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Hepatobiliary Surgery and Nutrition 2022年第2期11卷 314-316页

作者： Yasunari Kawabata yoshitsugu tajima Department of Digestive and General Surgery Shimane University Faculty of MedicineIzumoShimaneJapan

Perihilar cholangiocarcinoma(PHC)is an aggressive malignancy of the biliary tracts with a dismal outcome.Although the primary goal of surgery for PHC is complete tumor removal with negative resection margins and regional lymphadenectomy,surgery for PHC with curative intent remains a challenge for surgeons because it involves complex surgical procedures such as bile duct resection,major hepatectomy,and/or vascular resection.These intensive procedures are often associated with postoperative complications,including severe morbidity and 30-day mortality with incidences of 40%and 5%,respectively(1).From the perspective of surgical and oncological safety,the standardization of aggressive surgical approaches and the establishment of standardized benchmark values that secure the best achievable outcomes are warranted in the treatment of patients with PHC.

关键词： surgical surgery mortality

Successful resection of colonic metastasis of lung cancer after colonic stent placement:A case report and review of the literature

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World Journal of Gastrointestinal Surgery 2023年第7期15卷 1549-1558页

作者： Yoko Nakayama Minekazu Yamaguchi Keisuke Inoue Shunichi Hamaguchi yoshitsugu tajima Department of Surgery Oda Municipal HospitalOda 694-0063ShimaneJapan Department of General Medicine Shimane University Faculty of MedicineIzumo 693-8501Japan Department of Digestive and General Surgery Shimane University Faculty of MedicineIzumo 693-8501Japan

BACKGROUND Lung cancer is the leading cause of cancer deaths worldwide.Although lung cancer can metastasize to various organs such as the liver,lymph nodes,adrenal gland,bone,and brain,metastases to the digestive organs,especially the colon,are rare.CASE SUMMARY An 83-year-old man diagnosed with lung cancer received radiation and chemoimmunotherapy,resulting in a complete clinical response.One year after the initial lung cancer diagnosis,the patient presented with obstructive ileus caused by a tumor in the descending colon.An elective left hemicolectomy was successfully performed after the endoscopic placement of a self-expandable metallic stent(SEMS).Pathologically,the tumor of the descending colon was diagnosed as lung cancer metastasis.The postoperative course was uneventful,and the patient is in good condition 13 mo after surgery,with no signs of recurrence.The previous 23 cases of surgical resection of colonic metastasis from lung cancer were reviewed using PubMed to characterize their clinicopathological features and outcomes.CONCLUSION SEMS is useful for obstructive colonic metastasis as a bridge to surgery to avoid emergency operations.

关键词： Colonic metastasis Colonic obstruction Lung cancer Self-expandable metallic stent Surgical resection Case report

Case of colonic intussusception secondary to mobile cecum syndrome repaired by laparoscopic cecopexy using a barbed wound suture device

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World Journal of Gastroenterology 2017年第35期23卷 6534-6539页

作者： Tetsu Yamamoto yoshitsugu tajima Ryoji Hyakudomi Takanori Hirayama Takahito Taniura Kazunari Ishitobi Noriyuki Hirahara Department of Digestive and General Surgery Shimane University Faculty of Medicine

A 27-year-old man with recurrent right lower quadrant pain was admitted to our hospital. Ultrasonography and computed tomography examination of the abdomen revealed a target sign in the ascending colon, which was compatible with the diagnosis of cecal intussusception. The intussusception was spontaneously resolved at that time, but it relapsed 6 mo later. The patient underwent a successful colonoscopic disinvagination; there was no evidence of neoplastic or inflammatory lesions in the colon and terminal ileum. The patient underwent laparoscopic surgery for recurring cecal intussusception. During laparoscopy, we observed an unfixed cecum on the posterior peritoneum(i.e. a mobile cecum). Thus, we performed laparoscopic appendectomy and cecopexy with a lateral peritoneal flap using a barbed wound suture device. The patient's post-operative course was uneventful, and he continued to do well without recurrence at 10 mo after surgery. Laparoscopic cecopexy using a barbed wound suture device is a simple and reliable procedure that can be the treatment of choice for recurrent cecal intussusception associated with a mobile cecum.

