出版者・発行元：南江堂  

DOI： 10.15106/j_geka86_1288

CiNii Research

記述言語：英語   出版者・発行元：Asian Journal of Endoscopic Surgery  

Introduction: This study aimed to clarify the validity of laparoscopic surgery for lower gastrointestinal perforation by comparing the clinical outcomes of laparoscopic and open emergency surgery. Methods: We reviewed the data of patients who underwent surgery for lower gastrointestinal perforation. Patients were categorized into two groups: the laparoscopic group who underwent laparoscopic surgery, and the open group who underwent laparotomy. Clinical and operative outcomes between the two groups were evaluated. Results: A total of 219 patients were included in the study. There were 66 and 153 patients with small bowel and colorectal perforations, respectively. The median operative time in the laparoscopic group was shorter than that in the open group (126 min vs. 146 min, p =.049). The mean amount of intraoperative blood loss was significantly lower in the laparoscopic group (50.4 mL vs. 400.1 mL, p <.001). The incidence of postoperative complication was higher in the open group (20.0% vs. 66.5%, p <.001), especially wound infection (0% vs. 26.3%, p =.002). Median hospital stays were 14 days and 24 days in the laparoscopic and open groups, respectively (p <.001). In the laparoscopic group, hospital mortality was 0%. Conclusions: The laparoscopic approach for small bowel and colorectal perforation in an emergency setting is a safe procedure in carefully selected patients and may contribute to decreased intraoperative blood loss, shortened hospital stay, and decreased incidence of postoperative complications, especially wound infection.

DOI： 10.1111/ases.13373

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

下部消化管穿孔に対する腹腔鏡下手術の妥当性について、手術アウトカムを開腹下緊急手術と比較した。下部消化管穿孔をきたした219例を腹腔鏡下手術群25例(男性14例、女性11例、平均69.4歳)と開腹術群194例(男性98例、女性96例、平均72.4歳)に分類した。手術時間中央値は腹腔鏡下手術群の方が開腹術群より短く、出血量も腹腔鏡下手術群の方が有意に少なく、術後合併症の発症率は開腹術群の方が有意に高く、在院期間は腹腔鏡下手術群の方が有意に短かった。小腸穿孔をきたした患者のサブ解析では、出血量は腹腔鏡下手術群の方が有意に少なく、術後合併症の発症は開腹術群に有意に多く認め、在院期間は腹腔鏡下手術群の方が有意に短かった。大腸穿孔例においても同様のアウトカムが認められた。院内死亡率は腹腔鏡下手術群が0%、開腹術群が13.6%を示していた。単変量解析では術後合併症発症のリスク因子として、術中出血量560mL以上、開腹アプローチ、POSSUMにおける生理学的スコア26点以上、手術重症度スコア22点以上が抽出された。

記述言語：英語   出版者・発行元：(一社)日本大腸肛門病学会  

目的:大腸穿孔は、合併症の発生率と死亡率が高い疾患である。今回我々は、大腸穿孔に対し緊急手術を施行した症例の様々な臨床的特性を検証し、術後合併症と院内死の危険因子について検討した。方法:当科にて大腸穿孔に対し緊急手術を施行された147例の症例のデータを後方視的に検討した。Inflammation-based prognostic score(IBPS)を含むさまざまな臨床因子および手術因子を調査し、大腸穿孔による術後合併症および在院死の危険因子を評価した。結果:対象症例147名のうち、最も頻度の高い術後合併症は創感染(32例、21.8%)で、次いで腹腔内膿瘍(27例、18.4%)であった。発症から手術までの期間が2日以上(ハザード比[HR]=2.810、p=0.0383)、およびPrognostic nutritional index(PNI)<30(HR=3.190、p=0.0488)が腹腔内膿瘍の危険因子として同定された。一方、好中球リンパ球比(NLR)<6.15(HR=5.020、p=0.0009)は、創感染の危険因子として同定された。発症から手術までの期間が2日以上(HR=7.713、p=0.0492)、重篤な術後合併症(Clavien-Dindo Grade≧IIIa)(HR=10.98、p=0.0281)、および血小板リンパ球比(PLR)<144(HR=18.84、p=0.0190)は院内死の独立した予後不良因子であった。結論:発症から手術までの時間、およびPNI、NLR、PLRなどのIBPSは、大腸穿孔による術後合併症や病院死亡と関連している可能性が示唆された。(著者抄録)

