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Influence of bile contamination for patients who undergo pancreaticoduodenectomy after biliary drainage

World Journal of Gastroenterology 2019年第47期25卷 6847-6856页

作者： keiichi okano Yasuyuki Suzuki Departments of Gastroenterological Surgery Kagawa University

BACKGROUND The influence of bile contamination on the infectious complications of patients undergoing pancreaticoduodenectomy(PD)has not been thoroughly evaluated.AIM To evaluate the effect of preoperative biliary drainage and bile contamination on the outcomes of patients who undergo PD.METHODS The database of 4101 patients who underwent PD was reviewed.Preoperative biliary drainage was performed in 1964 patients(47.9%),and bile contamination was confirmed in 606 patients(14.8%).RESULTS The incidence of postoperative infectious complications was 37.9%in patients with preoperative biliary drainage and 42.4%in patients with biliary contamination,respectively.Patients with extrahepatic bile duct carcinoma,ampulla of Vater carcinoma,and pancreatic carcinoma had a high frequency of preoperative biliary drainage(82.9%,54.6%,and 50.8%)and bile contamination(34.3%,26.2%,and 20.2%).Bile contamination was associated with postoperative pancreatic fistula(POPF)Grade B/C,wound infection,and catheter infection.A multivariate logistic regression analysis revealed that biliary contamination(odds ratio 1.33,P=0.027)was the independent risk factor for POPF Grade B/C.The three most commonly cultured microorganisms from bile(Enterococcus,Klebsiella,and Enterobacter)were identical to those isolated from organ spaces.CONCLUSION In patients undergoing PD,bile contamination is related to postoperative infectious complication including POPF Grade B/C.The management of biliary contamination should be standardised for patients who require preoperative biliary drainage for PD,as the main microorganisms are identical in both organ spaces and bile.

关键词： Bile contamination Complication Pancreaticoduodenectomy Preoperative biliary drainage Postoperative pancreatic fistula Grade B/C

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^(18)F-fluorodeoxyglucose positron emission tomography in the diagnosis of small pancreatic cancer

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World Journal of Gastroenterology 2011年第2期17卷 231-235页

作者： keiichi okano Keitaro Kakinoki Shintaro Akamoto Masanobu Hagiike Hisashi Usuki Yuka Yamamoto Yoshihiro Nishiyama Yasuyuki Suzuki Department of Gastroenterological Surgery Faculty of MedicineKagawa University Department of Radiology Faculty of MedicineKagawa University

AIM:To investigate the role of 18 F-fluorodeoxyglucose positron emission tomography(FDG-PET) in the diagnosis of small pancreatic cancer. METHODS:This study involved 31 patients with proven invasive ductal cancer of the pancreas.The patients were divided into 3 groups according to the maximum diameter of the tumor:TS1(maximum tumor size≤2.0 cm) ,TS2(>2.0 cm and≤4.0 cm) or TS3-4(>4.0 cm) .The relationships between the TS and various diagnostic tools,including FDG-PET with dual time point evaluation,were analyzed. RESULTS:The tumors ranged from 1.3 to 11.0 cm in diameter.Thirty of the 31 patients(97%) had a positive FDG-PET study.There were 5 patients classified as TS1,15 as TS2 and 11 as TS3-4.The sensitivity of FDG-PET,computed tomography(CT) and magnetic resonanceimaging(MRI) were 100%,40%,0%in TS1,93%,93%,89%in TS2 and 100%,100%,100%in TS3-4. The sensitivity of FDG-PET was significantly higher in comparison to CT and MRI in patients with TS1(P< 0.032) .The mean standardized uptake values(SUVs) did not show a significant difference in relation to the TS(TS1:5.8±4.5,TS2:5.7±2.2,TS3-4:8.2±3.9) ,respectively.All the TS1 tumors(from 13 to 20 mm) showed higher SUVs in FDG-PET with dual time point evaluation in the delayed phase compared with the early phase,which suggested the lesions were malignant. CONCLUSION:These results indicate that FDG-PET with dual time point evaluation is a useful modality for the detection of small pancreatic cancers with a diameter of less than 20 mm.

