河原　仁守 (カワハラ　インス)

医学研究院　外科系部門　外科学分野特任助教
Last Updated :2024/12/06

■研究者基本情報

学位

  • 医学博士, 自治医科大学大学院医学研究科, 2017年03月

Researchmap個人ページ

ホームページURL

J-Global ID

研究キーワード

  • 肝芽腫
  • 先天性気管狭窄症

■研究活動情報

論文

  • Right esophageal lung with esophageal atresia and left bronchial stenosis.
    Keiichi Morita, Insu Kawahara, Hiroki Yashita, Tadashi Hatakeyama
    Pediatrics international : official journal of the Japan Pediatric Society, 64, 1, e14982, 2022年01月, ［国際誌］
    英語, 研究論文（学術雑誌）
  • AFP-L3 as a Prognostic Predictor of Recurrence in Hepatoblastoma: A Pilot Study.
    Insu Kawahara, Hiroaki Fukuzawa, Naoto Urushihara, Yoshiyuki Kosaka, Yasuhiro Kuroda, Yuki Fujieda, Yuki Takeuchi, Kotaro Uemura, Tamaki Iwade, Yoshitomo Samejima, Keiichi Morita, Kosaku Maeda
    Journal of pediatric hematology/oncology, 43, 1, e76-e79, 2021年01月, ［査読有り］, ［筆頭著者］, ［国際誌］
    英語, 研究論文（学術雑誌）, The α-fetoprotein (AFP) level is a sensitive biomarker of active hepatoblastoma (HB). This study aimed to clarify whether the Lens culinaris agglutinin A-reactive fraction of AFP (AFP-L3) after complete resection is a prognostic predictor of HB recurrence. Fourteen HB patients who underwent complete resection of HB were divided into the recurrence group (RG, n=4) and the non-recurrence group (NRG, n=10). The AFP level and AFP-L3 before and after radical surgery were compared between the 2 groups. There was no significant difference in AFP levels in the early postoperative period between the 2 groups (P=0.54), and AFP was not an early prognostic factor for HB recurrence. At 2 months after surgery, the AFP-L3 fell below the detection limit only in the NRG (7/10 cases) (NRG=70.0% vs. RG=0%, P=0.03). In addition, there were some cases of recurrence in those whose AFP level decreased to the normal range, but none in those whose AFP-L3 fell below the detection limit. In conclusion, the AFP-L3 decreased earlier than did the AFP level; thus, the AFP-L3 after complete resection may be a predictor for HB recurrence.
  • Hemi-Clamshell Approach for Fetal Lung Interstitial Tumor Resection in a Neonate: A Case Report.
    Yasuhiro Kuroda, Hiroaki Fukuzawa, Insu Kawahara, Keiichi Morita
    European journal of pediatric surgery reports, 9, 1, e72-e75, 2021年01月, ［国際誌］
    英語, Fetal lung interstitial tumor (FLIT) is a rare primary lung mass in neonates. Classical incisions, such as posterolateral thoracotomy or median sternotomy, do not provide optimal exposure of the operative field for the resection of pediatric thoracic giant tumors. Herein, we report a rare case of a FLIT in a full-term male neonate, with complete resection achieved using a hemi-clamshell approach, which provided the required visualization of the operative field. The neonate was transferred to our hospital because of mild respiratory distress, which developed 18-hour after normal vaginal delivery. A mass in his right chest, without a midline shift, was observed on chest radiographs. Computed tomography showed a well-circumscribed solid anterior cervicothoracic mass, with a uniform density and no apparent cysts, diagnosed as a primary thoracic giant tumor. Once the patient was clinically stabilized, we proceeded with right upper lobectomy, using a hemi-clamshell approach, full sternotomy, and anterolateral thoracotomy, on postnatal day 22. Histopathologic examination revealed an 8.5 × 6.5 × 4.0 cm solid mass within the right upper lobe, which was diagnosed as a FLIT. His postoperative recovery was uneventful. The patient was followed up for 1 year, with no complaints or symptoms and no postoperative shoulder dysfunction. Gross total resection of primary thoracic giant tumors can be accomplished in neonates with optimal exposure of the chest cavity using a hemi-clamshell approach.
  • Correction to: Two infant cases of intraperitoneal arterial hemorrhage due to a duplication cyst: a case report.
