胸部外科
・1948年創刊。常に最近の話題を満載した、わが国で最も長い歴史と伝統を持つ専門誌。
・心、肺、食道3領域の外科を含む商業医学雑誌として好評を得ている。
・複数の編集委員(主幹)による厳正な査読を経た投稿論文を主体とした構成。
・巻頭の「胸部外科の指針」は、投稿原稿の中から話題性、あるいは問題性のある論文を選定し、2人の討論者による誌上討論を行っている。
・胸部外科医にとって必須の特集テーマを年4回設定。また、「まい・てくにっく」、「1枚のシェーマ」、読み物として「胸部外科医の散歩道」を連載。
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Latest Articles
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目次
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今月の臨床
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合併症を伴わないStanford B型大動脈解離に対する胸部ステントグラフト内挿術―介入時期と大動脈リモデリング
77, 3(2024);View Description Hide DescriptionPurpose:We investigated the relationship between aortic remodeling and timing of thoracic endovascular aortic repair( TEVAR) in patients with uncomplicated Stanford type B aortic dissection. Methods:29 patients with sub-acute and early chronic uncomplicated Stanford type B aortic dissection underwent TEVAR between February 2019 and August 2022 in our hospital. We retrospectively compared aortic remodeling between 19 patients in the sub-acute( SA) group( 15-90 days from onset) and 10 patients in the early chronic( ECh) group( 91-365 days from onset) using the false luminal area reduction rate using computed tomography imagings. Results:The false lumen area reduction rates at the level of the carina in the SA and ECh groups were 21.9±13.5% and 7.0±21.2% (p=0.04) around 3-8 days after TEVAR, 91.8±13.8% and 62.6±48.4 % (p=0.26) at 6 months, 96.6±7.2% and 68.7±42.5% (p=0.14) at 12 months, and 96.2±10.0% and 79.2±37.6% (p=0.62) at 18 months respectively. There were no significant differences between the two groups regarding any complication. Conclusion:Preemptive TEVAR for sub-acute and early chronic uncomplicated Stanford type B aortic dissection resulted in good remodeling and it may provide a good prognosis, especially in the subacute stage.
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臨床と研究
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区域切除の理解を深めるための3D実体モデルを用いた医学教育
77, 3(2024);View Description Hide DescriptionBackground:Lung segment anatomy is complex and difficult for medical students to comprehend, so education is a challenging issue. Three-dimensional (3D) models may be a more effective teaching tool for medical students. We evaluated the usefulness of 3D models in education for segmentectomy. Methods:Sixty-six students who participated in clinical training for thoracic surgery from November 2020 to March 2022 were included in the study. Computed tomography (CT) images, 3D-CT images, and 3D models were used to investigate students’ level of understanding for each lung segment. Levels of understanding were assessed using a questionnaire administered using the interview method. The results of the questionnaire were tabulated and analyzed using the Kruskal-Wallis test. Results:The response rate was 100%. Comprehension scores for all questions were highest for 3D models, followed by 3D-CT and CT. These results suggest that use of a 3D entity model may have a high educational effect. Conclusion:Although it is unclear whether students’ comprehension was directly related to their understanding of correct anatomy, our results suggest that 3D models may be an effective way for medical students to understand lung segmentectomy.
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今月の話題
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ヘパリン用量感受性試験に基づいた開心術中凝固管理
77, 3(2024);View Description Hide DescriptionA 63-year-old woman with severe aortic regurgitation was admitted to our hospital due to congestive heart failure. She also had antiphospholipid syndrome (APS), necessitating strict coagulation management. Given her history of cerebellar infarction, deep vein thrombosis, and recurrent miscarriages, her thrombosis risk was higher, with all three types of antiphospholipid antibodies testing positive. Before the surgery, we created a heparin-activated clotting time (ACT) titration curve using the patient’s blood, and the calculated ACT corresponding to the target heparin concentration of 3 U/ml was 650 seconds. We planned to administer heparin according to this target during cardiopulmonary bypass. The patient underwent an aortic valve replacement (AVR) using a bioprosthesis and was discharged without complications. -
転位気管支および肺静脈走行異常を伴った右上葉肺癌
77, 3(2024);View Description Hide DescriptionThe patient is a 77-year-old man. He was referred to our hospital after a chest computed tomography (CT) scan revealed a 6.5 cm-sized mass in the right lung apex. Bronchoscopy revealed adenocarcinoma, clinical stageⅡB, and the patient was referred for surgery. Preoperative 3D-CT revealed the presence of a displaced bronchus, probably B1a, branching from the right main bronchus centrally from the upper lobe bronchus, and an abnormal vessel (V2) running dorsal to the upper lobe bronchus and the right main bronchus, and returning directly to the left atrium. Surgery was performed by resectioning the right upper lobe through a posterolateral incision, combined resection of the wall pleura, and lymph node dissection (ND2a-2). Because lung cancer surgery is sometimes accompanied by abnormal bronchial and pulmonary vascular branches, it is essential to thoroughly examine the patient before surgery for checking abnormal branches by bronchoscopy and 3D-CT.
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まい・てくにっく
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手術の工夫
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乳児特発性僧帽弁腱索断裂に対するsupra-annular僧帽弁置換術
77, 3(2024);View Description Hide DescriptionAcute rupture of the chordae tendineae of the mitral valve could lead to severe mitral regurgitation and circulatory collapse in infants. Mitral valve replacement may be often challenging because of the valve-annulus size mismatch in small infants when mitral valve repair cannot be accomplished. We present an infant with acute massive rupture of the chordae tendineae of the mitral valve who successfully underwent supra-annular mitral valve replacement using the short composite valve of an expanded polytetrafluoroethylene( ePTFE) graft and a mechanical valve. His mechanical valve has been functioning without complications such as thrombosis and pulmonary venous obstruction for 20 months after surgery. This technique could be helpful even infants with acute rupture of the chordae tendineae of the mitral valve whose left atrium may not be dilated.
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1枚のシェーマ
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臨床経験
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経カテーテル的大動脈弁置換術後のパンヌス形成による左室流出路狭窄に対する手術
77, 3(2024);View Description Hide DescriptionWe experienced a case of surgical aortic valve re-replacement due to structural valve deterioration caused by pannus formation 4 years after transcatheter aortic valve replacement( TAVR). The patient underwent surgery because the mean transvalvular pressure gradient increased to 48 mmHg on echo-cardiography. Contrast-enhanced computed tomography (CT) was useful for predicting the site of adhesion to surrounding tissue preoperatively and exploring the presence of the pannus. Intraoperative findings showed the TAVR valve was covered with neointima except around the origins of the left and right coronary arteries and was firmly adhered to the surrounding tissues. As residual pannus was present in the subvalvular tissues, it was carefully removed. The explanted TAVR valve functioned well with good opening and closure. The postoperative course was uneventful. Pannus formation can result from mechanical stress. TAVR valves put significantly greater stress on the left ventricular outflow tract than surgical valves and may be more likely to cause pannus formation.
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