研究等業績 - その他 - 栗山　章司

Extracorporeal Membrane Oxygenation-Assisted Thoracic Surgery: A Series of 10 Cases

Harata Yuzu, Imai Kazuhiro, Takashima Shinogu, Kuriyama Shoji, Iwai Hidenobu, Suzuki Haruka, Demura Ryo, Shibano Sumire, Minamiya Yoshihiro

Surgical Case Reports ( 一般社団法人 日本外科学会 )  11 ( 1 ) n/a   2025年

<p><b>INTRODUCTION:</b> Extracorporeal membrane oxygenation (ECMO) is a type of extracorporeal circulation used to divert blood from and deliver blood to peripheral blood vessels. Recently, the use of ECMO has been reported in various non-transplant surgeries. Particularly in tracheal surgeries, ECMO provides an unobstructed surgical field and enables safe induction of general anesthesia in difficult intubation cases. Here, we report on 10 cases of thoracic surgery in which ECMO was employed at our institution.</p><p><b>CASE PRESENTATION:</b> These 10 cases comprise 4 tracheal cancer surgeries, 2 lung cancer surgeries, and 1 case each of surgery for thyroid cancer, mediastinal cancer, tracheomalacia, and tracheobronchial injury. Veno-venous (VV)-ECMO is most often selected, but veno-arterial (VA)-ECMO is chosen when recirculation with VV-ECMO is unacceptable, when pulmonary artery bleeding needs to be controlled, or when cardiac support is necessary. Among the 10 presented cases, VV-ECMO was used in 8, while VA-ECMO was employed in 2. Three of these cases involved ECMO bailout due to dyspnea caused by airway stenosis. Six of the patients did not receive heparin maintenance. Of those, 1 was maintained on nafamostat mesilate, 2 were maintained on nafamostat mesilate after receiving a single dose of heparin, and 3 received only a single dose of heparin. In none of those cases did ECMO fail to maintain flow due to thrombus formation. A postoperative hemothorax occurred as one of the ECMO-related complications in Case 4. There were no perioperative cardiopulmonary complications, in-hospital deaths, or deaths within 30 days after surgery. One patient died from metastatic recurrence of non-small cell lung cancer 5 months after surgery, another from progression of disease in mediastinal anaplastic cancer 4 months after surgery, and the 3rd from upper gastrointestinal bleeding 2 years after surgery. The other 7 patients remain alive.</p><p><b>CONCLUSIONS:</b> ECMO is useful in tracheal surgery and in cases where intubation is difficult or dangerous, because it facilitates safe and accurate surgery. We also believe that individualized anticoagulant strategies can be safely implemented.</p>

DOI CiNii Research

Multiplex Intraoperative Rapid Immunohistochemistry with Noncontact Antibody Mixing for Distinguishing the Histologic Phenotype of Lung Cancer

Kuriyama S.

Pathobiology ( Pathobiology )  91 ( 6 ) 383 - 392   2024年12月

DOI

Does clinical T1N0 GGN really require checking for distant metastasis during initial staging for lung cancer?

Imai K.

Cancer Imaging ( Cancer Imaging )  24 ( 1 ) 69 - 69   2024年12月

BACKGROUND: Accurate clinical staging is crucial for selection of optimal oncological treatment strategies in non-small cell lung cancer (NSCLC). Although brain MRI, bone scintigraphy and whole-body PET/CT play important roles in detecting distant metastases, there is a lack of evidence regarding the indication for metastatic staging in early NSCLCs, especially ground-grass nodules (GGNs). Our aim was to determine whether checking for distant metastasis is required in cases of clinical T1N0 GGN. METHODS: This was a retrospective study of initial staging using imaging tests in patients who had undergone complete surgical R0 resection for clinical T1N0 Stage IA NSCLC. RESULTS: A total of 273 patients with cT1N0 GGNs (n = 183) or cT1N0 solid tumors (STs, n = 90) were deemed eligible. No cases of distant metastasis were detected on initial routine imaging evaluations. Among all cT1N0M0 cases, there were 191 incidental findings on various modalities (128 in the GGN). Most frequently detected on brain MRI was cerebral leukoaraiosis, which was found in 98/273 (35.9%) patients, while cerebral infarction was detected in 12/273 (4.4%) patients. Treatable neoplasms, including brain meningioma and thyroid, gastric, renal and colon cancers were also detected on PET/CT (and/or MRI). Among those, 19 patients were diagnosed with a treatable disease, including other-site cancers curable with surgery. CONCLUSIONS: Extensive staging (MRI, scintigraphy, PET/CT etc.) for distant metastasis is not required for patients diagnosed with clinical T1N0 GGNs, though various imaging modalities revealed the presence of adventitious diseases with the potential to increase surgical risks, lead to separate management, and worsen patient outcomes, especially in elderly patients. If clinically feasible, it could be considered to complement staging with whole-body procedures including PET/CT.