    Hiroaki Fukuzawa, Keisuke Kajihara, Yasuhiro Kuroda, Yuki Fujieda, Kotaro Uemura, Yuki Takeuchi, Yoshitomo Samejima, Insu Kawahara, Keiichi Morita, Tamaki Iwade, Kosaku Maeda
    Surgical case reports, 6, 1, 266, 266, 2020年10月08日, ［国際誌］
    英語, An amendment to this paper has been published and can be accessed via the original article.
  • Two infant cases of intraperitoneal arterial hemorrhage due to a duplication cyst: a case report.
    Hiroaki Fukazawa, Keisuke Kajihara, Yasuhiro Kuroda, Yuki Fujieda, Kotaro Uemura, Yuki Takeuchi, Yoshitomo Samejima, Insu Kawahara, Keiichi Morita, Tamaki Iwade, Kosaku Maeda
    Surgical case reports, 6, 1, 55, 55, 2020年03月21日, ［国際誌］
    英語, 研究論文（学術雑誌）, BACKGROUND: Intraperitoneal arterial hemorrhage without trauma is extremely rare. We report two infant cases of intraperitoneal arterial hemorrhage due to intestinal duplication. CASE PRESENTATION: In case 1, a 2-month-old girl experienced sudden intraperitoneal hemorrhage from the middle colic artery with no apparent trauma. Hemostasis was achieved with suturing of the hemorrhage point, but the cause of hemorrhage was still unknown. Computed tomography after the first operation revealed a duodenal duplication cyst and a pseudopancreatic cyst. Percutaneous drainage of the pseudopancreatic cyst was performed, and the contents had high pancreatic amylase. As the size of the duodenal duplication cyst also decreased with this drainage, we suspected that the duodenal duplication cyst was connected to the pseudopancreatic cyst and the arterial hemorrhage. We hypothesized that the pancreatic juice inside the duplication cyst leaked into the intraperitoneal cavity and caused rupture of the arterial wall. Therefore, marsupialization of the duodenal duplication was performed to evacuate the pancreatic juice contained in the cyst toward the native duodenum. The postoperative course was uneventful. In case 2, a 6-month-old boy experienced sudden intraperitoneal hemorrhage without trauma. The hemorrhage site was identified as the ileocecal artery, and hemostasis was achieved with sutures. Tissue near the hemorrhage point was biopsied, because the cause of arterial wall rupture was still unknown. The biopsied tissue was found to be intestinal mucosa. The patient had recurrent abdominal pain after the first operation, and computed tomography showed a duplication cyst located near the hemorrhage point. Therefore, we resected the intestinal duplication. Pathology results showed that the intestinal duplication contained intestinal mucosa, ectopic gastric mucosa, and pancreatic tissue. The postoperative course was uneventful. CONCLUSION: Intraperitoneal arterial hemorrhage without trauma is an extremely rare condition, and identifying its cause is difficult. To our knowledge, this is the first report of intraperitoneal arterial hemorrhage due to intestinal duplication. In cases of unexplained intraperitoneal arterial hemorrhage in infants, intestinal duplication near the hemorrhage point should be suspected.
  • Risk factors for the recurrence of perineal canal.
    Keisuke Kajihara, Hiroaki Fukuzawa, Koji Fukumoto, Naoto Urushihara, Yoshitomo Samejima, Kotaro Uemura, Kozo Nomura, Insu Kawahara, Kaori Isono, Keiiti Morita, Makoto Nakao, Akiko Yokoi, Kosaku Maeda
    Pediatric surgery international, 35, 10, 1137, 1141, 2019年10月, ［国際誌］
    英語, 研究論文（学術雑誌）, PURPOSE: The aim of this study was to investigate risk factors for recurrence in the perineal canal (PC). METHODS: Patients with PC who underwent operations were enrolled in this study and were divided into recurrence and non-recurrence groups. Preoperative infection, the age at the operation, the presence of colostomy and the treatment procedure for fistula were retrospectively investigated. Regarding the treatment procedure for fistula, either closure of the rectal wall with stitches or ligation of fistula in the rectum was performed. These factors were compared between the two groups. RESULTS: Six of 17 patients with PC who underwent surgical treatment had recurrence. There were no significant differences in the incidence of preoperative infection, age at operation or presence of colostomy (p = 0.60, 0.38, 1.00, respectively). In the recurrence group, all patients were treated by closure of the rectal wall. In the non-recurrence group, five were treated by the closure of the rectal wall with stitches and six by ligation of the fistula. There was a significant association between recurrence and the treatment procedure for fistula (p = 0.04). CONCLUSION: Closure of the rectal wall with stitches is a risk factor for the recurrence of PC.
