巻号一覧
50 巻 (1999)
- 6 号 p. 579-
- 5 号 p. 519-
- 4 号 p. 463-
- 3 号 p. 391-
- 2 号 p. 217-
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50 巻, 5 号
選択された号の論文の11件中1～11を表示しています
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北島 政樹, 北川 雄光1999 年 50 巻 5 号 p. 519-524
発行日: 1999/10/10
公開日: 2010/02/22
ジャーナル フリーEndoscopic surgery has become widespread and is currently used in a wide range of general, thoracic, urologic, gynecologic and orthopedic procedures. In the field of thoracic surgery, a number of endoscopic surgical procedures have been recognized as standard for benign diseases, including spontaneous pneumothorax, esophageal submucosal tumors, giant esophageal diverticulum and gastroesophageal regurgitation. However, the indication of endoscopic procedures for malignant diseases in thoracic surgery is still under the evaluation. The balance between the operative radicality and the less invasive quality of these procedures should be evaluated in long-term observations.
Although there are still many difficulties and limitations involved in endoscopic procedures, advanced technology is continually being introduced to overcome these problems. The introduction of three-dimensional video imaging, robotic surgery and advanced telecommunications will allow us to overcome many difficulties posed by the conventional endoscopic approach.抄録全体を表示PDF形式でダウンロード (6804K) -
白日 高歩1999 年 50 巻 5 号 p. 525-528
発行日: 1999/10/10
公開日: 2010/02/22
ジャーナル フリーThoracoscopic surgery has two functions, one diagnostic and the another therapeutic. In the former, thoracoscopy is useful for diagnoses of i) unknown pleural effusion, ii) diseases of the pleural surface, iii) peripheral lung nodule, iv) diffuse lung disease, v) mediastinal tumor, and vi) diseases related to diaphragm.
On the other hand, therapeutic thoracoscopy is used in the surgical treatment of various lung diseases. Bullaectomy for spontaneous pneumothorax using a thoracoscope is very popular. Video-assisted thoracoscopic surgery (VATS) for lung carcinoma has been adopted for peripheral small tumors with T1N0M0. Compared to standard thoracotomy, VATS lobectomy seems to be less invasive in terms of postoperative pain or bleeding volume during operations. It is also superior from a cosmetic point of view.
Thus, thoracoscopic surgery should be become an important option in the diagnosis and treatment of lung disease.抄録全体を表示PDF形式でダウンロード (2886K) -
佐藤 博信, 山形 基夫, 村山 公, 宋 圭男, 大塚 善久, 田中 和彦, 稲見 直邦, 小林 秀昭, 岩井 重富, 田中 隆1999 年 50 巻 5 号 p. 529-532
発行日: 1999/10/10
公開日: 2010/02/22
ジャーナル フリーLaparoscopic surgery was performed in 10 cases of esophageal achalasia. Indications for the operation, operative method and results are described in this report. The indications for laparoscopic surgery for esophageal achalasia were determined by patients' complaints and history, esophagogram, esophageal internal pressure and endoscopy. The operative procedure were as follows. Under general anesthesia, the patient was in a supine position, and five trocars were inserted to the abdomen. About 10 to 12cm of longmyotomy was performed along the lower esophagus and cardia lesions by an electric J-hook. After this procedure, a transverse suture were made on each side of the lower part of the myotomy. The gastric funds were covered at the upper part of the myotomy. There were no complications. Since we recently have had much experienced with this procedure, the operation time was short and there was little bleeding. No difference was found between the open and laparoscopic procedures in terms of a manometric study.抄録全体を表示PDF形式でダウンロード (507K) -
宮崎 修吉, 赤石 隆1999 年 50 巻 5 号 p. 533-538
発行日: 1999/10/10
公開日: 2010/02/22
