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- 저자 : Takayoshi Tsuchiya (검색결과 2 건)
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Invasiveness Reduction of Recent Total En Bloc Spondylectomy: Assessment of the Learning Curve
Takayoshi Ishii,Hideki Murakami,Satoru Demura,Satoshi Kato,Katsuhito Yoshioka,Moriyuki Fujii,Takashi Igarashi,Hiroyuki Tsuchiya 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.3
Study Design: Case-control study. Purpose: To evaluate the surgical magnitude and learning curve of “second-generation” total en bloc spondylectomy (TES). Overview of Literature: In June 2010, we developed second-generation TES combined with tumor-induced cryoimmunology, which does not require autograft harvesting. Methods: TES was performed in 63 patients between June 2010 and September 2013. Three groups of patients were evaluated: 20 undergoing surgery in the first year of development of second-generation TES (group I), 20 in the second year (group II), and 23 in the third year (group III). Patient backgrounds showed no remarkable differences. Operating time, intraoperative blood loss, blood transfusion, and postoperative C-reactive protein and creatine phosphokinase were compared among the groups. Results: Mean±standard deviation operating time was 486±130 minutes in group I, 441±85 minutes in group II, and 396±75 minutes in group III. The time was significantly shorter in group III than in group I (p <0.05). Intraoperative blood loss was 901±646 mL in group I, 433±177 mL in group II, and 411±167 mL in group III. Blood loss was significantly lower in groups II and III than in group I (p <0.01). Transfusion was not required in 20 of 23 patients in group III, and mean C-reactive protein levels on postoperative day 3 were significantly lower in this group than in group I (6.12 mg/L vs. 10.07 mg/L; p <0.05). Postoperative creatine phosphokinase levels did not differ among the groups. Conclusions: TES is associated with a significant learning curve. Thus, second-generation TES can no longer be considered highly invasive.
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Ryosuke Tonozuka,Takayoshi Tsuchiya,Shuntaro Mukai,Yuichi Nagakawa,Takao Itoi 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.5
Gastric outlet obstruction (GOO) can be caused by periampullary malignancies and often leads to a reduction in a patient’s quality oflife. Recently, endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) using a lumen-apposing self-expandable metal stent(LAMS) has been developed as a minimally invasive and durable endoscopic treatment for GOO. There are three types of EUS-GEtechnique: (1) the direct technique; (2) device-assisted techniques, such as a balloon catheter, nasobiliary drainage tube, and ultraslimendoscopy; and (3) EUS-guided double balloon-occluded gastrojejunostomy bypass. Previous reports of EUS-GE with LAMS haveshown technical and clinical success rates (regardless of technique and etiology) of 87%–100% and 84%–100%, respectively. Studiescomparing EUS-GE and surgical astrojejunostomy have shown similar success rates, reintervention rates, and cost benefits, witha lower rate of early adverse events in EUS-GE. A comparison of EUS-GE and endoscopic enteral stent placement revealed similar technical success rates, but initial clinical success rate was higher and the rate of stent failure requiring reintervention was lower with EUS-GE.
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