  • 消化管穿孔を来した多発十二指腸閉鎖症の1例
    鮫島 由友, 中尾 真, 梶原 啓資, 野村 皓三, 植村 光太郎, 河原 仁守, 磯野 香織, 森田 圭一, 福澤 宏明, 横井 暁子, 前田 貢作
    日本小児外科学会雑誌, 55, 5, 999, 999, (一社)日本小児外科学会, 2019年08月
    日本語
  • 原因不明の腹腔内出血を繰り返す1乳児例
    梶原 啓資, 福澤 宏明, 植村 光太郎, 野村 皓三, 鮫島 由友, 河原 仁守, 磯野 香織, 森田 圭一, 中尾 真, 横井 暁子, 前田 貢作
    日本小児外科学会雑誌, 55, 4, 904, 905, (一社)日本小児外科学会, 2019年06月
    日本語
  • C型食道閉鎖症を合併した気管無形成に対する気道と消化管の多段階再建術の経験
    前田 貢作, 河原 仁守, 森田 圭一, 梶原 啓資, 野村 皓三, 植村 光太郎, 鮫島 由友, 磯野 香織, 福澤 宏明, 中尾 真, 横井 暁子
    日本小児外科学会雑誌, 55, 3, 501, 501, (一社)日本小児外科学会, 2019年05月
    日本語
  • 鎖肛を伴わない直腸腟前庭瘻において瘻管は直腸内翻転・結紮にとどめるべきである
    梶原 啓資, 福澤 宏明, 福本 弘二, 漆原 直人, 鮫島 由友, 植村 光太郎, 野村 皓三, 河原 仁守, 磯野 香織, 森田 圭一, 中尾 真, 横井 暁子, 前田 貢作
    日本小児外科学会雑誌, 55, 3, 575, 575, (一社)日本小児外科学会, 2019年05月
    日本語
  • 先天性心疾患に併存する声門下腔狭窄症の治療戦略
    植村 光太郎, 横井 暁子, 前田 貢作, 梶原 啓資, 野村 皓三, 鮫島 由友, 河原 仁守, 磯野 香織, 森田 圭一, 福澤 宏明, 中尾 真
    日本小児外科学会雑誌, 55, 3, 597, 597, (一社)日本小児外科学会, 2019年05月
    日本語
  • 重症心身障碍児に対して施行した喉頭気管分離術後合併症の検討
    中尾 真, 前田 貢作, 横井 暁子, 福澤 宏明, 森田 圭一, 磯野 香織, 河原 仁守, 鮫島 由友, 野村 皓三, 梶原 啓資, 植村 光太郎
    日本小児外科学会雑誌, 55, 3, 611, 611, (一社)日本小児外科学会, 2019年05月
    日本語
  • Rexシャント手術を行った肝外門脈閉塞症の2例
    磯野 香織, 梶原 啓資, 植村 光太郎, 野村 皓三, 鮫島 由友, 河原 仁守, 森田 圭一, 福澤 宏明, 中尾 真, 横井 暁子, 前田 貢作
    日本小児外科学会雑誌, 55, 3, 663, 663, (一社)日本小児外科学会, 2019年05月
    日本語
  • 上大静脈症候群を伴った乳児頸部・縦隔リンパ管腫の治療経験
    野村 皓三, 前田 貢作, 梶原 啓資, 植村 光太郎, 鮫島 由友, 河原 仁守, 磯野 香織, 森田 圭一, 福澤 宏明, 中尾 真, 横井 暁子
    日本小児外科学会雑誌, 55, 3, 762, 762, (一社)日本小児外科学会, 2019年05月
    日本語
  • 正中頸嚢胞と類皮嚢胞は超音波診断で鑑別可能か? 画像的特徴について当院43例の検討
    鮫島 由友, 梶原 啓資, 植村 光太郎, 野村 皓三, 河原 仁守, 磯野 香織, 森田 圭一, 福澤 宏明, 中尾 真, 横井 暁子, 前田 貢作
    日本小児外科学会雑誌, 55, 3, 780, 780, (一社)日本小児外科学会, 2019年05月
    日本語
  • Repair of type IV laryngotracheoesophageal cleft (LTEC) on ECMO.