DOI： 10.1080/00219592.2023.2204899

Web of Science

記述言語：英語   出版者・発行元：Iscience  

Advances in cellular engineering, as well as gene, and cell therapy, may be used to produce human tissues with programmable genetically enhanced functions designed to model and/or treat specific diseases. Fabrication of synthetic human liver tissue with these programmable functions has not been described. By generating human iPSCs with target gene expression controlled by a guide RNA-directed CRISPR-Cas9 synergistic-activation-mediator, we produced synthetic human liver tissues with programmable functions. Such iPSCs were guide-RNA-treated to enhance expression of the clinically relevant CYP3A4 and UGT1A1 genes, and after hepatocyte-directed differentiation, cells demonstrated enhanced functions compared to those found in primary human hepatocytes. We then generated human liver tissue with these synthetic human iPSC-derived hepatocytes (iHeps) and other non-parenchymal cells demonstrating advanced programmable functions. Fabrication of synthetic human liver tissue with modifiable functional genetic programs may be a useful tool for drug discovery, investigating biology, and potentially creating bioengineered organs with specialized functions.

DOI： 10.1016/j.isci.2022.105503

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：Seminars in Liver Disease  

Although the underlying cause may vary across countries and demographic groups, liver disease is a major cause of morbidity and mortality globally. Orthotopic liver transplantation is the only definitive treatment for liver failure but is limited by the lack of donor livers. The development of drugs that prevent the progression of liver disease and the generation of alternative liver constructs for transplantation could help alleviate the burden of liver disease. Bioengineered livers containing human induced pluripotent stem cell (iPSC)–derived liver cells are being utilized to study liver disease and to identify and test potential therapeutics. Moreover, bioengineered livers containing pig hepatocytes and endothelial cells have been shown to function and survive after transplantation into pig models of liver failure, providing preclinical evidence toward future clinical applications. Finally, bioengineered livers containing human iPSC-derived liver cells have been shown to function and survive after transplantation in rodents but require considerable optimization and testing prior to clinical use. In conclusion, bioengineered livers have emerged as a suitable tool for modeling liver diseases and as a promising alternative graft for clinical transplantation. The integration of novel technologies and techniques for the assembly and analysis of bioengineered livers will undoubtedly expand future applications in basic research and clinical transplantation.

DOI： 10.1055/a-1934-5404

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

Delayed Appendectomy(DA)とInterval Appendectomy(IA)の実施可能性を検討した。腹腔鏡下虫垂切除術を施行した245例を緊急虫垂切除施行群(EA群)153例、DA施行群(DA群)38例、IA施行群(IA群)54例に分類し、各群の臨床データと手術成績を評価した。EA群とDA群の手術成績を比較すると手術時間、出血量、抗生剤の投与期間、在院期間、術中・術後合併症に有意差は認められなかった。IA群の手術成績はEA群、DA群とほぼ同等であり、在院期間はIA群が短かった。「夜間に虫垂切除術は施行しない」との規則を定めた2017年前後の比較では、外科研修医の時間外労働時間は2017年以降に有意に減少していた。腹腔鏡下DAとIAは実施可能な術式であり、患者の安全性を損なうことなく働き方改革の促進につながることが示された。

出版者・発行元：Digestive Surgery  

Introduction: Pancreatic duct stents are widely used to reduce the incidence of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD); however, small stents may cause adverse effects, such as occlusion. Recently, we have tried placing a 7.5-Fr pancreatic duct stent to achieve more effective exocrine output from the pancreas; however, the association between pancreatic duct stent size and POPF remains unknown. Methods: Sixty-five patients with soft pancreatic texture who underwent PD were retrospectively analyzed. After dividing the pancreas, a pancreatic duct stent (stent size 4.0 in 29 patients, 5.0 in 18, and 7.5 Fr in 18) was placed in the main pancreatic duct. Results: Twenty-five of 65 patients with soft pancreatic texture (38.5%) developed POPF. POPF became less frequent as the pancreatic duct stent size increased (p = 0.003). The factors associated with POPF development were a 7.5-Fr pancreatic duct stent (p = 0.005), 5.0-Fr pancreatic duct stent (p = 0.031), and male sex (p = 0.008). Pancreatic duct stent size and pancreatic duct diameter did not differ between the POPF and non-POPF groups. Discussion/Conclusions: In patients with a soft pancreas, the placement of a 7.5-Fr pancreatic duct stent may reduce the incidence of POPF.

DOI： 10.1159/000520462

Scopus

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