{"created":"2023-07-27T06:58:33.857529+00:00","id":57169,"links":{},"metadata":{"_buckets":{"deposit":"0dbec366-3d46-4310-ae12-da3c2bd69406"},"_deposit":{"created_by":18,"id":"57169","owners":[18],"pid":{"revision_id":0,"type":"depid","value":"57169"},"status":"published"},"_oai":{"id":"oai:kanazawa-u.repo.nii.ac.jp:00057169","sets":["2812:2813:2829"]},"author_link":["21811"],"item_9_biblio_info_8":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2006-07-10","bibliographicIssueDateType":"Issued"},"bibliographicPageStart":"2p.","bibliographicVolumeNumber":"2003 – 2004","bibliographic_titles":[{"bibliographic_title":"平成16(2004)年度 科学研究費補助金 基盤研究(B) 研究成果報告書概要"},{"bibliographic_title":"2004 Fiscal Year Final Research Report Summary","bibliographic_titleLang":"en"}]}]},"item_9_creator_33":{"attribute_name":"著者別表示","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{}],"nameIdentifiers":[{},{},{}]}]},"item_9_description_21":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"早期胃癌126例を対象に、術中胃内視鏡下に色素によるlymphatic mapping (IELM)を行った後D2定型手術を施行、IELMによる青染リンパ節(BN)と、術後病理検査によるリンパ節とにおける転移診断能を比較した。IELMは2% patent blueを用いて行い、IELMにより染色されるリンパ節、リンパ管を含む流域をlymphatic basin (LB)と定義した。IELMは119例(94%)に成功し、感度87%(34/39)、特異度100%(80/80)、正診率96%(114/119)であった。5例が偽陰性であったが、4例は肉眼的転移例で術中に容易に判定され、1例は迅速病理の誤診であった。転移状況は、BNのみへの転移、BNを含むLB内の他のリンパ節への転移がほとんどでLB外のリンパ節への転移は1例のみであった。微小転移について抗CK8/18抗体による免疫染色法により、HE染色にて転移のない35例、1028個のリンパ節を用いて連続切片を作製し検討した。微小転移は、症例別では11%(4/35)、リンパ節別では0.58%(6/1028)に認められた。しかし、いずれもBNのみまたは、BNとLB内の非BNの両者にみられ、LB外の非BNのみに見られることはなく、sentinel node conceptは成立していた。以上の成績から、LBを郭清しその中のリンパ節に転移が見られなければ以後の郭清は必要ないと結論され、そのような症例に縮小手術を施行した。縮小手術のうち胃分節切除術(分節群)51例と、標準手術の幽門側胃切除術Billroth I法再建術(B-I群)61例の成績を比較した。術後の食事摂取量は、術前の8割以上の摂取ができる例は分節群80%とB-I群67%に比べて良好である傾向を示した。ダンピング症状(全身症状)は、分節群は5%とB-I群の18%に比較して有意に良好であった。体重が術前の90%以上の回復を認めた症例は、分節群78%とB-I群66%に比べて良好であった。内視鏡検査所見では胆汁逆流と粘膜の発赤が、分節群0%,46%、B-I群41%,82%といずれも分節群で有意に低率であった。以上よりsentinel node生検による胃癌の縮小手術は、根治性を保ちながら機能を温存しうる術式と考えられた。\nまた直腸癌では脂肪層が厚く肉眼観察に不向きなためRIで検討した。方法は胃癌と同様に、術前日内視鏡下に99mTcフチン酸を癌の周囲に注射し、術中にγ-probeを用いてhot nodeを検索した。計43例に施行し深達度が粘膜下層までの症例に限ると、成功率は96%(25/26)、感度80%(4/5),特異度100%(20/20),正診率96%(24/25)であった。しかし筋層以深の症例では6/17に偽陰性例がみられ、方法の改善が必要と考えられた。","subitem_description_type":"Abstract"},{"subitem_description":"We developed the intraoperative endoscopic lymphatic mapping (IELM) for identifying sentinel lymph nodes of patients with early-stage gastric cancer (EGC). A total of 126 patients with EGC underwent the IELM. The patent blue (a lymphophilic dye) was intraoperatively injected into the surrounding mucosa of tumor by using electronic endoscopy. Some lymph nodes were stained blue several minutes after this procedure. We named a stained lymph node a blue node (BN) and an area including stained nodes and lymphatics a lymphatic basin. After IELM we performed lymphatic basin dissection with intraoperative pathology, and finally standard gastrectomy with D2. IELM succeeded in 119 patients (94%) with a good performance of 87% (34/39) in sensitivity, 100% (80/80) in specificity, and 96% (114/119) in accuracy. Five false negatives consisted of four gross metastases and one overlooked metastasis at intraoperative diagnosis. Lymphatic metastases in 33 of 34 (97%) patients were detected in BNs alone, or BNs and non-BNs in the basin, which included BNs. These results suggested that if lymphatic metastases in BNs in the dissected basin were not proven in the intraoperative pathology, limited nodal dissection and limited gastric resection could be applicable in EGC. We applied sleeve gastric resection (SGR) to 51 EGC patients and its postoperative quality of life (QOL) was compared with the QOL of 61 patients undergoing conventional Billroth I (B-I) reconstruction. The incidence of the patients who could eat more than 80% of preoperative oral intake in SGR group was high as 80% compared to 67% in B-I group. Dumpers in SGR group were 5% significantly fewer than 18% in B-I group. The incidences of intragastric bile reflux and mucosal redness by endoscopy in SGR group (0% and 46%) were significantly lower than those in B-I group (41% and 82%). These results suggested that limited surgery based on IELM and basin dissection was feasible and beneficial for the postoperative QOL in EGC patients.