    Insu Kawahara, Kosaku Maeda, Yoshitomo Samejima, Keisuke Kajihara, Kotaro Uemura, Kozo Nomura, Kaori Isono, Keiichi Morita, Hiroaki Fukuzawa, Makoto Nakao, Akiko Yokoi
    Pediatric surgery international, 35, 5, 565, 568, 2019年05月, ［国際誌］
    英語, 研究論文（学術雑誌）, PURPOSE: A type IV laryngotracheoesophageal cleft (LTEC) is a very rare congenital malformation. Type IV LTEC that extends to the carina have poor prognosis and are difficult to manage. We present our experience with surgical repair in such a case using extracorporeal membranous oxygenation (ECMO). METHODS: A male infant, who was diagnosed with Goldenhar syndrome, showed severe dyspnea and dysphagia. Laryngoscopy indicated the presence of LTEC. The patient was transferred to our institute for radical operation 26 days after birth. Prior to surgery, a balloon catheter was inserted in the cardiac region of stomach through the lower esophagus to block air leakage, to maintain positive pressure ventilation. We also performed observations with a rigid bronchoscope to assess extent of the cleft, and diagnosed the patient with type IV LTEC. After bronchoscopy, we could intubate the tracheal tube just above the carina. Under ECMO, repair of the cleft was performed by an anterior approach via median sternotomy. RESULTS: The patient was intubated via nasotracheal tube and paralysis was maintained for 2 weeks, using a muscle relaxant for the first 3 days. Two weeks after surgery, rigid bronchoscopy showed that the repair had been completed, and the tracheal tube was successfully extubated without tracheotomy. CONCLUSIONS: Although insertion of a balloon catheter is a very simple method, it can separate the respiratory and digestive tracts. This method allowed for positive pressure ventilation and prevented displacement of the endotracheal tube until ECMO was established. As a result, we safely performed the operation and the post-operative course was excellent.
  • Experimental validation of laryngotracheal growth and recurrent laryngeal nerve preservation after partial cricotracheal resection in a growing rabbit model.
    Keiichi Morita, Kosaku Maeda, Insu Kawahara, Yuko Bitoh
    Pediatric surgery international, 34, 10, 1053, 1058, 2018年10月, ［国際誌］
    英語, 研究論文（学術雑誌）, PURPOSE: The aim of this study was to confirm laryngotracheal growth and recurrent laryngeal nerve (RLN) preservation after partial cricotracheal resection (PCTR) in a growing rabbit model by performing the procedure in pediatric animals. METHODS: Six female Japanese white rabbits, 12 weeks of age, underwent PCTR. The course of the RLN was evaluated during surgery (n = 3). Endoscopic and histologic examinations were performed at 22 weeks of age (n = 6). Four non-operated rabbits, 22 weeks of age, underwent endoscopic and histologic examinations as controls. RESULTS: The RLN was preserved at the esophageal side and entered the larynx behind the cricothyroid joint after PCTR. Endoscopic examination showed normal vocal cord movements and the large reconstructed subglottis. Histologically, sufficient submucosal vessels and cartilage growth were identified at the reconstructed larynx. The median inside luminal area at the anastomotic site in the PCTR group was 24.8 mm2 (range 21.8-29.0 mm2), and that at the cricoid cartilage and trachea in the control group was 23.4 mm2 (range 20.0-26.6 mm2) and 25.6 mm2 (range 22.9-28.8 mm2), respectively. CONCLUSION: No interference with laryngotracheal growth was seen, and RLN preservation was confirmed after PCTR. Use of PCTR in the pediatric age group seems appropriate.
  • Clinical features and risk factors of bile duct perforation associated with pediatric congenital biliary dilatation.
