研究者業績
基本情報
- 所属
- 藤田医科大学ばんたね病院 医学部 消化器外科学 病院長・教授
- 学位
- 医学博士(1901年3月 藤田保健衛生大学大学院)
- J-GLOBAL ID
- 200901021819103327
- researchmap会員ID
- 1000170789
- 外部リンク
研究分野
1経歴
10-
2020年2月 - 現在
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2016年4月 - 現在
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2016年4月 - 現在
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2016年4月 - 2020年1月
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2015年4月 - 2016年3月
論文
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Journal of hepato-biliary-pancreatic sciences 2025年3月16日PURPOSE: This study aimed to clarify the current treatment status for biliary tract cancers based on data from the National Clinical Database (NCD) in Japan. METHODS: Total 3895 cases of biliary tract cancers registered in the NCD during 2021 were included. We identified the rates of resection, R0 resection, postoperative complications, and incidences of lymph node metastasis for gallbladder carcinoma, perihilar cholangiocarcinoma, distal bile duct carcinoma, and ampullary carcinoma. RESULTS: The number of biliary tract cancers registered in the NCD during 2021 was 3895 (1775 in extrahepatic bile duct carcinoma, 1422 in gallbladder carcinoma, and 698 in ampullary carcinoma). In gallbladder carcinoma, the resection (89.59%) and R0 resection rates (87.99%) were favorable, and the complication rate (6.05%) was lower than that of others. However, the postoperative complication rate could be higher in T3-T4 cases and when extrahepatic bile duct resection was performed concomitantly. Lymph node metastasis was frequently seen in 12.60% at the No. 13a lymph node. In perihilar cholangiocarcinoma, the R0 resection (69.82%) and complication rates (16.75%) were significantly lower and higher, respectively. In distal cholangiocarcinoma and ampullary carcinoma, metastasis was observed in approximately 2% and 10% of the dissected No. 16b1 para-aortic lymph nodes, respectively. In conclusion, although short-term surgical outcomes for biliary tract cancers in Japan might be acceptable, the significantly lower R0 resection and higher complication rates of perihilar cholangiocarcinomas indicate additional challenges for surgeons in the future and should continue to be monitored by the Japanese Society of Hepatobiliary and Pancreatic Surgery.
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Pathology international 2024年9月11日This study aimed to validate the DFS (direct fast scarlet) staining in the diagnosis of EC (eosinophilic colitis). The study included 50 patients with EC and 60 with control colons. Among the 60 control samples, 39 and 21 were collected from the ascending and descending colons, respectively. We compared the median number of eosinophils and frequency of eosinophil degranulation by HE (hematoxylin and eosin) and DFS staining between the EC and control groups. In the right hemi-colon, eosinophil count by HE was useful in distinguishing between EC and control (41.5 vs. 26.0 cells/HPF, p < 0.001), but the ideal cutoff value is 27.5 cells/HPF (high-power field). However, this method is not useful in the left hemi-colon (12.5 vs. 13.0 cells/HPF, p = 0.990). The presence of degranulation by DFS allows us to distinguish between the groups even in the left hemi-colon (58% vs. 5%, p < 0.001). DFS staining also enabled a more accurate determination of degranulation than HE. According to the current standard to diagnose EC (count by HE staining ≥20 cells/HPF), mucosal sampling from left hemi-colon is problematic since the number of eosinophils could not be increased even in EC. Determination of degranulated eosinophils by DFS may potentiate the diagnostic performance even in such conditions.
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Annals of gastroenterological surgery 8(5) 845-859 2024年9月BACKGROUND: Surgical resection is standard treatment for invasive intraductal papillary mucinous carcinoma (IPMC); however, impact of multidisciplinary treatment on survival including postoperative adjuvant therapy (AT), neoadjuvant therapy (NAT), and treatment for recurrent lesions is unclear. We investigated the effectiveness of multidisciplinary treatment in prolonging survival of patients with invasive IPMC. METHODS: This retrospective multi-institutional study included 1183 patients with invasive IPMC undergoing surgery at 40 academic institutions. We analyzed the effects of AT, NAT, and treatment for recurrence on survival of patients with invasive IPMC. RESULTS: Completion of the planned postoperative AT for 6 months improved the overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) of patients with stage IIB and stage III resected invasive IPMC, elevated preoperative carbohydrate antigen 19-9 level, lymphovascular invasion, perineural invasion, serosal invasion, and lymph node metastasis on un-matched and matched analyses. Of the patients with borderline resectable (BR) invasive IPMC, the OS (p = 0.001), DSS (p = 0.001), and RFS (p = 0.001) of patients undergoing NAT was longer than that of those without on the matched analysis. Of the 484 invasive IPMC patients (40.9%) who developed recurrence after surgery, the OS of 365 patients who received any treatment for recurrence was longer than that of those without treatment (40.6 vs. 22.4 months, p < 0.001). CONCLUSION: Postoperative AT might benefit selected patients with invasive IPMC, especially those at high risk of poor survival. NAT might improve the survivability of BR invasive IPMC. Any treatment for recurrence after surgery for invasive IPMC might improve survival.
