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Asian journal of endoscopic surgery 11(4) 346-354 2018年11月INTRODUCTION: In surgery for elderly patients with colorectal cancer, it is unclear whether radical lymph node (LN) dissection safely offers a survival benefit. The aim of the study was to evaluate the impact of the LN yield in elderly patients undergoing surgery for colorectal cancer. METHODS: The subjects were selected from a surgical database of 2065 patients aged ≥80 years old who underwent surgery for colorectal cancer at 41 hospitals in Japan between 2003 and 2007. The patients were divided into groups according to the number LN harvested: <12 and ≥12. Propensity scores were subsequently matched to balance the baseline characteristics. RESULTS: Of the 954 patients initially selected, 331 were in the <12 LN and 623 were in the ≥12 LN group. After cases were matched, 293 patients were allocated to each group, and all covariates were balanced. For short-term outcomes, the time for surgery was longer in the ≥12 LN group, but there was no significant difference in morbidity between the groups. Overall, relapse-free and cancer-specific survival rates were higher in the ≥12 LN group (P = 0.004, 0.001, and 0.02). CONCLUSIONS: In patients aged ≥80 years old with stage II-III colon cancer, harvesting ≥12 LN provides a survival benefit, and therefore, limited LN dissection is not recommended in these patients.
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Asian journal of endoscopic surgery 11(4) 355-361 2018年11月 査読有り
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日本臨床外科学会雑誌 79(増刊) 424-424 2018年10月
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Gastroenterological Endoscopy 60(7) 1331-1337 2018年7月大腸内視鏡が左鼠径ヘルニアに嵌入し挿入困難になった3例を経験した。症例はいずれも高齢の男性であった。1例は慎重に抜去を行った後、脱出した腸管を徒手整復手技に準じて還納することで全大腸内視検査が施行可能であったが、その他2例は検査の継続が不可能であった。大腸内視鏡は広く普及している手技であるが、検査中に内視鏡が鼠径ヘルニアに嵌入した報告は極めて少ない。大腸内視鏡検査を行う上で、高齢の男性では陰嚢腫脹を伴う外鼠径ヘルニアの病歴聴取が重要である。大腸内視鏡検査中に予期せず内視鏡が鼠径ヘルニアに嵌入した場合は、一旦手技を中断し、鼠径部痛などの臨床症状の確認を行った後、慎重に抜去するのが望ましい。(著者抄録)
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Medicine 97(30) e11357 2018年7月RATIONALE: Although systemic lupus erythematosus (SLE) can be complicated by various gastrointestinal tract diseases, it is rarely associated with lupus enteritis and protein-losing enteropathy (PLE). We report here the successful surgical treatment of lupus enteritis and therapy-resistant and refractory PLE in a patient with SLE. We also provide a review of relevant literature. PATIENT CONCERNS: A 16-year-old girl presenting with polyarthritis, malar rash, and palmar erythema was indicated for steroid therapy on the basis of positive results for antinuclear, anti-Smith, and antiphospholipid antibodies, which confirmed the diagnosis of SLE. During the course of steroid therapy, the patient developed acute abdomen and hypoalbuminemia. DIAGNOSES: Computed tomography and Tc-labeled human serum albumin scintigraphy revealed abnormal findings, and a diagnosis of lupus enteritis and PLE was made. Steroid treatment was continued but no significant improvement was observed, and the patient was referred and admitted to our hospital. Double-balloon enteroscopy revealed multiple ischemic stenoses and mucosal necroses in the small intestine, suggesting that PLE was associated with ischemic enteritis due to antiphospholipid syndrome. The patient received steroids, immunosuppressive drugs, and antithrombotic therapy, with no improvement in symptoms. Thus, the disease was judged to be refractory and resistant to medical therapy, and the patient was indicated for surgical treatment. INTERVENTIONS: Partial small intestinal resection was performed by removing the segment of the small intestine presenting PLE lesions, and a double-end ileostomy was created. OUTCOMES: Multiple stenotic lesions were confirmed in the resected segment. Histopathology evaluation revealed marked inflammatory cell infiltration in the intestinal tract wall and recanalization of the vessels, suggesting a circulatory disorder caused by vasculitis and antiphospholipid syndrome. Postoperatively, the clinical course was good. Serum albumin levels and body weight increased as nutritional status improved significantly. Secondary enteroenterostomy with ileostomy closure could be performed at 2 months after the initial surgery. LESSONS: Timely surgical treatment can be successful in managing therapy-resistant and refractory PLE in patients with SLE.
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日本臨床外科学会雑誌 79(6) 1319-1323 2018年6月76歳,女性.心窩部痛を主訴に救急搬送された.開腹歴なし.左鼠径部腫瘤を触知し,単純X線で小腸ガスを認め,左鼠径ヘルニア嵌頓による腸閉塞と診断された.用手的整復後,経過観察入院となった.腸閉塞の改善がなく,翌日の造影CTで右坐骨孔に腸管脱出を認め,右坐骨ヘルニア嵌頓の診断で緊急手術となった.腹腔鏡下観察で右坐骨ヘルニアを認めたが,嵌頓は既に解除されていた.腸管壊死を疑い開腹すると,回腸にRichter型嵌頓を起こしていた所見があった.壊死所見なく腸切除はしなかった.ヘルニア門は卵巣等周囲組織で被覆閉鎖した.術後は肺炎などのため,第35病日に退院となった.腹壁ヘルニア嵌頓時には他のヘルニアの合併に留意し,嵌頓解除後の症状観察が重要である.坐骨ヘルニアの診断・治療方針の決定に造影CT,腹腔鏡観察が有用であった.(著者抄録)
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321共同研究・競争的資金等の研究課題
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