    Hiroaki Fukuzawa, Naoto Urushihara, Chisato Miyakoshi, Keisuke Kajihara, Insu Kawahara, Kaori Isono, Yoshitomo Samejima, Shizu Miura, Kotaro Uemura, Keiichi Morita, Makoto Nakao, Akiko Yokoi, Koji Fukumoto, Masaya Yamoto, Kosaku Maeda
    Pediatric surgery international, 34, 10, 1079, 1086, 2018年10月, ［国際誌］
    英語, 研究論文（学術雑誌）, PURPOSE: This study aimed to investigate the clinical features and risk factors of bile duct perforation in pediatric congenital biliary dilatation (CBD) patients. METHODS: CBD patients, whose initial symptom was abdominal pain, were enrolled in this study and were divided into perforated and non-perforated groups. The clinical features of the perforated group were investigated. Moreover, the age at operation, sex, and morphologic features of the extrahepatic bile duct were compared between the groups. RESULTS: Fifteen cases of bile duct perforation (10.4%) were identified among the 144 CBD patients who had abdominal pain. Majority of bile duct perforation occurred in patients aged < 4 years. The median duration from onset of abdominal pain to bile duct perforation was 6 (4-14) days. Age at onset [< 4 years old; P = 0.02, OR 13.9, (1.663, 115.3)], shape of extrahepatic bile duct [non-cystic type; P = 0.009, OR 8.36, (1.683, 41.5)], and dilatation of the common channel [P = 0.02, OR 13.6, (1.651, 111.5)] were risk factors of bile duct perforation. CONCLUSIONS: Emergent bile duct drainage might be planned to prevent bile duct perforation if CBD patients have the abovementioned risk factors and experience persistent abdominal pain lasting for a few days from onset.
  • 先入性胆道拡張症における胆道穿孔のリスク因子　　　　　　　　　　　　　　　
    梶原 啓資, 福澤 宏明, 漆原 直人, 福本 弘二, 矢本 真也, 河原 仁守, 磯野 香織, 鮫島 由友, 三浦 紫津, 植村 光太郎, 森田 圭一, 中尾 真, 横井 暁子, 前田 貢作
    日本膵・胆管合流異常研究会プロシーディングス, 41, 62, 63, 日本膵・胆管合流異常研究会, 2018年08月
    日本語
  • Biodegradable polydioxanone stent as a new treatment strategy for tracheal stenosis in a rabbit model
    Insu Kawahara, Shigeru Ono, Kosaku Maeda
    JOURNAL OF PEDIATRIC SURGERY, 51, 12, 1967, 1971, W B SAUNDERS CO-ELSEVIER INC, 2016年12月, ［査読有り］
    英語, 研究論文（学術雑誌）, Purpose: Congenital tracheal stenosis (CTS) is a rare condition and difficult to treat. Slide tracheoplasty has unsatisfactory outcomes for severe neonatal symptomatic CTS. This study evaluated the use of biodegradable polydioxanone stents (BD stent) in a rabbit model of CTS.
    Methods: Tracheal stenosis was induced in female Japanese white rabbits, 9-10 weeks old, by direct scraping of the tracheal mucosa with a nylon brush following transverse incision of the trachea (control group, n = 4). Seven days later, we incised the trachea again and inserted a BD stent (15 x 5mm) into the trachea (stent group, n = 4). Arterial blood gas analysis was performed twice weekly for 1 month after the procedure.
    Results: In the control group, respiratory acidosis arising from ventilatory failure was observed on postoperative days 7-10. Rabbits were sacrificed at 11.5 days after scraping. Severe tracheal stenosis resulting from inflammatory granulation was detected in the scraped region in all rabbits. In the stent group, arterial blood gas analysis was normal at 28 days after stent insertion. The BD stent maintained patency of the tracheal lumen and prolonged survival for 1 month.
    Conclusions: The use of BD stent represents a promising new treatment method for tracheal stenosis. (C) 2016 Elsevier Inc. All rights reserved.