关键词： Colonic intussusception Adult Mobile cecum Cecopexy Barbed wound suture device

Altemeier perineal rectosigmoidectomy with indocyanine green fluorescence imaging for a female adolescent with complete rectal prolapse:A case report

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World Journal of Clinical Cases 2021年第4期9卷 847-853页

作者： Tetsu Yamamoto Ryoji Hyakudomi Kiyoe Takai Takahito Taniura Yuki Uchida Kazunari Ishitobi NoriyukiHirahara yoshitsugu tajima Department of Digestive and General Surgery Shimane University Faculty of MedicineIzumo 693-8501ShimaneJapan

BACKGROUND Rectal prolapse in young women is rare.Although laparoscopic ventral mesh rectopexy is the standard procedure because of its lower recurrence rate,postoperative infertility is a concern.Perineal rectosigmoidectomy(Altemeier procedure)is useful for these patients.However,the risk of anastomotic leakage should be considered.Recently,the usefulness of fluorescence imaging with indocyanine green(ICG)to prevent anastomotic leakage was reported.We report a case of an adolescent woman with complete rectal prolapse who underwent ICG fluorescence imaging-assisted Altemeier rectosigmoidectomy.CASE SUMMARY A 17-year-old woman who had a mental disorder was admitted to our hospital for treatment for water intoxication.The patient also suffered from rectal prolapse,approximately 3 mo before admission.She was referred to our surgical department because recurrent rectal prolapse could worsen her psychiatric disorder.Approximately 10 cm of complete rectal prolapse was observed.However,the mean maximum anal resting and constriction pressures were within normal limits on anorectal manometry.Because she had the desire to bear children in the future,she underwent Altemeier perineal rectosigmoidectomy to prevent surgery-related infertility.We performed ICG fluorescence imaging at the same time as surgery to reduce the risk of anastomotic leakage.Her postoperative course was uneventful,and the rectal prolapse was completely resolved.She continued to do well 18 mo after surgery,without recurrence of the rectal prolapse.CONCLUSION ICG fluorescence imaging-assisted Altemeier perineal rectosigmoidectomy is useful in preventing postoperative anastomotic leakage in young as well as elderly patients.

关键词： Indocyanine green fluorescence imaging Rectal prolapse Altemeier operation Young women Mental disorder Perineal rectosigmoidectomy Case report

Immunological milieu in the peritoneal cavity at laparotomy for gastric cancer

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World Journal of Gastroenterology 2012年第13期18卷 1470-1478页

作者： Akira Yoneda Shinichiro Ito Seiya Susumu Mitsutoshi Matsuo Ken Taniguchi yoshitsugu tajima Susumu Eguchi Takashi Kanematsu Yasuhiro Nagata Department of Surgery Nagasaki University Graduate School of Biomedical SciencesNagasaki 852-8051Japan Department of Surgery Yamaguchi Prefectural Medical CenterYamaguchi 747-8511Japan Department of Surgery National Hospital Organization Nagasaki Medical CenterNagasaki 856-8562Japan

AIM:To investigate the immunological repertoire in the peritoneal cavity of gastric cancer patients.METHODS:The peritoneal cavity is a compartment in which immunological host-tumor interactions can occur.However,the role of lymphocytes in the peritoneal cavity of gastric cancer patients is unclear.We observed 64 patients who underwent gastrectomy for gastric cancer and 11 patients who underwent laparoscopic cholecystectomy for gallstones and acted as controls.Lymphocytes isolated from both peripheral blood and peritoneal lavage were analyzed for surface markers of lymphocytes and their cytokine production by flow cytometry.CD4+CD25high T cells isolated from the patient's peripheral blood were co-cultivated for 4 d with the intra-peritoneal lymphocytes,and a cytokine assay was performed.RESULTS:At gastrectomy,CCR7 -CD45RA-CD8+ef-fector memory T cells were observed in the peritoneal cavity.The frequency of CD4+CD25 high T cells in both the peripheral blood and peritoneal cavity was elevated in patients at advanced stage[control vs stage Ⅳin the peripheral blood:6.89(3.39-10.4)vs 15.34(11.37-19.31),P<0.05,control vs stageⅣin the peritoneal cavity:8.65(5.28-12.0)vs 19.56(14.81-24.32),P<0.05].On the other hand,the suppression was restored with CD4+CD25high T cells from their own peripheral blood.This study is the first to analyze lymphocyte and cytokine production in the peritoneal cavity in patients with gastric cancer.Immune regulation at advanced stage is reversible at the point of gastrectomy.CONCLUSION:The immunological milieu in the peritoneal cavity of patients with advanced gastric cancer elicited a Th2 response even at gastrectomy,but this response was reversible.

