Hideyuki Kawahara

An experimental study on viability of the devascularized trachea

This experiment was designed to evaluate the effect of varying extents of devascularization to the viability of the trachea, and the influence of preservation of the right bronchial artery on the ischemia of the widely devascularized trachea. In experiment 1, the canine trachea was devascularized in a stepwise manner, and the regional blood flow was measured in each situation. This experiment revealed that the regional blood flow decreased to one-third of the non-treated trachea when the bilateral bronchial arteries were transected, and to nil when the cervical and mediastinal trachea was devascularized. In experiment 2, in which dogs were divided into 2 groups depending on preservation of the right bronchial artery, the trachea was stepwisely devascularized and the regional blood flow measured. This experiment indicated that the regional blood flow in the trachea when the right bronchial artery was preserved did not so remarkably diminish, though the cervical and mediastinal trachea was devascularized. In experiment 3, dogs were divided into 3 groups according to the extent of devascularization of the trachea and to the presence or absence of the preserved right bronchial artery, and were followed for 2 months postoperatively. This experiment demonstrated that the preservation of the right bronchial artery prevented tracheal necrosis caused by devascularization of the cervical and mediastinal trachea. We concluded that the regional tracheal blood flow markedly decreased and that tracheal necrosis occurred following devascularization of the cervical and mediastinal trachea when the bilateral bronchial arteries were transected. The preservation of the right bronchial artery however, prevented a decrease in the regional blood flow and necrosis of the widely devascularized trachea.

The latissimus dorsi muscle flap is useful for the repair of tracheal defects--an experimental study.

An experiment was designed to evaluate the limitations of the muscle flap method in treating various locations and sizes of tracheal defects. Five groups of dogs with several types of tracheal defects were prepared. Each defect was covered by the latissimus dorsi muscle flap. Defects of the tracheal membrane (posterior one-third of the tracheal wall) were successfully repaired by the muscle flap without stenosis, even if they extended to 10 rings in length or were situated at the carina. Defects in the posterior one-half of the trachea, up to 5 rings long, were repaired, with minimal stenosis. Defects of the posterior two-thirds, or anterior one-third of the trachea, resulted in marked stenosis following muscle flap repair. Tracheal movement as seen in the saver sheath type of tracheomalasia was observed when anterior support of the trachea was lost. On the other hand, the movement seen in the crescent type of tracheomalasia was observed when posterior support of the trachea was lost. We concluded that a defect of less than the posterior one-half of the trachea can be repaired by muscle flap, without inducing respiratory insufficiency. Therefore, muscle flap coverage for tracheal defects should be a useful technique in the combined resection of the tracheobronchial tree in cases of esophageal cancer.

Intrathoracic application of the latissimus dorsi muscle for esophageal cancer operation

In order to reinforce the difficult closure of the bronchial stump, or esophageal anastomosis, a pedicle flap, taken from the latissimus dorsi muscle, was applied to 7 patients with tracheal repairs, and 11 patients with extensively dissected areas, at the time of esophageal cancer surgery. Utilizing this technique, the complications associated with extended esophagectomy could be minimized. Intrathoracic application of the latissimus dorsi muscle flap is a useful method of supporting extended esophagectomy for esophageal cancer.

Surgical treatment of recurrent tracheo-esophageal fistula using a latissimus dorsi pedicled muscle flap--report of a case.

We report herein, a case of a child in whom a prepared latissimus dorsi muscle flap was successfully utilized in the treatment of recurrent tracheo-esophageal fistula (TEF). A 12-month-old girl who had undergone a primary repair of Gross’s type C esophageal atresia at 6 days of age and a secondary repair of recurrent TEF at 4 months of age experienced, postoperatively, repeated episodes of aspiration pneumonia caused by recurrence of the fistula. Thus, we performed a reoperation in which the fistula was excised, and a latissimus dorsi muscle pedicled flap was interposed between the tracheal and esophageal suture lines. Viability of the muscle flap was adequately achieved by means of a three-stage delayed operation. Although a minor anastomotic leakage of the esophagus was found postoperatively, it healed spontaneously, and the patient was commenced on a normal diet orally without any problems at 26 months of age.

A New Modality of Chemotherapy in the Treatment of Esophageal Carcinoma Using Angiotensin II-Induced Hypertension and OK-432-Induced Hyperthermia

In the treatment of patients with malignant tumors of the esophagus, conventional chemotherapeutic regimens have brought little improvement in long-term survival [1–3]. In view of the limited gains resulting from the therapy of these highly lethal diseases, new effective modalities are needed to improve the prognoses. The present report concerns our new method of cancer chemotherapy in combination with angiotensin II—induced hypertension and OK−432—induced hyperthermia (hypertensive-hyperthermo-chemotherapy [HHC]).

Clinical analysis and treatment for strictured anastomosis of the esophagus.

食道の吻合部狭窄の成因について検討し, その対策として, 教室で開発した拡張法を紹介した.食道吻合における吻合部狭窄の頻度は14% (12/92) で, このうち径9mmの内視鏡が通過不能の高度狭窄例は7% (6/92) であった.吻合部狭窄は手縫吻合例より器械吻合例に多く, とくに外径25mmのEEAを使用した症例に多かった.メラ製中山式食道内チューブ (Indwelling tube) を改造し, 種々の型のブジーを作成した.とくにGIF-P3やBF-1TRをガイドとする内視鏡下のブジーは安全で有効であった.しかし, 狭窄が高度なため内視鏡下電気切開を行った症例の半数 (2/4) は再狭窄をきたし, 頻回の拡張術を必要とした.