症例報告
EUSガイド下膵仮性嚢胞ドレナージが有効であった膵癌の1例

山本　龍一^＊，高林　英日己，寺井　悠二，小林　泰輔，青山　徹，加藤　真吾，岡　政志，名越　澄子，屋嘉比　康治
埼玉医科大学　総合医療センター　消化器・肝臓内科

〔平成28年5月9日 受付 / 平成28年7月19日 受理〕

A case of pancreatic cancer with pseudocyst successfully treated by EUS-guided drainage
Ryuichi Yamamoto^＊, Hidehiko Takabayashi, Yuji Terai, Taisuke Kobayashi, Toru Aoyama, Shingo Kato, Masashi Oka, Sumiko Nagoshi, Koji Yakabi
Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University

A 58-year-old man complaining of jaundice was diagnosed with advanced cancer in the head of the pancreas and pancreatic pseudocyst. After the placement of a 7Fr plastic biliary stent, endoscopic ultrasonography-guided pseudocyst drainage was successfully performed. The cytology of pseudocyst fluid was class V.The jaundice and abdominal pain improved. The patient underwent FOLFILINOX chemotherapy without major complaints. Here, we report a case of pancreatic pseudocyst associated with pancreatic cancer that was successfully treated with endoscopic pseudocyst drainage, and chemotherapy.

J Saitama Medical University 2016; 43: 1-6
(Received May 9, 2016 / Accepted July 19, 2016)

Keywords: pancreatic cancer, pseudocyst, EUS-guided drainage

原 著
結腸癌および直腸 S 状部癌における腹腔鏡手術の手術時間短縮に関する研究　-多孔式と単孔式腹腔鏡手術のビデオ分析を用いた比較検討-

田代 浄^＊，山口 茂樹
埼玉医科大学 国際医療センター 消化器外科

〔平成27年12月21日 受付 / 平成28年8月16日 受理〕

Shortening the operative time of laparoscopic colon and rectosigmoid cancer surgery: A comparison of multi-port surgery and single-port surgery using video analysis

Jo Tashiro^＊, Shigeki Yamaguchi

【Purpose】Reducing the operative time of laparoscopic colorectal cancer surgery is desirable. The potential to shorten the operative time of laparoscopic surgery was studied by single-port laparoscopic surgery (SPS) which used less ports and a less assistant surgeon workload than multi-port laparoscopic surgery (MPS).
【Methods】A total of 106 consecutive colon and rectosigmoid cancer patients, including 53 patients who underwent MPS from October 2012 to December 2013, as well as 53 patients who underwent SPS from SPS induction until January 2014, were selected. The operative time was compared between MPS and SPS. In addition, a video review was performed as part of procedure.
【Results】The major factors to shorten operative time were fewer trocar insertions, solo surgery which reduced the assistant surgeon’s work time, prior umbilical laparotomy, and omission of temporary abdominal wall closure. It was estimated that the operative time of SPS was shorter than that of MPS by more than 10 min.
【Conclusions】The possibility to shorten operative time of laparoscopic colorectal surgery has great potential. Several factors highlighted by video analysis contributed to shortening operative time. Shortened laparoscopic surgery times were enabled by reviewing procedures following SPS for colon cancer and RS cancer, including advanced cancer. Video analysis highlighted the factors contributing to a shortened operative time. These results have positive implications for both patients and gastroenterological surgeons.

J Saitama Medical University 2017; 43(2): 143-153
(Received December 21, 2015 / Accepted August 16, 2016)

Keywords: shorten operative time, single-port laparoscopic surgery (SPS), multi-port laparoscopic surgery (MPS), colorectal cancer, video analysis

Original
Short segment pedicle screw fixation by using additional screws at the fracture level　- for the fixation of thoracolumbar burst fractures -

Tetsuya Torio^1,2)*, Jun Kikkawa^1,2), Fumihiro Kannari^1,2), Keiko Suzuki^1,2), Manabu Nemoto²⁾, Hiromi Oda¹⁾
1) Department of Orthopaedic Surgery, Saitama Medical University
2) Department of Emergency and Acute Medicine, Saitama Medical University International Medical Center, Critical Care Center

　Short segment pedicle screw fixation (non-segmental SSPSF) is an excellent technique to preserve segmental motion for thoracolumbar burst fractures (TLBFs). However, unacceptable failures, such as vertebral collapse and progression of kyphosis, have been reported. Therefore, to evaluate the effectiveness of SSPSF with additional pedicle screws in the fractured vertebra (segmental SSPSF) in maintaining fracture reduction, a clinical course for patients was followed until after implant removal.
　This study included 11 patients in a non-segmental group (Group A) and 24 patients in a segmental group (Group B). The mean age was 48.7 years and 46.9 years, and mean follow-up duration was 36 months and 29.4 months.
　The anterior vertebral height compression ratio (AVHC) at the time of injury (pre-operatively) in Group A and Group B was 41.67 % and 38.38 % (P=0.62). The local kyphosis angle (KA) was 14.55° and 14.04° (P=0.88). The immediate postoperative AVHC was 15.25 % and 10.88 %, respectively (P=0.08); and the KA was 1.18° and 1.42° (P=0.91). Satisfactory initial reduction was achieved in both groups. At the time of bone union, the AVHC was significantly different, 30.69 % and 13.61 %, respectively (P<0.05), and the KA was significantly different, 16° and 4.46°, respectively (P<0.05). After implant removal, the AVHC correction loss was only 3.5 % and 2.27 %, and the KA loss was only 4.5° and 3.46°.
　Satisfactory initial reduction and kyphosis correction were achieved with SSPSF. However, reduction and kyphosis correction were not adequately maintained by non-segmental SSPSF, but they were effectively maintained by segmental SSPSF with additional pedicle screws in the fractured vertebra. In addition, implant removal is recommended to regain segmental motion.

J Saitama Medical University 2017; 43(2): 155-161
(Received October 16, 2016 / Accepted January 10, 2017)

Keywords: thoracolumbar, short segment, additional screw, fracture level, pedicle screw