ジャーナル フリーWith the advent of operative thoracoscopy, it has become possible to apply thoracoscopic techniques to the resection of the thoracic esophagus. In our department, from March 1995 to December 1998, 34 patients with thoracic esophageal cancer lesions underwent total esophagectomy with mediastinal lymphadenectomy by means of thoracoscopy. Their ages ranged from 50 to 80. A total thoracoscopic esophagectomy was technically feasible, and its completeness was comparable to that of the open technique. However, it resulted in less postoperative pain and a better preservation of the vital capacity than the open technique. Here, we describe the procedure for thoracoscopic esophagectomy with mediastinal lymphadenectomy, and our clinical results using this technique. We also discuss thoracoscopic and laparoscopic surgery for esophageal cancer as techniques for the near future.抄録全体を表示PDF形式でダウンロード (646K) -
小澤 壮治, 安藤 暢敏, 大上 正裕, 北川 雄光, 北島 政樹1999 年 50 巻 5 号 p. 539-542
発行日: 1999/10/10
公開日: 2010/02/22
ジャーナル フリーThoracoscopic surgery for esophageal submucosal tumor is less invasive than open surgery. Surgical indications are limited to cases with a pathological finding benign, combined with certain symptoms. On the other hand, malignant submucosal tumors should be treated by esophagectomy and regional lymph node dissection using either the open or thoracoscopic procedures.抄録全体を表示PDF形式でダウンロード (441K) -
加勢田 静, Teruhiro Aoki, Nanae Hangai, Kunihiko Shimizu1999 年 50 巻 5 号 p. 543-548
発行日: 1999/10/10
公開日: 2010/02/22
ジャーナル フリーFrom September 1992 to April 1999, 165 video-assisted thoracic surgery (VATS) lobectomies were performed at Saiseikai Kanagawa-ken Hospital. The lesions consisted of 130 cases of lung cancer, 12 cases of bronchiectasis, 8 cases of granuloma, 5 cases of metastatic tumors, and 10 cases with other miscellaneous diseases. Among the 130 cases with lung cancer, 94, who were diagnosed as stage I clinically, underwent a VATS lobectomy with extended lymph node dissection. The 5-year survival rate of these final stage I lung cancers following VATS was 96.6%. This survival rate is significantly better than that for open thoracotomy (78.5%: p<0.001). We conclude that VATS lobectomy with extended lymph node dissection can become a new standard procedure for clinical stage I lung cancer to replace open thoracotomy.抄録全体を表示PDF形式でダウンロード (2582K) -
長坂 不二夫, 大森 一光1999 年 50 巻 5 号 p. 549-553
発行日: 1999/10/10
公開日: 2010/02/22
ジャーナル フリーRecent advances in optical and endoscopic instruments for surgery have made it possible to perform operations for spontaneous pneumothorax under video-assisted thoracic conditions (VATS), and now VATS is the first choice of operating methods for the pneumothorax. VATS has several advantages such as less surgical stress, and VATS use for spontaneous pneumothorax is likely to increase in the future. A major problem of VATS for pneumothorax, however, is that the incidence of postoperative recurrence of pneumothorax with VATS is higher than with thoracotomy. The causes of such recurrences are the failure to seek other bullae with video-assisted thoracoscopy, the inadequate firing of the endostaplers, and the new development of bullae from damage to the lung owing to the use of the endostapler or endoforceps. In order to decrease this high incidence of recurrence, preoperative investigations of bullae by chest CT scan, administering an endostapler to a normal lung area at the base of the bullae, and treating the lung gently with endoforceps are all important. The use of VATS for pneumothorax is just beginning and will develop greatly if these precautions are taken.抄録全体を表示PDF形式でダウンロード (2336K) -
安藤 陽夫, 清水 信義1999 年 50 巻 5 号 p. 554-558
発行日: 1999/10/10
公開日: 2010/02/22
ジャーナル フリーThoracoscopic surgery is very useful in the mediastinal region, and it also expands the indications. The best indication for thoracoscopic surgery is benign mediastinal tumors. We performed thoracoscopic surgery for benign mediastinal tumor in 36 patients. These consisted of neurogenic tumor in 14 cases, teratoma in 2 cases, a mediastinal cyst in 19 cases, and Castleman's disease in 1 case. There were 3 cases which required an open thoracotomy for severe adhesion. However major complications were not seen. Myasthenia gravis not associated with thymoma is another good indication for thoracoscopic surgery. We have established techniques for thoracoscopic extended thymectomy combined with collar incision of the neck (TET) and performed TET in 18 cases of myasthnia gravis with satisfactory results. On the other hand, thoracoscopic surgery for thymoma is regarded as a necessary part of the operative procedure, and is regarded as indicated only for small, encapsulated, non-invasive thymoma.抄録全体を表示PDF形式でダウンロード (725K) -