关键词：免疫调节作用胃癌腹腔环境淋巴细胞探查剖腹细胞因子

Pancreatic carcinoma coexisting with chronic pancreatitis versus tumor-forming pancreatitis:Diagnostic utility of the time-signal intensity curve from dynamic contrast-enhanced MR imaging

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World Journal of Gastroenterology 2007年第6期13卷 858-865页

作者： yoshitsugu tajima Tamotsu Kuroki Ryuji Tsutsumi Ichiro Isomoto Masataka Uetani Takashi Kanematsu Department of Surgery Nagasaki University Graduate School of Biomedical Sciences Japan Department of Radiology and Radiation Biology Nagasaki University Graduate School of Biomedical Sciences Japan

AIM: To evaluate the ability of the time-signal intensity curve (TIC) of the pancreas obtained from dynamic contrast-enhanced magnetic resonance imaging (MRI) for differentiation of focal pancreatic masses, especially pancreatic carcinoma coexisting with chronic pancreatitis and tumor-forming pancreatitis. METHODS: Forty-eight consecutive patients who underwent surgery for a focal pancreatic mass, including pancreatic ductal carcinoma (n = 33), tumor-forming pancreatitis (n = 8), and islet cell tumor (n = 7), were reviewed. Five pancreatic carcinomas coexisted with longstanding chronic pancreatitis. The pancreatic TICs were obtained from the pancreatic mass and the pancreatic parenchyma both proximal and distal to the mass lesion in each patient, prior to surgery, and were classified into 4 types according to the time to a peak: 25 s and 1, 2, and 3 min after the bolus injection of contrast material, namely, type-Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively, and were then compared to the corresponding histological pancreatic conditions. RESULTS: Pancreatic carcinomas demonstrated type-Ⅲ (n = 13) or Ⅳ (n = 20) TIC. Tumor-forming pancreatitis showed type-Ⅱ (n = 5) or Ⅲ (n = 3) TIC. All islet cell tumors revealed type-Ⅰ. The type-Ⅳ TIC was only recognized in pancreatic carcinoma, and the TIC of carcinoma always depicted the slowest rise to a peak among the 3 pancreatic TICs measured in each patient, even in patients with chronic pancreatitis.CONCLUSION: Pancreatic TIC from dynamic MRI provides reliable information for distinguishing pancreatic carcinoma from other pancreatic masses, and may enable us to avoid unnecessary pancreatic surgery and delays in making a correct diagnosis of pancreatic carcinoma, especially, in patients with longstanding chronic pancreatitis.

关键词：胰腺癌慢性胰腺炎肿瘤形成鉴别诊断动态磁共振成像时间-信号强度曲线

Extrahepatic collaterals and liver damage in embolotherapy for ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery

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World Journal of Gastroenterology 2007年第3期13卷 408-413页

作者： yoshitsugu tajima Tamotsu Kuroki Ryuji Tsutsumi Ichiro Sakamoto Masataka Uetani Takashi Kanematsu Department of Surgery Nagasaki University Graduate School of Biomedical Sciences 1-7-1 Sakamoto Nagasaki 852-8501 Japan Department of Radiology and Radiation Biology Nagasaki University Graduate School of Biomedical Sciences 1-7-1 Sakamoto Nagasaki 852-8501 Japan

AIM: To evaluate the effects of extrahepatic collaterals to the liver on liver damage and patient outcome after embolotherapy for the ruptured hepatic artery pseudoa- neurysm following hepatobiliary pancreatic surgery. METHODS: We reviewed 9 patients who underwent transcatheter arterial embolization (TAE) for the ruptured hepatic artery pseudoaneurysm following major hepato- biliary pancreatic surgery between June 1992 and April 2006. We paid special attention to the extrahepatic arte- rial collaterals to the liver which may affect post-TAE liver damage and patient outcome. RESULTS: The underlying diseases were all malignan- cies, and the surgical procedures included hepatopancre- atoduodenectomy in 2 patients, hepatic resection with removal of the bile duct in 5, and pancreaticoduodenec- tomy in 2. A total of 11 pseudoaneurysm developed: 4 in the common hepatic artery, 4 in the proper hepatic artery, and 3 in the right hepatic artery. Successful he- mostasis was accomplished with the initial TAE in all patients, except for 1. Extrahepatic arterial pathways to the liver, including the right inferior phrenic artery, the jejunal branches, and the aberrant left hepatic artery, were identified in 8 of the 9 patients after the completion of TAE. The development of collaterals depended on the extent of liver mobilization during the hepatic resection, the postoperative period, the presence or absence of an aberrant left hepatic artery, and the concomitant arte- rial stenosis adjacent to the pseudoaneurysm. The liver tolerated TAE without significant consequences when at least one of the collaterals from the inferior phrenic ar-tery or the aberrant left hepatic artery was present. One patient, however, with no extrahepatic collaterals died of liver failure due to total liver necrosis 9 d after TAE. CONCLUSION: When TAE is performed on ruptured hepatic artery pseudoaneurysm, reduced collateral path- ways to the liver created by the primary surgical proce- dure and a short postoperative interval may lead to an unfavorable

关键词：肝病动脉胰腺栓塞现象

Solitary recurrence of hilar cholangiocarcinoma in a mediastinai lymph node two years after curative resection

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World Journal of Gastroenterology 2007年第15期13卷 2243-2246页