DOI PubMed

Epithelial granuloma occurring on the staple-stump after segmentectomy for ovarian cancer lung metastasis

Kuriyama S.

Thoracic Cancer ( Thoracic Cancer )  15 ( 21 ) 1681 - 1684   2024年07月

When a mass occurs at the staple line following lung resection, it can be difficult to distinguish between local cancer recurrence and granuloma. We present a case of a staple-line granuloma with 18F-fluorodeoxyglucose-positron emission tomography uptake and elevated serum carbohydrate antigen 19-9 (CA19-9) in a patient with ovarian cancer lung metastasis. After granuloma resection, serum CA19-9 levels normalized, and CA19-9 positive cells were identified in the resected tumor. Therefore, serum CA19-9 elevation does not rule out a staple-line granuloma. Whereas granulomas on computed tomography (CT) scans tend to show smooth shadows along the staple line unilaterally, detailed CT evaluation may help diagnostic differentiation. Differentiation based on imaging and tumor markers has limitations. However, core needle biopsy has the risk of misdiagnosis and tumor cell dissemination, therefore surgical resection should be considered when comprehensive findings indicate a potential recurrence.

DOI PubMed

再生検が有用であった再発胸腺上皮性腫瘍の経験

鈴木 陽香, 今井 一博, 高嶋 祉之具, 栗山 章司, 岩井 英頌, 出村 遼, 原田 柚子, 柴野 菫, 南谷 佳弘, 南條 博

日本呼吸器外科学会雑誌 ( (一社)日本呼吸器外科学会 )  38 ( 3 ) MO55 - 4   2024年04月

再発病変への生検が有用であった多発肺癌の経験

柴野 菫, 高嶋 祉之具, 今井 一博, 栗山 章司, 出村 遼, 岩井 英頌, 鈴木 陽香, 原田 柚子, 南谷 佳弘

日本呼吸器外科学会雑誌 ( (一社)日本呼吸器外科学会 )  38 ( 3 ) MO9 - 1   2024年04月

右上肺静脈の走行異常を術前3D-CTにて把握し右中葉切除術を施行した浸潤性粘液腺癌の1切除例

出村 遼, 今井 一博, 高嶋 祉之具, 栗山 章司, 鈴木 陽香, 岩井 英頌, 原田 柚子, 柴野 菫, 南谷 佳弘

日本呼吸器外科学会雑誌 ( (一社)日本呼吸器外科学会 )  38 ( 3 ) MO21 - 6   2024年04月

右下葉肺癌に対するSleeve Right Lower Lobectomyの有用性

原田 柚子, 今井 一博, 高嶋 祉之具, 栗山 章司, 岩井 英頌, 鈴木 陽香, 出村 遼, 柴野 菫

日本呼吸器外科学会雑誌 ( (一社)日本呼吸器外科学会 )  38 ( 3 ) MO28 - 3   2024年04月

秋田大学呼吸器外科における術後再発・一次治療でのOsimertinibの使用経験