\nWe also applied the sentinel node mapping to 43 rectal cancer patients by RI method. The ^<99m>Tc-phytate was preoperatively injected into the surrounding mucosa of tumor by using electronic endoscopy. The hot nodes were intraoperatively detected using γ-probe. In the patients with the invasion up to submucosa, RI-mapping succeeded in 25 of 26 patients (96%) with a good performance of 80% (4/5) in sensitivity, 100% (20/20) in specificity, and 96% (24/25) in accuracy. But six of 17 patients with the invasion deeper than submucosa showed false negative. Technical improvement should be needed in sentinel node mapping of rectal cancer","subitem_description_type":"Abstract"}]},"item_9_description_22":{"attribute_name":"内容記述","attribute_value_mlt":[{"subitem_description":"研究課題/領域番号:15390390, 研究期間(年度):2003 – 2004","subitem_description_type":"Other"},{"subitem_description":"出典：「胃がんセンチネルリンパ節生検による縮小手術の適応拡大」研究成果報告書　課題番号15390390\n（KAKEN：科学研究費助成事業データベース（国立情報学研究所））\n（https://kaken.nii.ac.jp/ja/report/KAKENHI-PROJECT-15390390/153903902004kenkyu_seika_hokoku_gaiyo/)を加工して作成","subitem_description_type":"Other"}]},"item_9_description_5":{"attribute_name":"提供者所属","attribute_value_mlt":[{"subitem_description":"金沢大学医学系研究科","subitem_description_type":"Other"}]},"item_9_identifier_registration":{"attribute_name":"ID登録","attribute_value_mlt":[{"subitem_identifier_reg_text":"10.24517/00063439","subitem_identifier_reg_type":"JaLC"}]},"item_9_relation_28":{"attribute_name":"関連URI","attribute_value_mlt":[{"subitem_relation_name":[{"subitem_relation_name_text":"https://kaken.nii.ac.jp/ja/search/?kw=80019968"}],"subitem_relation_type_id":{"subitem_relation_type_id_text":"https://kaken.nii.ac.jp/ja/search/?kw=80019968","subitem_relation_type_select":"URI"}},{"subitem_relation_name":[{"subitem_relation_name_text":"https://kaken.nii.ac.jp/ja/grant/KAKENHI-PROJECT-15390390/"}],"subitem_relation_type_id":{"subitem_relation_type_id_text":"https://kaken.nii.ac.jp/ja/grant/KAKENHI-PROJECT-15390390/","subitem_relation_type_select":"URI"}},{"subitem_relation_name":[{"subitem_relation_name_text":"https://kaken.nii.ac.jp/ja/report/KAKENHI-PROJECT-15390390/153903902004kenkyu_seika_hokoku_gaiyo/"}],"subitem_relation_type_id":{"subitem_relation_type_id_text":"https://kaken.nii.ac.jp/ja/report/KAKENHI-PROJECT-15390390/153903902004kenkyu_seika_hokoku_gaiyo/","subitem_relation_type_select":"URI"}}]},"item_9_version_type_25":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_version_resource":"http://purl.org/coar/version/c_ab4af688f83e57aa","subitem_version_type":"AM"}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2021-11-05"}],"displaytype":"detail","filename":"ME-PR-MIWA-K-kaken 2006-2p.pdf","filesize":[{"value":"109.2 kB"}],"format":"application/pdf","licensetype":"license_11","mimetype":"application/pdf","url":{"label":"ME-PR-MIWA-K-kaken 2006-2p.pdf","url":"https://kanazawa-u.repo.nii.ac.jp/record/57169/files/ME-PR-MIWA-K-kaken 2006-2p.pdf"},"version_id":"8879c34e-bdc4-42b0-a29e-0cb2c3fd1e37"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"research report","resourceuri":"http://purl.org/coar/resource_type/c_18ws"}]},"item_title":"胃がんセンチネルリンパ節生検による縮小手術の適応拡大","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"胃がんセンチネルリンパ節生検による縮小手術の適応拡大"},{"subitem_title":"Extended application of sentinel node navigation surgery to gastric cancer","subitem_title_language":"en"}]},"item_type_id":"9","owner":"18","path":["2829"],"pubdate":{"attribute_name":"公開日","attribute_value":"2021-11-05"},"publish_date":"2021-11-05","publish_status":"0","recid":"57169","relation_version_is_last":true,"title":["胃がんセンチネルリンパ節生検による縮小手術の適応拡大"],"weko_creator_id":"18","weko_shared_id":-1},"updated":"2023-07-27T14:26:28.639671+00:00"}