Hiroyuki Sugo

Hepatic resection using the harmonic scalpel.

We describe herein our technique of performing extensive resection of the liver by blunt dissection in combination with excision using a harmonic scalpel. A ball coagulator was inserted at 3-cm intervals along the proposed cutting line in the liver, and the liver parenchyma between these holes was then cut using coagulation shears. Regardless of the condition of the liver, good coagulation and cutting were achieved using the harmonic scalpel without vascular occlusion when dividing the shallow layer of the liver, and no complications in association with the harmonic scalpel, such as postoperative bleeding, bile leakage, or abscess formation at the cut margins, occurred. In the deep layer below the main trunk of the hepatic vein, blunt dissection was used, since it was difficult to achieve sufficient control of bleeding from large vessels using the harmonic scalpel alone. Therefore, when used in combination with other techniques, the harmonic scalpel appears to be an effective device for liver surgery that minimizes bleeding and decreases the vascular clamping time.

The influence of viral genotypes and rejection episodes on the recurrence of hepatitis C after liver transplantation

AbstractPurpose. The aim of this study was to report the influence of hepatitis C virus (HCV) genotype and rejection episodes on the outcome of orthotopic liver transplantation (OLT), hepatitis recurrence, and progression to graft cirrhosis after OLT.nMethods. Fifty-three patients who all had undergone OLT for end-stage liver cirrhosis were selected for this study. Hepatitis C genotype was determined. Recurrent hepatitis and rejection were diagnosed based on elevated liver function tests and a liver biopsy.nResults. The patients were followed up for a mean of 51.9 ± 34.3 months. The cumulative survival rate was no different in OLT for hepatitis C and OLT for all other liver diseases. After OLT, serum HCV RNA was detected in 93%. Histological recurrence occurred in 85% of all patients. The 1-, 3-, and 5-year recurrence rates were 48%, 77%, and 85%, respectively. Of the 41 patients with recurrent hepatitis C, 4 (10%) had cirrhosis, 18 (44%) had hepatitis with fibrosis, and 91 (46%) had hepatitis without fibrosis at the end of follow-up. A total of 32% of the patients were infected by HCV genotype 1b and 68% by other HCV genotypes. The recurrence rates were significantly higher in patients infected with genotype 1b than in those with other genotypes (p = 0.04). Twenty of 48 patients (42%) experienced acute rejection. There was a strong association between the number of rejection episodes and the incidence of HCV-related cirrhosis (p < 0.01).nConclusion. Our findings showed the genotype 1b to result in a higher recurrence rate after OLT. On the other hand, rejection episodes were associated with a more rapid progression to graft cirrhosis.

A Case of Congenital Esophageal Stenosis Operated on at the Age of 23.

症例は23歳の女性で, 離乳食開始時より食後の嘔吐を認められていた. 徐々に嚥下困難が進行し, 6歳時に先天性食道狭窄症と診断されたが, 合併奇形は認められていない. 以後, 近医で内視鏡検査, 食道造影にて経過観察をし, 時にbougieを行っていた. 22歳時の検査にて内視鏡ファイバーが通過困難となり, 手術目的にて当院外科入院となった. 当院での内視鏡検査にて切歯より約30cmと40cmの部位2か所に狭窄が認められた. 平成10年11月12日, 右開胸開腹食道亜全摘, 胸腔内胃管食道吻合, 胆摘, 幽門形成が施行された. 病理組織診断にて2か所の狭窄とも筋性線維性食道狭窄症と診断された. 本症例は狭窄部が2か所認められたこと, 保存的治療が無効であったことより食道亜全摘術が施行された. 成人例の先天性食道狭窄症の報告は少なく, また, 2か所に狭窄を有した筋性線維性狭窄は本邦での報告がなくまれな症例である.