作者： Yuichiro Ito yoshitsugu tajima Fumihiko Fujita Ryuji Tsutsumi Tamotsu Kuroki Takashi Kanematsu Department of Transplantation and Digestive Surgery Nagasaki University Graduate School of Biomedical Sciences 1-7-1 SakamotoNagasaki 852-8501Japan

我们最近遇到了在一个纵隔淋巴节点的独居的复发在发生了的门 cholangiocarcinoma 的一个不平常的盒子在原发性瘤的药品切除术以后的二年。一个 64 年的老妇人与正确 hypochondrial 不快的抱怨进入我们的医院。在成像研究在左肝的管表... 详细信息

我们最近遇到了在一个纵隔淋巴节点的独居的复发在发生了的门 cholangiocarcinoma 的一个不平常的盒子在原发性瘤的药品切除术以后的二年。一个 64 年的老妇人与正确 hypochondrial 不快的抱怨进入我们的医院。在成像研究在左肝的管表明了门 cholangiocarcinoma 以后，肿瘤的药品切除术被执行，由与额外的肝的胆汁管的有尾的叶切除术，地区性的淋巴节点解剖，和切除术一起的左肝的叶切除术组成。没有节的转移组织学地被观察。在外科以后的二年，病人 thoracoscopically 被发现在以后的纵隔有一个小瘤，它是 resected。没有另外的肿的淋巴节点，本地复发，或远转移被注意。组织学地，小瘤证明了是一个变形淋巴节点，并且辅助 chemoradiation 治疗被开始。病人留下了很好跟随她的第一个手术的四年并且没在她的第二个手术以后有疾病复发 28 瞬间的证据。到我们的知识，这个案例是在在门 cholangiocarcinoma 的药品切除术以后的一个纵隔淋巴节点的独居的复发的第一份报告。

关键词：肝门胆管癌治疗性切除纵隔淋巴结复发

Inflammatory cytokines promote inducible nitric oxide synthase-mediated DNA damage in hamster gallbladder epithelial cells

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World Journal of Gastroenterology 2007年第47期13卷 6379-6384页

作者： Amane Kitasato yoshitsugu tajima Tamotsu Kuroki Ryuji Tsutsumi Tomohiko Adachi Takehiro Mishima Takashi Kanematsu Department of Surgery Nagasaki University Graduate School of Biomedical Sciences1-7-1 SakamotoNagasaki 852-8501Japan

AIM: To investigate the link between chronic biliary inflammation and carcinogenesis using hamster gallbladder epithelial cells. METHODS: Gallbladder epithelial cells were isolated from hamsters and cultured with a mixture of inflammatory cytokines including interleukin-1β,interferon-γ,and tumor necrosis factor-α. Inducible nitric oxide synthase (iNOS) expression,nitric oxide (NO) generation,and DNA damage were evaluated. RESULTS: NO generation was increased significantly following cytokine stimulation,and suppressed by an iNOS inhibitor. iNOS mRNA expression was demonstrated in the gallbladder epithelial cells during exposure to inflammatory cytokines. Furthermore,NO-dependent DNA damage,estimated by the comet assay,was significantly increased by cytokines,and decreased to control levels by an iNOS inhibitor. CONCLUSION: Cytokine stimulation induced iNOS expression and NO generation in normal hamster gallbladder epithelial cells,which was sufficient to cause DNA damage. These results indicate that NO-mediated genotoxicity induced by inflammatory cytokines through activation of iNOS may be involved in the process of biliary carcinogenesis in response to chronic inflammation of the biliary tree.

关键词：胆囊癌症状细胞因子氮氧化物

Endoscopic naso-pancreatic stent-guided single-branch resection of the pancreas for multiple intraductal papillary mucinous adenomas

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World Journal of Gastroenterology 2006年第44期12卷 7203-7205页

作者： Tamotsu Kuroki yoshitsugu tajima Ryuji Tsutsumi Noritsugu Tsuneoka Amane Kitasato Tomohiko Adachi Takashi Kanematsu Department of Surgery Nagasaki University Graduate School of Biomedical Sciences 1-7-1 Sakamoto Nagasaki 852-8501 Japan

In benign or low-grade malignant pancreatic tumors, complete removal of the lesion is sufficient for a cure, and thus minimal resection techniques with preservation of the pancreatic functional reserve have advantages over more extended pancreatic resections. However, a high incidence of postoperative pancreatic fistula in such procedures has been reported. Moreover, branch-type intraductal papillary mucinous neoplasms of the pancreas tend to locate in the head of the pancreas, and show less malignant potential. We describe an endoscopic naso- pancreatic stent-guided single-branch resection of the pancreas for branch-type multiple intraductal papillary mucinous adenomas, along with a gastric wall-covering method for the prevention of pancreatic leakage.

关键词：管内乳头瘤单分支切除术恶性胰腺瘤胰腺切除术