  • 小児急性虫垂炎に対する保存的治療の適応と限界
    福田 篤久, 小野 滋, 馬場 勝尚, 薄井 佳子, 辻 由貴, 河原 仁守
    日本小児外科学会雑誌, 51, 6, 1042, 1047, The Japanese Society of Pediatric Surgeons, 2015年
    日本語, 【目的】当科では小児急性虫垂炎に対し，保存的治療を第一選択としている．今回，我々の治療経験から小児急性虫垂炎に対する保存的治療の適応および限界について検討した．
    【方法】2012 年1 月から2014 年8 月までに急性虫垂炎の診断で入院し抗菌薬を用いた保存的治療を行った53 症例を対象とし，保存的治療奏効群と保存的治療抵抗群に分けて比較検討した．
    【結果】53 例中，奏効群は36 例，抵抗群は17 例．入院時体温は奏効群が37.4±0.7°C，抵抗群が38.2±0.8°C で抵抗群において高かった（p＝0.01）．入院時血液検査所見では，CRP が奏効群1.4±1.7 mg/dl，抵抗群9.7±7.0 mg/dl と，抵抗群で高値であった（p＜0.01）．画像所見では，虫垂最大径が奏効群8.4±2.7 mm，抵抗群11.3±2.5 mm と抵抗群で有意に腫大していた（p＜0.01）．糞石は奏効群の16.7％（6/36 例），抵抗群の76.5％（13/17 例）に認めていた（p＜0.01）．治療開始後24 から48 時間での白血球数は奏効群6,988.9±2,884.8/μl，抵抗群11,741.2±3,845/μl と，抵抗群で高値であった（p＜0.01）．再発率は奏効群8.3％に対し，抵抗群では36.4％と高率であった（p＝0.042）．治療開始から48 時間での2 群のカットオフ値は，白血球数9,650.0/μl，CRP 値が6.67 mg/dl と推定された．
    【結論】治療後48 時間において白血球数が9,650.0/μl またはCRP 値が6.67 mg/dl を超える症例では早期の外科治療を検討すべきである．
  • Importance and difficulty of correctly diagnosing covered cloacal exstrophy for adequate reconstruction: A case report
    Insu Kawahara, Shigeru Ono, Katsuhisa Baba, Atsuhisa Fukuta, Yuki Tsuji, Yoshiko Usui, Taiju Hyuga, Shina Kawai, Shigeru Nakamura, Hideo Nakai
    Journal of Pediatric Surgery Case Reports, 3, 2, 75, 78, Elsevier Inc., 2015年, ［査読有り］
    英語, 研究論文（学術雑誌）, Covered cloacal exstrophy (CCE) is extremely rare condition. In patients with a single perineal orifice and no pubic bone separation, it is very difficult to suspect and/or diagnose CCE based on external signs alone. We present the case of a 2-month-old girl diagnosed with CCE based on cystography, ileostomy contrast study and cystoscopy.
  • 13・18トリソミー症例の小児外科疾患に対する積極的医療介入の妥当性
    薄井 佳子, 小野 滋, 馬場 勝尚, 辻 由貴, 河原 仁守, 福田 篤久
    日本小児外科学会雑誌, 51, 5, 868, 872, The Japanese Society of Pediatric Surgeons, 2015年
    日本語, 【目的】13・18 トリソミーの治療方針は各施設に委ねられている．自施設では積極的な外科治療も行う方針としており，その妥当性について検討した．【方法】2008 年1 月から2014 年6 月に，当院NICU に入院した13・18 トリソミー21 例を対象として後方視的に解析した．【結果】全例が出生前に超音波検査で胎児異常を指摘され，染色体異常の出生前診断は9 例（42.9％）に行われた．出生後，11 例（52.4％）に小児外科疾患が診断され，内訳は腸回転異常（症）4 例，食道閉鎖症2 例，胃食道逆流症2 例，横隔膜ヘルニア1 例，肝芽腫1 例，低位鎖肛1 例，臍帯ヘルニア1 例，鼠径ヘルニア1 例であった．根治術を施行した腸回転異常症2 例と食道閉鎖症1 例は，在宅で2～5 年の長期生存中である．肝芽腫1 例は，積極的治療希望であったが，体重4 kg 台で心奇形合併があり治療困難と判断され緩和ケアに移行した．食道閉鎖症1 例，低位鎖肛1 例，臍帯ヘルニア1 例は，姑息的手術を選択した．長期に気管挿管された4 例には気管切開術を施行した．心奇形は20 例（95.2％）に合併し，3 例に心内修復術や肺動脈絞扼術が施行された．主に心疾患の重症度が予後を規定しており，新生児集中治療と心疾患に対する治療選択により経過が左右された．一方，小児外科医による外科治療は生命予後に直接関与することは少なく，予後不良症例に対する姑息的手術も患児と家族の時間を妨げるものではなかった．【結論】近年13・18 トリソミーの長期生存例が着目されるようになり，個々の病状に応じた治療が必要とされる．客観的な医学的評価に基づいた積極的な外科治療の提供は倫理的にも妥当である．
  • Balloon tracheoplasty as initial treatment for neonates with symptomatic congenital tracheal stenosis
    Shigeru Ono, Kosaku Maeda, Katsuhisa Baba, Yoshiko Usui, Yuki Tsuji, Insu Kawahara, Atsuhisa Fukuta, Sachi Sekine
    PEDIATRIC SURGERY INTERNATIONAL, 30, 9, 957, 960, SPRINGER, 2014年09月, ［査読有り］
    英語, 研究論文（学術雑誌）, Neonates with congenital tracheal stenosis (CTS) sometimes develop respiratory distress and may be difficult to intubate. We used balloon tracheoplasty with a rigid bronchoscope for emergency airway management in neonates with symptomatic CTS. Herein, we describe the balloon tracheoplasty procedure and the early outcomes following its use as the initial treatment of neonatal symptomatic CTS. We performed a retrospective analysis of five neonates with CTS who were initially treated with balloon tracheoplasty at our institution from January 2010 to December 2013. Five patients with a mean birthweight of 2,117 g were treated during the study period. Of these, four developed respiratory distress after birth, and all patients had difficult intubations. In all five patients, definitive diagnosis of CTS was made by rigid bronchoscopy and 3-dimensional reconstruction scan. A total of nine balloon dilatations were performed in five patients. Following balloon tracheoplasty, two patients were extubated, one was extubated after resection and end-to-end anastomosis following initial balloon dilatation, and one remained hospitalized with tracheostomy for tracheomalacia. The remaining patient died from tracheal bleeding associated with congenital heart disease. Although our sample size was small, balloon tracheoplasty is a potentially effective initial treatment for selected cases with neonatal symptomatic CTS.