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Fujita medical journal 10(3) 69-74 2024年8月OBJECTIVE: This study was performed to demonstrate the clinical application of duodenum-preserving pancreatic head resection (DPPHR) as a surgical treatment for pancreatic neuroendocrine tumors (PNETs) in terms of both curability and maintenance of postoperative quality of life. METHODS: Seven patients diagnosed with PNETs underwent DPPHR from January 2011 to December 2021 at our institution. We investigated the clinical relevance of DPPHR based on the patients' clinicopathological findings. RESULTS: The median operative time was 492 min, and the median blood loss was 302 g. Postoperative complications were evaluated according to the Clavien-Dindo classification, and postoperative intra-abdominal bleeding was observed in one patient. Pathological examination revealed a World Health Organization classification of G1 in six patients and G2 in one patient. Microvascular invasion was observed in two patients (29%); however, no patients developed lymph node metastasis or recurrence during the follow-up period. A daughter lesion was observed near the primary tumor in one patient. All patients achieved curative resection, and no tumor specimens showed positive margins. CONCLUSIONS: DPPHR facilitates anatomical resection of the pancreatic head in patients with PNETs as well as detailed pathological evaluation of the resected specimen. Therefore, this surgical procedure is an acceptable alternative to pancreaticoduodenectomy or enucleation for patients with PNETs.
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Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 22(7) 1416-1426 2024年7月BACKGROUND & AIMS: Despite previously reported treatment strategies for nonfunctioning small (≤20 mm) pancreatic neuroendocrine neoplasms (pNENs), uncertainties persist. We aimed to evaluate the surgically resected cases of nonfunctioning small pNENs (NF-spNENs) in a large Japanese cohort to elucidate an optimal treatment strategy for NF-spNENs. METHODS: In this Japanese multicenter study, data were retrospectively collected from patients who underwent pancreatectomy between January 1996 and December 2019, were pathologically diagnosed with pNEN, and were treated according to the World Health Organization 2019 classification. Overall, 1490 patients met the eligibility criteria, and 1014 were included in the analysis cohort. RESULTS: In the analysis cohort, 606 patients (59.8%) had NF-spNENs, with 82% classified as grade 1 (NET-G1) and 18% as grade 2 (NET-G2) or higher. The incidence of lymph node metastasis (N1) by grade was significantly higher in NET-G2 (G1: 3.1% vs G2: 15.0%). Independent factors contributing to N1 were NET-G2 or higher and tumor diameter ≥15 mm. The predictive ability of tumor size for N1 was high. Independent factors contributing to recurrence included multiple lesions, NET-G2 or higher, tumor diameter ≥15 mm, and N1. However, the independent factor contributing to survival was tumor grade (NET-G2 or higher). The appropriate timing for surgical resection of NET-G1 and NET-G2 or higher was when tumors were >20 and >10 mm, respectively. For neoplasms with unknown preoperative grades, tumor size >15 mm was considered appropriate. CONCLUSIONS: NF-spNENs are heterogeneous with varying levels of malignancy. Therefore, treatment strategies based on tumor size alone can be unreliable; personalized treatment strategies that consider tumor grading are preferable.
