{"created":"2021-03-01T06:09:54.389092+00:00","id":6021,"links":{},"metadata":{"_buckets":{"deposit":"0327ef02-4ee4-4e55-b977-b38f638f2a97"},"_deposit":{"id":"6021","owners":[],"pid":{"revision_id":0,"type":"depid","value":"6021"},"status":"published"},"_oai":{"id":"oai:niigata-u.repo.nii.ac.jp:00006021","sets":["453:455","471:561:562"]},"item_6_alternative_title_1":{"attribute_name":"その他のタイトル","attribute_value_mlt":[{"subitem_alternative_title":"Surgical Outcomes of pT1b Gallbladder Cancer : Comparison of Simple Cholecystectomy Versus Radical Resection"}]},"item_6_biblio_info_6":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2018-03-23","bibliographicIssueDateType":"Issued"},"bibliographic_titles":[{}]}]},"item_6_date_granted_51":{"attribute_name":"学位授与年月日","attribute_value_mlt":[{"subitem_dategranted":"2018-03-23"}]},"item_6_degree_grantor_49":{"attribute_name":"学位授与機関","attribute_value_mlt":[{"subitem_degreegrantor":[{"subitem_degreegrantor_name":"新潟大学"}]}]},"item_6_degree_name_48":{"attribute_name":"学位名","attribute_value_mlt":[{"subitem_degreename":"博士（医学）"}]},"item_6_description_4":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"【目的】 壁深達度が固有筋層に留まる胆囊癌(pT1b胆囊癌)の切除術式に関して, 胆囊摘出術で十分であるか, 肝切除やリンパ節郭清を伴う切除(根治切除)が必要であるかについては, 未だに一定の見解が得られていない. 本研究では, pT1b胆囊癌に対する適切な切除術式を明らかにする. 【対象と方法】 外科切除されたpT1b胆囊癌43例を対象とした. 術式の内訳は胆囊摘出術25例, 根治切除18例であり, 両術式間で臨床病理学的因子および術後遠隔成績を比較した. 癌巣の全割標本から組織学的壁深達度を診断した. 合計168個の摘出リンパ節において転移の有無を評価した. 術後経過観察期間の中央値は127か月であった. 【結果】 術前に胆囊癌または胆囊癌疑いと診断された症例は, pT1b胆囊癌43例中16例(37%)であり, いずれの症例も術前に確証的な画像的根拠をもって壁深達度を診断できなかった. 術前に診断された16例中14例と胆囊癌と術中診断された2例は進行胆囊癌を除外できずに根治切除が実施された. 胆囊摘出術後に追加で根治切除が実施されたのは2例であった. 残りの25例は胆囊摘出術のみが実施された. 検索したすべてのリンパ節に転移を認めなかった. 静脈浸潤, 神経浸潤を全例で認めなかったが, リンパ管浸潤を根治切除実施の1例に認めた. 切離断端は全例で組織学的に陰性であった. 原病死は遠隔転移再発による2例(肝転移, 肺転移が各々1例)であり, いずれの症例も根治切除を受けていた. 胆囊摘出術実施例および根治切除実施例の累積5年全生存率は, 各々86%, 82%であり, 両術式間で明らかな差を認めなかった(P=0.956). 【結論】 pT1b胆囊癌のほとんどが局所への進展に留まる. pT1b胆囊癌の壁深達度を確証的な画像的根拠を持って術前診断することは困難であるため, 術前に進行胆囊癌を除外できない場合, 結果としてpT1b胆囊癌に根治切除を実施することは正当である. 一方, 胆囊摘出術後に癌巣の全割標本で病理診断されたpT1b胆囊癌に対しては, 切離断端が癌陰性であれば追加切除は必要ではない.","subitem_description_type":"Abstract"}]},"item_6_description_5":{"attribute_name":"内容記述","attribute_value_mlt":[{"subitem_description":"学位の種類: 博士（医学）. 報告番号: 甲第4423号. 学位記番号: 新大院博（医）甲第822号. 学位授与年月日: 平成30年3月23日","subitem_description_type":"Other"},{"subitem_description":"新潟医学会雑誌. 2015.  129(6), 309-316.","subitem_description_type":"Other"}]},"item_6_description_53":{"attribute_name":"学位記番号","attribute_value_mlt":[{"subitem_description":"新大院博（医）甲第822号","subitem_description_type":"Other"}]},"item_6_dissertation_number_52":{"attribute_name":"学位授与番号","attribute_value_mlt":[{"subitem_dissertationnumber":"13101甲第4423号"}]},"item_6_full_name_3":{"attribute_name":"著者別名","attribute_value_mlt":[{"nameIdentifiers":[{"nameIdentifier":"51266","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Maruyama, Tomohiro"}]}]},"item_6_publisher_7":{"attribute_name":"出版者","attribute_value_mlt":[{"subitem_publisher":"新潟大学"}]},"item_6_select_19":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_select_item":"ETD"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"丸山, 智宏"}],"nameIdentifiers":[{"nameIdentifier":"51265","nameIdentifierScheme":"WEKO"}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2019-08-05"}],"displaytype":"detail","filename":"h29nmk822.pdf","filesize":[{"value":"1.9 MB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"本文","url":"https://niigata-u.repo.nii.ac.jp/record/6021/files/h29nmk822.pdf"},"version_id":"31236ec5-88b8-4cdc-b25c-7bc183d9da0e"},{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2019-08-05"}],"displaytype":"detail","filename":"h29nmk822_a.pdf","filesize":[{"value":"596.0 kB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"要旨","url":"https://niigata-u.repo.nii.ac.jp/record/6021/files/h29nmk822_a.pdf"},"version_id":"eabb7087-84f9-4b75-b732-f825782e8e2d"}]},"item_keyword":{"attribute_name":"キーワード","attribute_value_mlt":[{"subitem_subject":"胆囊癌","subitem_subject_scheme":"Other"},{"subitem_subject":"T1b","subitem_subject_scheme":"Other"},{"subitem_subject":"リンパ節郭清","subitem_subject_scheme":"Other"},{"subitem_subject":"胆囊摘出術","subitem_subject_scheme":"Other"},{"subitem_subject":"根治切除","subitem_subject_scheme":"Other"}]},"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":"thesis","resourceuri":"http://purl.org/coar/resource_type/c_46ec"}]},"item_title":"pT1b胆囊癌の手術成績 : 胆囊摘出術と根治切除との比較","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"pT1b胆囊癌の手術成績 : 胆囊摘出術と根治切除との比較"},{"subitem_title":"pT1b胆囊癌の手術成績 : 胆囊摘出術と根治切除との比較","subitem_title_language":"en"}]},"item_type_id":"6","owner":"1","path":["455","562"],"pubdate":{"attribute_name":"公開日","attribute_value":"2018-07-26"},"publish_date":"2018-07-26","publish_status":"0","recid":"6021","relation_version_is_last":true,"title":["pT1b胆囊癌の手術成績 : 胆囊摘出術と根治切除との比較"],"weko_creator_id":"1","weko_shared_id":2},"updated":"2022-12-15T03:39:24.648824+00:00"}