  • Surgical reconstruction and endoscopic pancreatic stent for traumatic pancreatic duct disruption
    Insu Kawahara, Kosaku Maeda, Shigeru Ono, Hiroshi Kawashima, Ryoichi Deie, Satohiko Yanagisawa, Katsuhisa Baba, Yoshiko Usui, Yuki Tsuji, Atsuhisa Fukuta, Sachi Sekine
    PEDIATRIC SURGERY INTERNATIONAL, 30, 9, 951, 956, SPRINGER, 2014年09月, ［査読有り］
    英語, 研究論文（学術雑誌）, Nonoperative management is acceptable treatment for minor pancreatic injuries. However, management of major pancreatic duct injury in children remains controversial. We present our experience in treating isolated pancreatic duct injury. We describe the cases of three male patients treated for complete pancreatic duct disruption in the past 5 years at our institution. We performed pancreatic duct repair to avoid distal pancreatectomy and to maintain normal pancreatic function. All patients underwent enhanced computed tomography and endoscopic retrograde cholangiopancreatography in the early period. The injuries were classified as grade III according to the American Association for the Surgery of Trauma classification. In two cases, we performed end-to-end anastomosis of the pancreatic duct during the delayed period. In the third case, we placed a stent across the disruption to the distal pancreatic duct. The patients' postoperative courses were uneventful, and the average hospitalization was 25.6 days after the procedure. At a median follow-up of 36 months (range 14-54 months), all patients remain asymptomatic, with normal pancreatic function, but with persistent distal pancreatic duct dilatation. We suggest that distal pancreatectomy should not be routinely performed in patients with isolated pancreatic duct injury.
  • Management of blunt pancreatic trauma in children
    Kosaku Maeda, Shigeru Ono, Katsuhisa Baba, Insu Kawahara
    Pediatric Surgery International, 29, 10, 1019, 1022, 2013年10月
    英語, 研究論文（学術雑誌）, Blunt trauma to the abdomen accounts for the majority of abdominal injuries in children. Pancreatic injury is the fourth most common solid organ injury, following injuries to the spleen, liver and kidneys. The most common complications are the formation of pancreatic fistulae, pancreatitis and the development of pancreatic pseudocysts, which usually present several weeks after injury. The nonoperative management of minor pancreatic injury is well accepted
    however, the treatment of more serious pancreatic injuries with capsular, ductal or parenchymal disruption in pediatric patients remains controversial. Based on the data presented in this literature review, although children with pancreatic injuries (without ductal disruption) do not appear to suffer increased morbidity following conservative management, patients with ductal disruption may benefit from operative intervention. © 2013 Springer-Verlag Berlin Heidelberg.