MISC
939-
HEPATO-GASTROENTEROLOGY 55(85) 1238-1241 2008年7月 査読有りBackground/Aims: Although the role of hepatectomy for patients with colorectal liver metastases is well established, few reports exist of hepatectomy for patients with metastases of gastric cancer origin. This study reviews cases of hepatectomy for metastatic gastric cancer at Fujita Health University Hospital. Methodology: Between 1.989 and 2004, 18 patients underwent hepatectomy for liver metastases from gastric cancer. The patients consisted of 16 men and 2 women and their ages ranged from 51-76 (median 64) years. Hepatic resection was indicated for patients with synchronous metastases who did not have peritoneal dissemination or any other distant metastases (11 patients), and patients with metachronous metastases who did not have any other recurrent lesions (7 patients). Results: Overall survival rate for 1, 2 3, and 5 years are 56.3, 36.52 27.3, and 27.3%, respectively. Although the 5-year survival rate was considerable, an early and rapid decrease of survival rate occurred in the first 1-2 years (compared with the colorectal patients). Univariate analysis showed serosal invasion and lymphatic invasion of the primary tumor as significant prognostic factors for survival. Conclusions: Surgical resection for liver metastases of gastric cancer is thought to be beneficial for small part of the patients. For other patients, the procedure may only provide the limited beneficial effects on survival.
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EUROPEAN JOURNAL OF ENDOCRINOLOGY 159(1) 81-86 2008年7月 査読有りContext and objective: Arterial stimulation and venous sampling (ASVS) is an important technique for localizing insulinoma. The principle behind ASVS is that insulin secretion is promoted from insulinoma cells by the injection of calcium into the insulinoma-feeding artery. However, the mechanism for ASVS-induced insulin secretion remains unclear. Both insulnoma and familial hypocalciuric hypercalcemia (FHH) are rare diseases. This study reports on a case in which both of these diseases occur concurrently. Design and patient: The patient with FHH also suffered from insulinoma. We reasoned that insulin secretion for ASVS is dependent on the calcium-sensing receptor (CaSR). ASVS was performed on this patient. The expression of the CaSR protein and corresponding mRNA were confirmed. Results: No significant changes in the plasma levels of insulin and C-peptide were observed during ASVS. The patient was clinically diagnosed as having FHH. We confirmed that a mutation in the CaSR gene was present in the genomic DNA of this patient and that there were no mutations in the multiple endocrine neoplasia type I gene. In addition, expression of both CaSR mRNA and CaSR protein was confirmed in the insulinoma samples. Conclusion: These results suggest that the CaSR gene is involved in ASVS-induced insulin secretion.
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胆道 22(2) 202-206 2008年5月25日66歳女性。患者は心窩部痛を主訴に近医を受診、腹部CTにて膵頭部腫瘤を指摘され、著者らの施設へ紹介となった。腹部MD-CT・血管造影・ERCPの結果、右肝動脈・総胆管浸潤を伴う膵頭部腫瘍および胆管癌と診断され、2群リンパ節郭清を伴う全層胆嚢摘出術、右肝動脈合併膵頭十二指腸切除術が行われた。術前処置として右肝動脈は塞栓術を行い、非再建としたところ、本症例は病理組織学的にss胆嚢癌の右肝動脈・総胆管・膵浸潤を伴う孤立性リンパ節転移であり、術後1年6ヵ月経過現在、再発はみられていない。
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JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 15(3) 334-337 2008年5月 査読有りWe report two cases of pneumatosis intestinalis and hepatic portal venous gas. The first case was in a 67-year-old woman who complained of strong right lower abdominal pain and high fever on the twelfth day after pancreatoduodenectomy (PD) with portal vein (PV) resection. Abdominal X-ray and computed tomography showed hepatic portal venous gas and pneumatosis intestinalis. The emergency laparotomy performed disclosed extensive necrosis of the bowel from the jejunum to the ascending colon. All necrotic parts of the bowel were resected and a jejunostomy was performed. The residual intact small intestine was 30 cm in length. Her postoperative course was stable. This is a rare complication after PD and cannot be cured by any other treatment but surgery. The second case was in a 45-year-old woman with the chief complaint of abdominal pain and constipation. She had a past history of chronic toluene inhalation. Abdominal X-ray and computed tomography also showed hepatic portal venous gas and pneumatosis intestinalis, as well as free air, but no physical examination or laboratory test results supported a diagnosis of bowel necrosis. Hyperbaric oxygen (HBO) therapy effectively controlled the symptoms and signs.