千々和 圭一, 富田 和英, 梅野 博仁, 森 一功, 中島 格1999 年 50 巻 5 号 p. 559-564
発行日: 1999/10/10
公開日: 2010/02/22
ジャーナル フリーSince 1989 at Kurume University Hospital, extensive resection of the larynx, pharynx and cervical esophagus with bilateral extended radical neck dissection and upper mediastinal dissection followed by free-jejunum transfer, has been employed for patients with advanced carcinoma of the hypopharynx. In addition, retropharyngeal and mediastinal lymph nodes have been irradiated postoperatively. These treatment modalities decreased local and neck recurrence effectively, whereas distant metastasis was not significantly decreased. In this paper, in order to determine the indications for supportive chemotherapy, 18 patients (17 males and 1 female) with distant metastasis and 45 survival patients without locoregional recurrence (35 males and 10 females) who had undergone these treatment modalities from 1989 to 1997 at Kurume University Hospital were reviewed in detail.
Patients with N2 and N3 neck metastases had a significantly higher risk for the development of distant metastasis. In addition, patients with more than 5 positive nodes, with metastases at more than 4 neck levels, with positive nodes greater than 4cm in diameter, and with extracapsular spread had significantly higher risk for the development of distant metastasis. These results suggest that some supportive chemotherapy might be neccessary for these high-risk patients.抄録全体を表示PDF形式でダウンロード (828K) -
高木 誠治, 津田 邦良, 松山 篤二, 澤津橋 基広, 大谷 信二, 進 武幹1999 年 50 巻 5 号 p. 565-568
発行日: 1999/10/10
公開日: 2010/02/22
ジャーナル フリーA statistical study was made of foreign bodies in the trachea and bronchi of 34 patients (male:female=23:11) hospitalized at our clinic between 1982 and 1998. Nineteen patients were under 3 years of age. Fifteen cases (44%) had aspirated peanuts. The chief complaints were coughing, wheezing and fever. In radiological diagnoses, emphysema and atelectasis were found in some cases. MRI should be performed when the possibility of a foreign body is not completely excluded, even though it is not apparently suggested by an interview, physical examination, or chest X-ray.
Foreign bodies were found under direct bronchoscopy in the trachea of 5 patients, in the right bronchus in 17 patients and in the left bronchus in 12 patients. These were all removed by means of a ventilation bronchoscope under general anesthesia without any complications.抄録全体を表示PDF形式でダウンロード (461K) -
下咽頭全周切除後の遊離空腸による再建術田中 信三, 田辺 正博, 與那嶺 裕, 箕山 学, 岩永 迪孝1999 年 50 巻 5 号 p. 569-573
発行日: 1999/10/10
公開日: 2010/02/22
ジャーナル フリーWe developed a new method of reconstruction using a free jejunal flap after nearly total hypopharyngectomy with conservation of a functioning larynx. The free jejunum was transsected longitudinally to suppress peristalsis, and then sutured back in place. To avoid compression of the reconstructed tract by the larynx, the free jejunum was connected to one side of the pharynx after resecting the lateral half of the lamina of the thyroid cartilage. The arytenoid cartilage was fixed to the cricoid cartilage in median position after extirpation of the posterior cricoarytenoid muscle and the muscular process of the arytenoid cartilage on the affected side.
The surgery described above was performed for a patient with T2 carcinoma of the piriform sinus invading the anterior and posterior walls of the post-croicoid region. Bilateral radical neck dissection was combined with this surgery. The tracheal stoma was closed three months after surgery, with no disturbance in phonation, respiration or swallowing.抄録全体を表示PDF形式でダウンロード (7112K)
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