡大，降圧療法により症状が落ち着いたため予定手術としたが，3日目激しい背部痛を訴えショック状態となり破裂死した．破裂を危惧して緊急手術もしくはステントグラフト治療を考慮すべきであった．

DOI： 10.4326/jjcvs.37.17

DOI： 10.4009/jsdt.44.957_references_DOI_aLgW5ES3Cx0ZQZyzn6oYE08cPEZ

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本心臓血管外科学会  

2001年1月から2006年9月までに,腹部大動脈の全周性の石灰化を伴った大動脈腸骨動脈閉塞症(AIOD)の患者4例(透析患者2例含む)と高位大動脈閉塞症(HAO)の5例に対して,胸部大動脈(上行大動脈8例および下行大動脈1例)から両側大腿動脈へ非解剖学的バイパス手術を施行した.年齢は46～80歳,平均69歳,男6例,女3例で,HAOの2例は急性閉塞で,うち1例は下肢の麻痺を伴っていた.AIODの2例はsmall aorta syndromeを示した.手術時間は平均2時間25分で出血はほとんどなかった.腹膜透析患者のAIODの1例をCAPDチューブによる腹膜炎併発のため術後2週目に失ったが,そのほかは生存,HAOの下肢の麻痺も術後改善した.術後3例に人工血管そのものの合併症であるperigraft seromaを合併した.人工血管の開存率は術後2年で100%と良好であった.

DOI： 10.4326/jjcvs.36.225

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本呼吸器外科学会  

その他リンク:： https://search.jamas.or.jp/link/ui/2006213788

DOI： 10.2995/jacsurg.20.920_4

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本呼吸器外科学会  

その他リンク:： https://search.jamas.or.jp/link/ui/2006213620

DOI： 10.2995/jacsurg.20.878_4

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本呼吸器外科学会  

その他リンク:： https://search.jamas.or.jp/link/ui/2006213264

DOI： 10.2995/jacsurg.20.779_2

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記述言語：日本語   出版者・発行元：札幌医科大学  

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