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JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 15(3) 322-326 2008年5月 査読有りBackground/Purpose. When a pancreatoduodenectomy is to be conducted, preoperative understanding of the vascular anatomy of the pancreatic head is important in order to reduce intraoperative bleeding. Using multislice computed tomography (MS-CT), we investigated the depiction rate and branching of the inferior pancreaticoduodenal artery (IPDA) and dorsal pancreatic artery (DPA), afferent arteries to the pancreatic head. Methods. In 109 patients (68 with pancreatic cancer, 21 with biliary tract cancer, 15 with intraductal papillary mucinous tumor of the pancreas, and 5 others), images were taken, using 64-row MS-CT, in the early and late arterial phases. Results. The depiction rates were 98.2% for the IPDA and 96.3% for the DPA. Branching of the IPDA was categorized into three types: a type in which the IPDA formed a common vessel with the first jejunal branch (72.0%), a type in which the IPDA branched directly from the superior mesenteric artery (18.7%), and a type in which the anterior inferior pancreaticoduodenal artery (AIPDA) and posterior inferior pancreaticoduodenal artery (PIPDA) branched separately (9.3%). DPA branching was categorized into five types, in which the DPA branched from the splenic artery (40.0%), from the common hepatic artery (25.7%), from the superior mesenteric artery (20.0%), and from the celiac artery (8.6%), and a type in which the DPA branching did not follow any of the above patterns (5.7%). Conclusions. MS-CT images of vascular architecture enable evaluation from any angle, which is not possible with conventional angiography, making MS-CT a useful diagnostic imaging technique for understanding the vascular anatomy of the pancreatic head prior to conducting pancreatoduodenectomy for diseases of the pancreatic head region.
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日本外科学会雑誌 109(2) 84-89 2008年3月1日
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Nihon Geka Gakkai zasshi 109(2) 84-89 2008年3月 査読有り
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胆道 22(2) 202-206 2008年膵頭部腫瘤を呈したss胆嚢癌の右肝動脈・総胆管・膵浸潤を伴う孤立性リンパ節転移の1切除例を報告した. 症例は66歳, 女性. MD-CT (multidetector row CT) で腫瘤は膵と連続しているが, 外方へ突出しており, 門脈本幹と接していた. また, 胆嚢底部腹側に径10×10mmの淡く造影される腫瘤を認めた. 血管造影検査で右肝動脈本幹にencasementを認めた. ERCPで総胆管の片側性の欠損像を認めた. 右肝動脈・総胆管・膵浸潤を伴う膵頭部腫瘍と胆嚢癌の診断で手術を施行した. 病理組織学的に膵頭部病変は胆管壁を外方から圧排し胆管内に穿破した腫瘍であり, 内部にリンパ節組織を認めたことから, 胆嚢癌の孤立性リンパ節転移の膵, 胆管直接浸潤と診断した. 自験例は膵頭部腫瘤として描出された12b<sub>2</sub>以外の転移は認めない孤立性なもので, それが膵, 総胆管に直接浸潤を呈し, 膵腫瘤のように描出された稀な進展形式の症例であった.
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膵臓 23(4) 525-532 2008年症例は62歳,男性.2006年4月,検診にて血清アミラーゼ値の高値を指摘され受診.腹部CTにて膵頭部に造影不良腫瘤と主膵管の拡張,上腸間膜動脈(SMA)周囲神経叢浸潤を認めた.また,ERCPにて膵頭部主膵管の狭窄と尾側膵管の拡張を認めた.局所高度浸潤膵癌と診断し放射線化学療法として総照射線量50Gy及びGemcitabine(GEM)600mg/m<sup>2</sup>の投与を開始した.2コース目以降,800mg/m<sup>2</sup>のGEMをBi-weeklyで施行し,3コース終了時の腹部CTにて原発巣でPRとSMA周囲神経叢浸潤の軽快を認めたため膵頭十二指腸切除術を施行した.病理検査にて十二指腸粘膜下筋層内に少数の癌遺残を認めたが,膵頭部は腺房萎縮と広範な線維化を認めるのみで明らかな癌細胞は認めなかった.現在,外来にてGEMによる化学療法を継続中であり,明らかな再発·転移は認めていない.<br> 今回,SMA周囲神経叢浸潤を伴う進行膵頭部癌に対しGEM併用放射線化学療法が奏功し膵頭十二指腸切除術を施行しえた1例を経験したため報告した.<br>
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CELL TRANSPLANTATION 17(1-2) 165-171 2008年 査読有りThe shortage of organ donors has impeded the development of human hepatocyte transplantation. Immortalized hepatocytes could provide an unlimited supply of transplantable cells. To determine whether immortalized hepatocytes could provide global metabolic support in end-stage liver disease, rat hepatocyte clones were developed by transduction with the gene encoding the Simian virus 40 T antigen (SVT) using the human artificial minichromosome (HAC). The SVLT sequence was excised by FRT recombination. Following HAC infusion, the transduced hepatocytes express SVT, blasticidine resistance (BS), and the PGK promoter TK gene. Forty-six cell clones were obtained and at least partially characterized, as previously described, for albumin, alpha-1-antitrypsin, glucose-6-phosphatase (G6Pase), dipeptidylpeptidase 4 (Dpp4), gamma-glutamyltransferase 1 (Ggt), SVT, and beta-actin expression using RT-PCR. Clones were also assessed for albumin secretion into the culture medium using ELISA. All of the cell line secreted approximately 10 mg/ dl of albumin, which is equivalent to the amount secreted by primary hepatocytes. In further experiments, this cell line will be used for transplantable cells or artificial organ using HAC. These results represent an important step toward the development of immortalized hepatocytes.