高嶋 祉之具, 今井 一博, 栗山 章司, 出村 遼, 鈴木 陽香, 岩井 英頌, 原田 柚子, 柴野 菫, 南谷 佳弘

日本呼吸器外科学会雑誌 ( (一社)日本呼吸器外科学会 )  38 ( 3 ) MO49 - 4   2024年04月

高齢肺癌患者に対する術前CTにおける横隔膜筋厚と術後合併症・予後との関連性についての検討

栗山 章司, 今井 一博, 高嶋 祉之具, 岩井 英頌, 鈴木 陽香, 出村 遼, 原田 柚子, 柴野 菫, 南谷 佳弘

日本呼吸器外科学会雑誌 ( (一社)日本呼吸器外科学会 )  38 ( 3 ) O64 - 4   2024年04月

Radio Isotope法と術中intact-PTHモニタリングを併用し摘出した縦隔内異所性副甲状腺腺腫の1例

原田 柚子, 今井 一博, 髙嶋 祉之具, 栗原 伸泰, 栗山 章司, 南谷 佳弘

日本呼吸器外科学会雑誌 ( 一般社団法人 日本呼吸器外科学会 )  38 ( 2 ) 99 - 105   2024年03月

<p>症例は74歳女性．血清Caとintact-PTHの高値を指摘され，原発性副甲状腺機能亢進症の疑いで^99mTc-MIBI SPECTを実施．右上縦隔に点状の集積を認め，縦隔内異所性副甲状腺腺腫の診断で切除目的に当科へ紹介された．標的病変は縦隔脂肪織内に埋没しており術中局在同定が困難と予想され，^99mTc-MIBIを用いたRadio Isotope法と術中intact-PTHモニタリング法を併用し手術に臨んだ．第3肋間前腋窩線上に6 cmの小開胸を置き，胸腔鏡補助下に縦隔脂肪織内の病変を切除した．摘出病変は^99mTc高集積であり，血中intact-PTHも切除後10分で低下が得られ，完全切除と判断した．最終病理診断は異所性副甲状腺腺腫であり，1年6ヵ月経過した現在まで高Ca血症や腺腫の再発なく経過している．術中同定困難な縦隔内異所性甲状腺腺腫においては，Radio Isotope法や術中intact-PTHモニタリング法などを用いることで正確な腫瘍位置の特定が可能であり，遺残病変の有無も術中に遅滞なく確認できることから，再発率の低下にも寄与し得る．</p>

DOI CiNii Research

Radio Isotope法と術中intact-PTHモニタリングを併用し摘出した縦隔内異所性副甲状腺腺腫の1例

原田 柚子, 今井 一博, 高嶋 祉之具, 栗原 伸泰, 栗山 章司, 南谷 佳弘

日本呼吸器外科学会雑誌 ( (一社)日本呼吸器外科学会 )  38 ( 2 ) 99 - 105   2024年03月

症例は74歳女性.血清Caとintact-PTHの高値を指摘され,原発性副甲状腺機能亢進症の疑いで99mTc-MIBI SPECTを実施.右上縦隔に点状の集積を認め,縦隔内異所性副甲状腺腺腫の診断で切除目的に当科へ紹介された.標的病変は縦隔脂肪織内に埋没しており術中局在同定が困難と予想され,99mTc-MIBIを用いたRadio Isotope法と術中intact-PTHモニタリング法を併用し手術に臨んだ.第3肋間前腋窩線上に6cmの小開胸を置き,胸腔鏡補助下に縦隔脂肪織内の病変を切除した.摘出病変は99mTc高集積であり,血中intact-PTHも切除後10分で低下が得られ,完全切除と判断した.最終病理診断は異所性副甲状腺腺腫であり,1年6ヵ月経過した現在まで高Ca血症や腺腫の再発なく経過している.術中同定困難な縦隔内異所性甲状腺腺腫においては,Radio Isotope法や術中intact-PTHモニタリング法などを用いることで正確な腫瘍位置の特定が可能であり,遺残病変の有無も術中に遅滞なく確認できることから,再発率の低下にも寄与し得る.(著者抄録)

Intraoperative rapid immunohistochemistry of microsatellite instability using non-contact alternating current electric field mixing

Imai K.

General Thoracic and Cardiovascular Surgery ( General Thoracic and Cardiovascular Surgery )    2024年

