附属病院 とちぎ子ども医療センター 小児外科

薄井 佳子

ウスイ ヨシコ  (Yoshiko Usui)

基本情報

所属
自治医科大学 小児外科 講師

J-GLOBAL ID
201401049829754603
researchmap会員ID
B000238691

論文

 16
  • Yoshiko Usui, Shigeru Ono, Katsuhisa Baba, Yuki Tsuji
    Pediatric Surgery International 34(10) 1035-1040 2018年10月1日  
    Purpose: Congenital tracheal stenosis (CTS) is rare and challenging. Complete tracheal rings cause a wide spectrum of airway-obstructing lesions and varying degrees of respiratory distress. Although surgical reconstruction is the primary option for symptomatic CTS, sometimes an appropriate management strategy may be difficult due to other anomalies. We aimed to identify pitfalls in the management of CTS. Methods: We retrospectively reviewed the records of patients with CTS during the last 10 years in our institution. Results: Sixteen pediatric patients were diagnosed with CTS. Of the 16 patients, 12 (75.0%) had cardiovascular anomalies including seven left pulmonary artery sling. Six patients with dyspnoea caused by CTS and three patients with difficult intubations due to CTS underwent tracheoplasty. Four patients underwent only cardiovascular surgery without tracheoplasty. Three asymptomatic patients were followed up without undergoing any surgical procedure. We repeatedly discussed management of four patients with especially complex pathophysiology at multidisciplinary meetings. Right ventricular outflow tract obstruction, tracheobronchial malacia, increased pulmonary blood flow, and pulmonary aspiration due to gastroesophageal reflux presumably accounted for their severe respiratory distress, and we forewent their tracheal reconstruction. Conclusion: The management of CTS should be individualized, and conservative management is a feasible option in selected cases.
  • 薄井 佳子, 小野 滋, 馬場 勝尚, 辻 由貴, 若尾 純子, 關根 沙知, 堀内 俊男, 眞田 幸弘, 水田 耕一
    日本外科学会定期学術集会抄録集 118回 1994-1994 2018年4月  
  • Yoshiko Usui, Shigeru Ono
    Pediatric Surgery International 32(9) 881-886 2016年9月1日  
    Purpose: The management of esophageal atresia is established, but the rate of postoperative complications remains high. We focused on a new, recently reported method of esophageal elongation using botulinum toxin type A (BTX-A) and evaluated the efficacy of BTX-A injection around esophageal anastomoses with tension in a rabbit model. Methods: Twenty rabbits aged 8–10 weeks and weighing 1.27–1.72 kg underwent resections of the esophagus measuring 1.5 cm long using an anterior cervical approach. Esophagoesophagostomies were performed after intramural administration of Xeomin™ (3 U/body) in the BTX-A group and saline in the control group. Morphological and histological evaluations were examined on postoperative day 14. Results: Six rabbits in each group survived. The BTX-A group showed significantly less postoperative anastomotic stricture and less fibrosis than the control group. Changes in wall thickness on both sides of the anastomotic areas were equivalent between the two groups, and no muscle fracturing was observed. Conclusion: Local administration of BTX-A for esophagoesophagostomy significantly reduced postoperative anastomotic stricture with less fibrosis than that observed in the control group. Reduced anastomotic tension with BTX-A presumably contributed to better anastomotic healing. Determining the optimum dose of BTX-A is necessary for clinical application.
  • Insu Kawahara, Shigeru Ono, Katsuhisa Baba, Atsuhisa Fukuta, Yuki Tsuji, Yoshiko Usui, Taiju Hyuga, Shina Kawai, Shigeru Nakamura, Hideo Nakai
    Journal of Pediatric Surgery Case Reports 3(2) 75-78 2015年  
    Covered cloacal exstrophy (CCE) is extremely rare condition. In patients with a single perineal orifice and no pubic bone separation, it is very difficult to suspect and/or diagnose CCE based on external signs alone. We present the case of a 2-month-old girl diagnosed with CCE based on cystography, ileostomy contrast study and cystoscopy.
  • 福田 篤久, 小野 滋, 馬場 勝尚, 薄井 佳子, 辻 由貴, 河原 仁守
    日本小児外科学会雑誌 51(6) 1042-1047 2015年  
    【目的】当科では小児急性虫垂炎に対し,保存的治療を第一選択としている.今回,我々の治療経験から小児急性虫垂炎に対する保存的治療の適応および限界について検討した.<br>【方法】2012 年1 月から2014 年8 月までに急性虫垂炎の診断で入院し抗菌薬を用いた保存的治療を行った53 症例を対象とし,保存的治療奏効群と保存的治療抵抗群に分けて比較検討した.<br>【結果】53 例中,奏効群は36 例,抵抗群は17 例.入院時体温は奏効群が37.4±0.7°C,抵抗群が38.2±0.8°C で抵抗群において高かった(p=0.01).入院時血液検査所見では,CRP が奏効群1.4±1.7 mg/dl,抵抗群9.7±7.0 mg/dl と,抵抗群で高値であった(p<0.01).画像所見では,虫垂最大径が奏効群8.4±2.7 mm,抵抗群11.3±2.5 mm と抵抗群で有意に腫大していた(p<0.01).糞石は奏効群の16.7%(6/36 例),抵抗群の76.5%(13/17 例)に認めていた(p<0.01).治療開始後24 から48 時間での白血球数は奏効群6,988.9±2,884.8/μl,抵抗群11,741.2±3,845/μl と,抵抗群で高値であった(p<0.01).再発率は奏効群8.3%に対し,抵抗群では36.4%と高率であった(p=0.042).治療開始から48 時間での2 群のカットオフ値は,白血球数9,650.0/μl,CRP 値が6.67 mg/dl と推定された.<br>【結論】治療後48 時間において白血球数が9,650.0/μl またはCRP 値が6.67 mg/dl を超える症例では早期の外科治療を検討すべきである.

MISC

 49

共同研究・競争的資金等の研究課題

 1