关键词：正电子发射断层扫描诊断工具胰腺癌计算机断层扫描最大直径氟 SUV车 FDG

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A case report of extrahepatic portal vein aneurysm with thrombosis

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World Journal of Gastrointestinal Surgery 2011年第3期3卷 39-42页

作者： Ken Ishimura Tsuyoshi Otani Hisao Wakabayashi keiichi okano Fuminori Goda Yasuyuki Suzuki Department of Surgery Kagawakensaiseikai Hospital Department of Gastroenterological Surgery Faculty of MedicineKagawa University

Extrahepatic portal vein aneurysm (PVA) is very rare with only 17 previously reported cases.Methods of treatment include resection,thrombectomy,and portal venous decompression.We report herein the first case of large PVA with thrombosis which has been managed without surgical treatment over a long period.A PVA was detected in a 78-year-old woman by abdominal ultrasonography.Computed tomography revealed an aneurysm of 6 cm in a diameter in the porta hepatis.Portal venography showed obstruction of the portal vein and developed collateral vessels around the aneurysm.Since the patient had no symptoms of portal hypertension,we decided to carefully manage her clinical course without surgical treatment.At present,this patient is healthy and has developed no complications over the 5 years since leaving our hospital.This case suggests that surgical treatment is not required for PVA without portal hypertension.

关键词： Portal vein aneurysm Thrombosis Surgical treatment

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Outcomes of gastrointestinal defect closure with an overthe-scope clip system in a multicenter experience: An analysis of a successful suction method

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World Journal of Gastroenterology 2017年第9期23卷 1645-1656页

作者： Hideki Kobara Hirohito Mori Shintaro Fujihara Noriko Nishiyama Taiga Chiyo Takayoshi Yamada Masao Fujiwara keiichi okano Yasuyuki Suzuki Masayuki Murota Yoshitaka Ikeda Makoto Oryu Mohamed Abo Ellail Tsutomu Masaki Department of Gastroenterology and Neurology Faculty of MedicineKagawa University Department of Gastroenterology Kochi Health Sciences Center Department of Gastroenterological Surgery Faculty of MedicineKagawa University Department of Gastroenterology Sakaide City Hospital Department of Surgery Ehime Rosai Hospital Department of Gastroenterology Kagawa Saiseikai Hospital Department of Gynecology Faculty of MedicineKagawa University

AIM To demonstrate the clinical outcomes of a multicenter experience and to suggest guidelines for choosing a suction method. METHODS This retrospective study at 5 medical centers involved 58 consecutive patients undergoing over-the-scope clips(OTSCs) placement. The overall rates of technical success (TSR), clinical success (CSR), complications, and procedure time were analyzed as major outcomes. Subsequently, 56 patients, excluding two cases that used the Anchor device, were divided into two groups: 14 cases of simple suction (SS-group) and 42 cases using the Twin Grasper (TG-group). Secondary evaluation was performed to clarify the predictors of OTSC success.RESULTS The TSR, CSR, complication rate, and median procedure time were 89.7%, 84.5%, 1.8%, and 8 (range 1-36) min, respectively, demonstrating good outcomes. However, significant differences were observed between the two groups in terms of the mean procedure time (5.9 min vs 14.1 min). The CSR of the SS- and TG-groups among cases with a maximum defect size ≤ 10 mm and immediate or acute refractory bleeding was 100%, which suggests that SS is a better method than TG in terms of time efficacy. The CSR in the SS-group (78.6%), despite the technical success of the SS method (TSR, 100%), tended to decrease due to delayed leakage compared to that in the TG-group (TSR, CSR; 88.1%), indicating that TG may be desirable for leaks and fistulae with defects of the entire layer. CONCLUSION OTSC system is a safe and effective therapeutic option for gastrointestinal defects. Individualized selection of the suction method based on particular clinical conditions may contribute to the improvement of OTSC success.

关键词： Over-the-scope 片断漏胃肠的倔强的流血管内视镜的闭合

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Role of 18F-fluorodeoxyglucose positron emission tomography imaging in surgery for pancreatic cancer

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World Journal of Gastroenterology 2008年第1期14卷 64-69页

作者： Hisao Wakabayashi Yoshihiro Nishiyama Tsuyoshi Otani Takanori Sano Shinichi Yachida keiichi okano Kunihiko Izuishi Yasuyuki Suzuki Department of Gastroenterological Surgery Kagawa University Kagawa 761-0793 Japan Department of Radiology Kagawa University Kagawa 761-0793 Japan

