{"_buckets": {"deposit": "b769de41-5fb0-4b22-9240-3ac285f9767f"}, "_deposit": {"id": "8628", "owners": [], "pid": {"revision_id": 0, "type": "depid", "value": "8628"}, "status": "published"}, "_oai": {"id": "oai:niigata-u.repo.nii.ac.jp:00008628", "sets": ["456", "908"]}, "item_7_alternative_title_1": {"attribute_name": "その他のタイトル", "attribute_value_mlt": [{"subitem_alternative_title": "A Case of Submucosal Gastric Cancer With Lymph Node Metastasis to the Splenic Hilum Receiving Additional Gastrectomy After ESD"}]}, "item_7_biblio_info_6": {"attribute_name": "書誌情報", "attribute_value_mlt": [{"bibliographicIssueDates": {"bibliographicIssueDate": "2015-08", "bibliographicIssueDateType": "Issued"}, "bibliographicIssueNumber": "8", "bibliographicPageEnd": "468", "bibliographicPageStart": "463", "bibliographicVolumeNumber": "129", "bibliographic_titles": [{"bibliographic_title": "新潟医学会雑誌"}, {"bibliographic_title": "新潟医学会雑誌", "bibliographic_titleLang": "en"}]}]}, "item_7_description_4": {"attribute_name": "抄録", "attribute_value_mlt": [{"subitem_description": "症例は60歳, 女性. 人間ドックを契機に胃穹窿部大彎に7cm大の0-IIa+IIb型病変を指摘され, 当院消化器内科にてESDが施行された. 病理組織学的検討で, 腫瘍は一部に低分化成分を伴った高分化型管状腺癌であり, 免疫染色で胃型の粘液形質を有する腫瘍であった. 粘膜下層浸潤があり, 垂直断端陽性であったことから外科的追加切除の適応と判断され当科を受診した. 高度なリンパ管侵襲を認めたこと, 胃型の腫瘍であったことから, 腹部CT所見では明らかなリンパ節の腫大を認めなかったものの, リンパ節転移の可能性は低くないと考えた. また, 病変部位は胃上部の大彎側病変であり, 脾門リンパ節郭清も省略できないと判断した. 手術はESD2か月後に胃全摘術, 脾合併切除術, D2リンパ節郭清, Roux-en Y再建を施行した. 病理組織学的検討では, ESD瘢痕部に癌の遺残を認めたが深達度は粘膜下層までであった. 脾門リンパ節に4個, 大彎左群リンパ節に1個, 計5個のリンパ節転移を認め, いずれも原発巣と同様の胃型形質を示す腫瘍であった. 胃型形質を示す高分化型腺癌は, 比較的リンパ節転移をきたしやすいことが報告されている. 早期胃癌で脾摘を伴うD2郭清が検討されることは稀であるが, 本症例のように局在, 組織型, リンパ管侵襲の程度によっては, 脾門リンパ節郭清を考慮してもよいと思われた. 消化器内科医, 病理医と緊密な連携を図り, 過不足のない術式を検討しなければならない.", "subitem_description_type": "Abstract"}]}, "item_7_full_name_3": {"attribute_name": "著者別名", "attribute_value_mlt": [{"nameIdentifiers": [{"nameIdentifier": "60111", "nameIdentifierScheme": "WEKO"}], "names": [{"name": "Tanaka, Kana"}]}, {"nameIdentifiers": [{"nameIdentifier": 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