Mitsuru Dohke

Perineural invasion by ductal adenocarcinoma of the pancreas

The correlation between various levels of perineural invasion by pancreatic carcinoma and the patients prognosis has never been cleared. The authors carried out a histopathologic study of resected pancreatic carcinoma to elucidate the significance of a new histologic finding concerning perineural invasion, which we designated “ntrapancreatic, extratumoral perineural invasion (nex),” and also to determine its predictive value for prognoses of patients after surgical removal of the tumor.

Comparison of Bassini Repair and Mesh-Plug Repair for Primary Inguinal Hernia: A Retrospective Study

Abstract The purpose of this study was to compare the mesh-plug repair with the Bassini repair for the treatment of primary unilateral inguinal hernias. Patients with primary unilateral inguinal hernias who underwent a Bassini repair (n = 118) between January 1992 and May 1996 and a mesh-plug repair (n = 113) between July 1996 and April 1998 were retrospectively reviewed. We recorded information regarding the types of hernia according to Nyhus classification, operation time, complications, postoperative recovery, and recurrence after surgery. The two groups were comparable regarding age, sex, side of hernia, types of hernia, and the follow-up interval. The operation time was 55 ± 20 min for Bassini repair and 54 ± 18 min for mesh-plug repair. There was no incidence of mesh infection in the mesh-plug repair cases. The amount of diclofenac sodium (suppository) was 307 ± 222 mg in the Bassini repair group and 132 ± 182 mg in the mesh-plug repair group (P < 0.0001). The length of hospital stay was 8.2 ± 2.0 days in the Bassini repair group and 4.3 ± 2.7 days in the mesh-plug repair group (P < 0.01). Nine patients (7.6%) in the Bassini repair group had recurrence, compared with one patient (0.9%) in the mesh-plug repair group. The recurrence-free survival in the mesh-plug repair group was significantly longer than that in the Bassini repair group (P = 0.03). In conclusion, patients with primary unilateral inguinal hernias who undergo a mesh-plug repair recover more rapidly and have less recurrence in comparison with those who undergo a Bassini repair.

A Case of Portal Vein Gas Which was Treated Conservatively and was Potentially Related to the Behcet's Disease

最近の画像診断技術の進歩により, 臨床の現場で門脈ガス血症に出会う機会が増え, その報告数も増加してきている. かつて門脈ガス血症は予後不良の兆候として報告され, 死亡率が75%とも言われていたが, 最近では治癒しえた, 救命しえたという報告が多い. さらに門脈ガス血症を認めたら, 即開腹手術であるという報告に警鐘を鳴らすような報告もなされている. 今回我々は, 保存的に治癒しえた門脈ガス血症の1例を経験したので報告する. なお, 患者は退院3年後にベーチェット病と診断されており, 今回の事例と何らかの因果関係が示唆された.

Duodenum-Preserving Resection of the Head of the Pancreas in Patients with Chronic Pancreatitis or Low-Grade Malignancy

Duodenum-preserving resection of the head of the pancreas was performed in 41 patients with chronic pancreatitis and 23 with pancreatic neoplastic lesions. Denervation of the body and tail of the pancreas was added for the patients with chronic pancreatitis. The major advantage of this procedure is that only the small pancreas head is resected, leaving the endocrine and exocrine systems functioning normally. This procedure provides complete pain relief for the patients with chronic pancreatitis; 92% of patients experienced alleviation of pain and no recurrence. Postoperatively, 76% of patients could work well, and 87% maintained their preoperative body weight. Postoperative glucose tolerance test showed 21% of the patients with preoperative diabetic pattern improved to the nondiabetic pattern between 3 months and 3 years after surgery. In 23 patients with pancreatic neoplasms, 22 patients were alive during the follow-up period with no recurrence of the tumor, except 1 patient who died of acute myocardial infarction. We concluded that our procedure allows, patients with chronic pancreatitis to be free from intractable pain and to maintain good endocrine function of the pancreas. Furthermore, this procedure can be applied to patients with low-grade malignant lesions of the pancreas.

Clinicopathologic evaluation of mucin‐producing tumor of the pancreas

We studied the diagnostic problems, surgical management, and histopathologic characteristics of 28 patients with intra-ductal tumors and mucinous cystadenomas of the pancreas who underwent surgical resection. Endoscopic ultrasonography (EUS) and endoscopic retrograde pancreatography (ERP) were the most useful means for confident diagnosis of the diseases. New diagnostic modalities, including intra-pancreatic ductal endoscopy and intraductal ultrasonography, also improved the qualitative diagnosis of these tumors. Minimally invasive surgery i.e., duodenum-and choledochus-preserving resection of the head of the pancreas, was conducted in our patients. The long-term results were good and no patients had disease recurrence. Although these diseases are regarded as precancerous lesions of the pancreas, there were several unclear points regarding biologic behavior and the correlation with invasive cystadenocarcinoma. Thus, a molecular biological explanation concerning the roles of oncogenes such asp53 and Ki-ras in carcinogenesis is an important question that remains to be resolved.

A Case of Pancreas Head Carcinoma Associated with Stenosis of the Celiac Axis. The Significance of Intraoperative Evaluation of the Hepatic Artery.

腹腔動脈起始部に正中弓状靱帯による狭窄を伴った膵癌に対し, 電磁血流量計で肝動脈血流量を測定しながら安全に膵頭十二指腸切除術を施行できた1例を報告する.症例は52歳の男性.上腸間膜動脈造影検査で, 膵頭部アーケードが著明に拡張し, 下膵十二指腸動脈, 胃十二指腸動脈を介して肝動脈, 脾動脈が描出された.大動脈造影側方向像で腹腔動脈起始部に腹側からの圧排狭窄を認め, 腹腔動脈起始部に狭窄を伴った膵頭部癌と診断した.術中の電磁血流量計による左肝動脈血流量は正常時20ml/秒, 胃十二指腸動脈遮断時20ml/秒, 総肝動脈遮断時4ml/秒, 胃十二指腸動脈と正中弓状靱帯切離後に26ml/秒であった.腹腔動脈起始部に狭窄を伴った患者の膵頭部切除時には, 肝動脈血流量を測定しながら, 手術操作をすすめることが術後合併症の予防に必須であると考えられた.

A Case of Bile Duct Carcinoma Reconstructed Right Hepatic Artery with Jejunal Artery of the Efferent Limb.

右肝動脈に浸潤した中部胆管癌に対し, 右肝動脈再建を伴った幽門輪温存膵頭十二指腸切除を施行した. 症例は64歳の男性. 閉塞性黄疸で入院した. 経皮経肝胆道ドレナージで, 中部胆管に狭窄を, 血管造影検査で右肝動脈に不整狭窄を認めた. 右肝動脈に浸潤した中部胆管癌と診断し, 膵頭十二指腸切除術を予定した. 腫瘤と右肝動脈は剥離不能であり, 浸潤部を合併切除した. この際, 右肝動脈からの血液の逆流を認めなかった. 胆道再建に用いる挙上空腸脚とともに第2空腸動脈を肝門部に持ち上げ空腸動脈と右肝動脈吻合を施行した. 術後経過良好で血管造影により右肝動脈の開存が確認された. 本例は左右肝動脈の交通が不良であり, 右肝動脈再建の適応と思われた. 挙上空腸脚動脈は胆道再建を伴う胆膵手術時の肝動脈再建の選択肢の1つになりうると思われる.