AIM: To evaluate the role of positron emission tomo-graphy using 18F-fluorodeoxyglucose (FDG-PET) in the surgical management of patients with pancreatic cancer, including the diagnosis, staging, and selection of patients for the subsequent surgical treatment.METHODS: This study involved 53 patients with proven primary pancreatic cancer. The sensitivity of diagnosing the primary cancer was examined for FDG-PET, CT, cytological examination of the bile or pancreatic juice, and the serum levels of carcinoembrionic antigens (CEA) and carbohydrate antigen 19-9 (CA19-9). Next, the accuracy of staging was compared between FDG-PET and CT. Finally, FDG-PET was analyzed semiquantitatively using the standard uptake value (SUV). The impact of the SUV on patient management was evaluated by examining the correlations between the SUV and the histological findings of cancer.RESULTS: The sensitivity of FDG-PET, CT, cytological examination of the bile or pancreatic juice, and the serum levels of CEA and CA19-9 were 92.5%, 88.7%, 46.4%, 37.7% and 69.8%, respectively. In staging, FDG-PET was superior to CT only in diagnosing distant disease (bone metastasis). For local staging, the sensitivity of CT was better than that of FDG-PET. The SUV did not correlate with the pTNM stage, grades, invasions to the vessels and nerve, or with the size of the tumor. However, there was a statistically significant difference (4.6 ± 2.9 vs 7.8 ± 4.5, P = 0.024) in the SUV between patients with respectable and unresectable disease.CONCLUSION: FDG-PET is thus considered to be useful in the diagnosis of pancreatic cancer. However, regarding the staging of the disease, FDG-PET is not considered to be a sufficiently accurate diagnostic modality. Although the SUV does not correlate with the patho-histological prognostic factors, it may be useful in selecting patients who should undergo subsequent surgical treatment.

关键词：胰腺癌正电子发射X射线层析照相术脱氧葡萄糖外科治疗

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A patient with unresectable advanced pancreatic cancer achieving long-term survival with Gemcitabine chemotherapy

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World Journal of Gastroenterology 2008年第44期14卷 6876-6880页

作者： Yoshiki Okamoto Takashi Maeba Keitarou Kakinoki keiichi okano Kunihiko Izuishi Hisao Wakabayashi Hisashi Usuki Yasuyuki Suzuki Department of Gastroenterological Surgery Kagawa UniversityKagawa 7610793Japan Department of Surgery Social Insurance Ritsurin HospitalKagawa 7610793Japan

A 68-year-old female visited a local clinic with epigastralgia. A routine laboratory test revealed jaundice and liver dysfunction. She was referred to this hospital. Abdominal computed tomography (CT) and endoscopic retrograde cholangio-pancreatography (ERCP) revealed that the density of the entire pancreas had decreased,and showed dilatation of the common bile duct (CBD) and the main pancreatic duct (MPD). Pancreatic cancer was diagnosed by cytological examination analyzing the pancreatic juice obtained by ERCP. When jaundice had decreased the tumor was observed via laparotomy. No ascites,liver metastasis,or peritoneal dissemination was observed. The entire pancreas was a hard mass,and a needle biopsy was obtained from the head,body and tail of the pancreas. These biopsies diagnosed a poorly differentiated adenocarcinoma. Hepaticojejunostomy was thus performed,and postoperative progress was good. Chemotherapy with 1000 mg/body per week of gemcitabine was administered beginning 15 d postoperatively. However,the patient suffered relatively severe side effects,and it was necessary to change the dosing schedule of gemcitabine. Abdominal CT revealed a complete response (CR) after 3 treatments. Therefore,weekly chemotherapy was stopped and was changed to monthly administration. To date,for 4 years after chemotherapy,the tumor has not reappeared.

关键词：胰腺癌肝功能黄疸治疗方法

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A rare case of hyaline-type Castleman disease in the liver

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World Journal of Hepatology 2013年第7期5卷 404-408页

作者： Hisaaki Miyoshi Shima Mimura Takako Nomura Joji Tani Asahiro Morishita Hideki Kobara Hirohito Mori Hirohito Yoneyama Akihiro Deguchi Takashi Himoto Naoki Yamamoto keiichi okano Yasuyuki Suzuki Tsutomu Masaki Department of Gastroenterology and Neurology Faculty of Medicine Kagawa University Department of Gastroenterological Surgery Faculty of Medicine Kagawa University

Castleman disease often develops in the neck, mediastinum and pulmonary hilum. Its onset in the peritoneal cavity is very rare. The patient, a woman in her 70s, was referred to our department for a detailed examination of an abdominal mass. On abdominal ultrasonography, computed tomography scan, magnetic resonance imaging and positron emission tomography, a mass approximately 15 mm in diameter was noted in the hepatic S6. We attempted radical treatment and conducted a laparoscope-assisted right lobectomy. On the basis of histopathological findings, the patient was diagnosed as having hyaline type Castleman disease in the liver, a very rare condition.