OBJECTIVES: Tumors caused by failure of the DNA-mismatch repair system generally show microsatellite instability (MSI). High-frequency MSI cancers have been shown to be susceptible to immuno-oncology therapies. The aim of this study was to evaluate the clinical reliability of a rapid immunohistochemistry (IHC) technique for intraoperatively assessing molecular status through detection of tumoral deficiencies in the expression of mismatch repair proteins (dMMR; MLH1, MSH2, MSH6, and PMS2). METHODS: The rapid IHC method uses non-contact alternating current (AC) mixing to achieve more rapid/stable staining within a minimum of 13 min during surgery. Sixteen formalin-fixed paraffin-embedded (FFPE) tumor samples from 3 dMMR patients with Lynch syndrome and 6 FFPE samples from 6 dMMR-cancer patients were collected to establish an IHC protocol for MMR proteins. Next, 26 surgical patients treated and whose MSI status was determined using PCR-based tests were retrospectively analyzed. The concordance of dMMR diagnoses for thoracic tumors between the conventional (frozen section (FS)- and FFPE-IHCs) and rapid AC-mixing IHC with FSs were compared. RESULTS: A rapid IHC protocol using primary antibodies against four MMR proteins (mixed 5-10 min) was established (entire process within 40 min). The concordance rate for MMR-IHC between the conventional and rapid IHC was 100%. dMMR diagnoses including an MSI-high pulmonary sarcoma patient entirely matched between FS- and FFPE-IHC. CONCLUSION: Rapid MMR-IHC could potentially serve as a clinical tool for intraoperative determination of tumor MSI/dMMR status. AC-mixing technology will contribute to improving pathological diagnostic capability through the development of an original and innovative rapid IHC.

DOI PubMed

Transmanubrial approachが有用だった肺尖部胸壁浸潤癌の1手術例

藤林 立吉, 今井 一博, 高嶋 祉之具, 栗山 章司, 鈴木 陽香, 出村 遼, 原田 柚子, 柴野 菫, 南谷 佳弘

肺癌 ( (NPO)日本肺癌学会 )  63 ( 7 ) 1016 - 1016   2023年12月

COVID-19感染者に発生した外傷性気管分岐部損傷に対して緊急修復術を施行した1例

出村 遼, 今井 一博, 高嶋 祉之具, 栗原 伸泰, 栗山 章司, 鈴木 陽香, 原田 柚子, 南谷 佳弘

日本臨床外科学会雑誌 ( 日本臨床外科学会 )  84 ( 11 ) 1813 - 1814   2023年11月

気道狭窄症の外科治療における心臓血管外科の役割

堀江 祐紀, 桐生 健太郎, 角浜 孝行, 山浦 玄武, 田中 郁信, 高木 大地, 板垣 吉典, 荒井 岳史, 和田 卓也, 五十嵐 至, 五十嵐 亘, 今井 一博, 高嶋 祉之具, 栗原 信泰, 栗山 章司, 鈴木 陽香, 出村 遼, 原田 柚子, 森下 葵, 山本 浩史, 南谷 佳弘

日本臨床外科学会雑誌 ( 日本臨床外科学会 )  84 ( 11 ) 1814 - 1814   2023年11月

電界撹拌技術を応用した迅速免疫組織化学染色(R-IHC)によるMSI&PD-L1術中迅速診断法の開発

今井 一博, 齊藤 元, 柳川 直樹, 高嶋 祉之具, 松尾 翼, 栗山 章司, 菅井 有, 南谷 佳弘

日本胸部外科学会定期学術集会 ( (一社)日本胸部外科学会 )  76回   JP3 - 2   2023年10月

気胸・肺気腫の病態と治療戦略 COPDの重症度別にみた肺葉切除術後呼吸機能の検討

鈴木 陽香, 今井 一博, 高嶋 祉之具, 栗山 章司, 出村 遼, 原田 柚子, 藤林 立吉, 柴野 菫, 南谷 佳弘

日本気胸・嚢胞性肺疾患学会雑誌 ( 日本気胸・嚢胞性肺疾患学会 )  23 ( 2 ) 68 - 68   2023年08月

Tracheal bifurcation repair for blunt thoracic trauma in a patient with COVID-19

Shoji Kuriyama, Kazuhiro Imai, Kasumi Tozawa, Shinogu Takashima, Ryo Demura, Haruka Suzuki, Yuzu Harata, Tatsuki Fujibayashi, Sumire Shibano, Yoshihiro Minamiya

Surgical case reports     2023年06月  [査読有り]

単著

COVID-19感染を伴う外傷性気管分岐部損傷に対してECMO下に修復術を施行した1例

栗山 章司, 今井 一博, 高嶋 祉之具, 栗原 伸泰, 出村 遼, 鈴木 陽香, 原田 柚子

日本呼吸器外科学会雑誌 ( (一社)日本呼吸器外科学会 )  37 ( 3 ) P30 - 2   2023年06月