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JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 14(6) 575-578 2007年11月 査読有りBackground/Purpose. Pancreatoduodenectomy (PD) is one of the most difficult operations in gastrointestinal surgery. Standard PD ligates and cuts superior mesenteric vein (SMV) branches after the removal of the pancreas head, which leads to congestion and bleeding of these veins. Methods. In this study, we modified the standard PD and first ligated the efferent vessels ( arteries); namely, the gastroduodenal artery and inferior pancreatoduodenal artery (IPDA), before ligating and cutting the corresponding afferent vessels ( veins) of the pancreas head. By doing this, congestion of these veins was relieved and bleeding from the resected surface was substantially prevented. Thirty-six patients ( 18 underwent standard PD and 18 had modified PD) formed the study population. Results. The amount of bleeding in the modified PD group was significantly lower than that in the standard PD group. ( 678 +/- 329 g vs 1225 +/- 375 g, respectively; P < 0.05) However, no difference in operation time was found between the two groups. Conclusions. We believe this modified PD procedure is valuable to enable the safe performance of PD.
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JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 22 A248-A248 2007年10月
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JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 22 A165-A165 2007年10月
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JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 22 A51-A51 2007年10月
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JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 22 A249-A249 2007年10月
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XENOTRANSPLANTATION 14(5) 487-487 2007年9月
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日本消化器病学会雑誌 104(臨増大会) A497-A497 2007年9月
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癌の臨床 53(4) 247-253 2007年8月Multi slice(MS)CTを用い膵管癌の進展度診断能を検討した。局所進展のうち腫瘍の大きさ、膵内胆管浸潤、十二指腸浸潤、門脈浸潤、動脈浸潤、他臓器浸潤、肝転移は良好な診断能であった。膵前後方組織浸潤は感度が高かったが特異度は低かった。これは癌に随伴する膵炎に伴う脂肪濃度上昇を陽性と診断したためと思われた。膵外神経叢浸潤も膵炎に伴う神経叢の脂肪濃度上昇が感度低下の一因と考えられた。随伴性膵炎による腫瘍周囲の変化と癌浸潤の鑑別は癌の線維性間質の量にもよるが、今後さらなる検討が必要である。リンパ節転移は大きさ以外の因子の検討が必要と思われた。MS-CTは詳細なvolume dataを短時間に得ることができ、低侵襲であり膵癌の進展度診断には欠かせない検査法である。(著者抄録)
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肝胆膵治療研究会誌 5(1) 88-93 2007年8月54歳男性。患者は直腸癌に対する低位前方切除術後の経過観察中、腫瘍マーカーの上昇、CTにて膵体部腫瘍、肝腫瘍を指摘され、術後1年経過で著者らの施設へ紹介となった。入院時、腫瘍マーカーはCEA、CA19-9ともに上昇を認め、造影CTでは直腸癌の膵・肝転移と診断された。治療として膵体尾部切除術および肝部分切除術が行われた結果、病理組織学的所見は術前診断と一致し、術後8ヵ月現在、外来にて化学療法を施行中である。
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日本消化器外科学会雑誌 40(7) 1090-1090 2007年7月1日
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日本消化器外科学会雑誌 40(7) 1222-1222 2007年7月1日
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日本消化器外科学会雑誌 40(7) 1387-1387 2007年7月1日