关键词： Castleman disease Hyaline type Liver tumor Hepatectomy Positron emission tomography

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Bicuspidization Using the Open-Sleeve Technique for Congenital Aortic Stenosis during Infancy

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Congenital Heart Disease 2024年第2期19卷 177-183页

作者： Toshi Maeda Hiroki Ito keiichi Hirose Kisaburo Sakamoto Departments of Cardiovascular Surgery Mt.Fuji Shizuoka Children’s HospitalShizuoka420-8660Japan

Congenital aortic stenosis(cAS)frequently requires intervention during the neonatal or infantile period.However,surgical repair is challenging because of the narrow surgical space.We performed bicuspidization using the open-sleeve technique for cAS with a unicuspid aortic valve in two patients.Postoperatively,the patients were doing well without reintervention for the aortic valve for 8 and 6 years,respectively.Their aortic annular diameter increased along with somatic growth.Bicuspidization for neonates or infancy can be performed safely using the open-sleeve technique as its midterm results have been satisfactory.

关键词： Aortic valve repair infant bicuspidization open-sleeve technique

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Surgical strategies for challenging common bile duct stones in the endoscopic era: A comprehensive review of current evidence

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World Journal of Gastrointestinal Endoscopy 2024年第6期16卷 305-317页

作者： Tharathorn Suwatthanarak Vitoon Chinswangwatanakul Asada Methasate Chainarong Phalanusitthepha Minoru Tanabe keiichi Akita Thawatchai Akaraviputh Minimally Invasive Surgery Unit Department of SurgeryFaculty of Medicine Siriraj HospitalMahidol UniversityBangkok Noi 10700BangkokThailand Graduate School of Medical and Dental Sciences Tokyo Medical and Dental UniversityBunkyo 113-8519TokyoJapan Department of Hepatobiliary and Pancreatic Surgery Tokyo Medical and Dental UniversityBunkyo 113-8519TokyoJapan Department of Clinical Anatomy Tokyo Medical and Dental UniversityBunkyo 113-8519TokyoJapan

While endoscopic retrograde cholangiopancreatography(ERCP)remains the primary treatment modality for common bile duct stones(CBDS)or choledocho-lithiasis due to advancements in instruments,surgical intervention,known as common bile duct exploration(CBDE),is still necessary in cases of difficult CBDS,failed endoscopic treatment,or altered anatomy.Recent evidence also supports CBDE in patients requesting single-step cholecystectomy and bile duct stone removal with comparable outcomes.This review elucidates relevant clinical anatomy,selection indications,and outcomes to enhance surgical understanding.The selection between trans-cystic(TC)vs trans-choledochal(TD)approaches is described,along with stone removal techniques and ductal closure.Detailed surgical techniques and strategies for both the TC and TD approaches,including instrument selection,is also provided.Additionally,this review comprehensively addresses operation-specific complications such as bile leakage,stricture,and entrapment,and focuses on preventive measures and treatment strategies.This review aims to optimize the management of CBDS through laparoscopic CBDE,with the goal of improving patient outcomes and minimizing risks.

关键词： Choledocholithiasis Common bile duct stone Difficult common bile duct stone Common bile duct exploration Laparoscopic common bile duct exploration

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A Case Report of Kissing Molars Class II

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Open Journal of Stomatology 2024年第5期14卷 249-254页

作者： Toshiyuki Inou keiichi Uchida Keiko Kaneko Anna Fuji Nina Wakimoto Tatsuo Takaya Hiroyuki Kitamura Hiroshi Mori Yuji Kurihara Department of Oral Diagnostics and Comprehensive Dentistry Matsumoto Dental University Hospital Shiojiri Japan Department of Oral and Maxillofacial Surgery School of Dentistry Matsumoto Dental University Shiojiri Japan

Kissing molars (KMs) is a condition of occlusal molar surfaces in a single follicular space with roots extending in opposite directions. Here, we have reported a case of KMs in a 58-year-old woman. The patient complained of pain in the right mandibular molar region and was diagnosed with KMs consisting of the right mandibular second and third molars. Because of the patient’s pain having subsided at the time of the visit and her unwillingness to undergo tooth extraction, the patient was followed up. KMs is classified into three classes (I-III) and is either true-KMs or pseudo-KMs and presents with or without cystic variants of dental follicles. The presents as true-KMs class II without a cystic variant. With reference to the literature and based on our analysis, the mean age of patients affected by this specific case of KMs is 31.7 years and unilateral KMs is relatively more common (85.7%). Histopathological findings of dentigerous cysts are more often indicated (42.9%). The treatment policy for KMs should therefore be based on the classification of KMs. Importantly, the focus should be on preserving the first and second molars as much as possible. The treatment approach, such as the employment of surgical removal or orthodontics, should be determined by considering the associated factors such as the crowns, tissues, and age of the patient.

关键词： Kissing Molars Mandibular Second Molar Mandibular Third Molar Cone-Beam Computed Tomography

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