  • Do neonates conceived after assisted reproductive technology require neonatal surgery more frequently? A 5-year single-center experience
    Satohiko Yanagisawa, Kosaku Maeda, Yuko Tazuke, Yuki Tsuji, Insu Kubota, Yasunori Koike, Yukari Yada, Yumi Kono, Naoto Takahashi, Shigeki Matsubara
    JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH, 39, 5, 974, 978, WILEY-BLACKWELL, 2013年05月, ［査読有り］
    英語, 研究論文（学術雑誌）, Aim Assisted reproductive technology (ART) has increased the incidences of multiple gestations and low birth weights, which frequently warrant pediatric surgery. ART may have also increased the rate of birth defects. In this study, we aimed to determine whether infants conceived after ART required neonatal surgery more frequently compared with naturally conceived infants. Material and Methods Our study population comprised 1891 infants (160 ART (+) and 1731 ART ()) who were admitted to our neonatal intensive care unit during a 5-year period (January 2006December 2010); of these, 198 infants (9 ART (+) and 189 ART ()), with diseases requiring surgery, were referred to pediatric surgeons (consultation cases). We examined the following: (i) factors potentially increasing the requirement for surgery; (ii) frequency of birth defects; and (iii) maternal factors that may increase the need for surgery. Results A significantly higher incidence of multiple gestation and low birth weight was observed in the ART (+) group than the ART () group. However, ART did not yield a higher rate of surgery and birth defects: overall, the rate of surgery was 4% (7/160) in the ART (+) group and 8% (143/1731) in the ART () group. Of 198 consultation cases, the percentage of infants actually requiring surgery was approximately the same in the ART (+) group (7/9 [78%]) and the ART () group (143/189 [76%]). Conclusion Infants conceived after ART comprised a small proportion of neonatal surgery cases, and did not require surgery more frequently.
  • Intrapericardial extralobar pulmonary sequestration detected as an intrathoracic cystic mass by using prenatal ultrasonography: Case report and review of the literature
    Satohiko Yanagisawa, Kosaku Maeda, Yuko Tazuke, Katsuhisa Baba, Yuki Tuji, Insu Kawahara, Tomokazu Nakagami
    JOURNAL OF PEDIATRIC SURGERY, 47, 12, 2327, 2331, W B SAUNDERS CO-ELSEVIER INC, 2012年12月, ［査読有り］
    英語, 研究論文（学術雑誌）, Intrapericardial extralobar pulmonary sequestration is a very rare congenital lung anomaly. We report a case of this condition, detected as an intrathoracic cystic lesion by using prenatal ultrasonography. The neonate was born at 38weeks of gestation with no progression of the lesion and no respiratory or cardiac symptoms. Ultrasonography and computed tomography (CT) revealed a 40x17x17-mm intrapericardial lesion, composed of cystic components and a solid component. Intrapericardial extrapulmonary sequestration was suspected largely because CT showed a vague aberrant artery. At the age of 3months, elective surgery was performed, and the postoperative course was uneventful. (C) 2012 Elsevier Inc. All rights reserved.
  • 小児膿胸に対する当院での外科治療の検討
    洲尾 昌伍, 横井 暁子, 中尾 真, 尾藤 祐子, 荒井 洋志, 大片 祐一, 園田 真理, 谷本 光隆, 吉田 拓哉, 河原 仁守, 西島 栄治
    日本小児外科学会雑誌, 48, 7, 1103, 1103, (一社)日本小児外科学会, 2012年12月
    日本語
  • DEX 乳児気管・呼吸器疾患術後のプレセデックスの使用経験
    河原 仁守, 吉田 拓哉, 洲尾 昌伍, 谷本 光隆, 園田 真理, 大片 祐一, 荒井 洋志, 尾藤 祐子, 中尾 真, 横井 暁子, 西島 栄治
    日本小児外科学会雑誌, 48, 6, 907, 907, (一社)日本小児外科学会, 2012年10月
    日本語
  • Aortogenic cerebrovascular accident
    Shin-Ichi Ohki, Insu Kubota, Kei Aizawa, Yoshio Misawa
    Interactive Cardiovascular and Thoracic Surgery, 9, 5, 899, 900, 5, 2009年11月, ［査読有り］
    英語, 研究論文（学術雑誌）, A 59-year-old man was transferred to our hospital because of mural thrombus in the ascending aorta. He had suffered some neurological dysfunctions such as transient dysorientation. Electrocardiogram showed normal sinus rhythm without premature beats. Trans-thoracic echocardiogram and three-dimensional CT showed a mobile mural mass sticking to the ascending aortic wall. No coagulopathy was detected in the patient. The mural masses were thought to be a possible cause of the repeated cerebro-vascular symptoms. Under cardiopulmonary bypass and cardiac arrest, the masses were removed including the mass sticking to the aortic wall. Postoperative pathological findings showed the masses were organizing thrombi that had originated from the atherosclerotic aortic wall. Postoperative course was uneventful, and the patient was doing well one year after the operation without neurological dysfunction.

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