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To find out the appropriate dye laser output and frequency for each kind of stone experimentally, and to use flashlamp-excited dye laser for impacted biliary stones.Prospective study.University hospital, Japan.12 patients undergoing lithotripsy for both intrahepatic and extrahepatic impacted biliary stones.Appropriate dye laser output and frequency, histological changes in the bile duct wall, and outcome.Stones were pulverised, and required a median 155 pulses (range 80-205) at 40 mJ for bilirubin stones and 355 pulses (range 205-405) at 50 mJ for cholesterol stones. At the standard energies used, the laser caused only superficial damage to the serosa of the common bile duct. It was successful in fragmenting 133/135 stones (99%), and in addition pulverised 125/135 stones (93%). No patients complained of pain during laser lithotripsy even under local anaesthesia. All patients were discharged from the hospital after an uneventful recovery, and no recurrent stones have been found at outpatient follow-up ranging between 2 and 85 months.Flashlamp-excited dye laser with a small choledochoscope seems to be safe and painless way of treating biliary stones, even if they are impacted in the peripheral biliary tree and patients are at high risk.

Infectious epidermid cysts of the spleen with high serum levels of CA19-9 and CA125 are rare. We successfully performed a laparoscopic splenectomy for a 20-year-old woman who was diagnosed as having the disease. The patient was admitted to the hospital becuse of high fever and left hypochondralgia. After a workup of ultrasonography, CT and magnetic resonance imaging, she was diagnosed as having infectious splenic cyst. In addition, malignancy was suspected because serum levels of CA19-9 and CA125 were as high as 1.1×106U/ml and 1.8×104U/ml, respectively. Immunological stainings indicated that CA19-9 might escape from epithelium of the cystic wall to the blood. CA19-9 and CA125 decreased to 100U/ml and

An 81-year-old man with early gastric cancer chronic with renal failure was successfully treated by intragastric endoscopic surgery. He had early gastric cancer locating beyond the pyloric ring. After making a temporary gastrostomy under epidural anesthesia, a mucosal resection was performed using a Buess's endoscope. Operation time was 120 minutes. He was discharged from the hospital uneventfully. In conclusion, among minimally invasive surgeries for gastric cancer, this method seems to be advantagenus to lesions locating near the cardia and pylorus and can be recommeded for patients with risk factors such as elderly and same underlying diseases.

The principle of treatment of choledochal cysts is total cyst excision with hepaticojejunostomy because of the high rate of associated malignancy of the biliary system. The authors used a minimally invasive laparoscopic procedure to treat a patient with nonmalignant choledochal cyst. Although a large median laparotomy is usually used for cyst excision and hepaticoenterostomy, laparoscope-assisted total cystectomy and hepaticojejunostomy were performed with minimal skin incision. To avoid gas embolism during dissection around the hepatic hilus the surgical procedure was divided into two stages: CO2 insufflation and abdominal lifting without pneumoperitoneum. This combination of procedures was as safe and technically adequate as conventional surgery. No abnormalities were observed in liver function, and the patient could sit up in bed the first day postoperatively. Thirteen days after surgery, he was discharged from the hospital uneventfully.

Twenty-three cases of congenital biliary dilatation in children experienced at the hospital in a recent two decade were didided into two groups by type of the common bile duct, namely, cystic type dilatation (C-type; 12 cases) and fusiform type dilatation (F-type; 11 cases). There were five male and 18 female patients. Averaged age at operation was 2.8, ranging from 2 months to 10 years old. Items investigated included the age of onset of the disease, symptoms at the onset, blood biochemical data (white blood cell count, CRP, and total bilirubin), histopathologic types.The onset age was younger in C-type patients who manifested the disease less than one year of age. Higher total bilirubin level in serum noted in C-type cases than F-type cases. Elevated amylase level in the common bile duct was noted in F-type cases compared to the others.In C-type cases there were more pancreatico-choledochus types, and in C-type cases there were more choledoco-pancreas types in a type of pancreatico-biliary maljunction. Pathological sections of the common bile duct revealed severe chronic inflammation such as wall thickness and fibrosis in C-type cases.It is suggested that the age of onset, the presence of obstructive mechanism at the common bile duct, and type of pancreatico-biliary maljunction might be contributing factors to the type of dilatation.

A 75-year-old man who was diagnosed as having mucin-producing pancreatic cystic lesion ofthe main pancreatic duct by duodenoscopic examination was reported. Because of the low malignant potential of such lesions, duodenum-preserving resection of the head of the pancreas was performed, and the intra-operative histological examination showed no malig-nancy of the resected pancreatic head and no other surgical procedures, such as lymph-adenectomy nor pancreato-duodenectomy were necessary. The significance of this case report lies in that a less invasive operation should be selected at first to diagnose whether the lesion is malignant or not, and als0 that the selected operation itself must be sufficient to resect an adequate part of the pancreatic tissue involving the cystic lesion, ifnot malignant. Here, we report the process to select the procedure and the surgical technique.

In this study, assessment by a flow cytometric method using dichlorhydroxy fluorescin diacetate (DCFADH) in vitro revealed that human peripheral blood inhibits the production of active oxygen species by human peripheral neutrophils. It was also revealed that among the blood components, the plasma fraction inhibits active oxygen production most strongly. This plasma inhibitory activity was dose-dependent. Human serum also exerted an inhibitory activity; however, its activity was only one-third that of plasma. Moreover, when HL-60 human promyelocytic leukemic cells, with or without differentiation into the neutrophils by culturing with dimethyl sulfoxide (DMSO), active oxygen, which was also inhibited by plasma, was produced. Heat inactivation of the plasma did not alter the inhibitory activity, and gel filtration analysis showed that the peak activity was associated with a molecular mass of 70,000. The results of this study indicate that human plasma contains one or more substances that inhibit the active oxygen production of neutrophils, which may play an important role in inhibiting unneeded neutrophil activation in the bloodstream.

Long-term results of hepatic resection for hepatolithiasis in 34 patients having intrahepatic biliary strictures were studied. The left lateral and the right posterior segmental ducts were commonly and often simultaneously involved. Fourteen patients had multiple segmental involvement. Hepatic resection included left sided resection (n = 27), right sided resection (n = 6), and repeated bilateral resection (n = 1). Seven patients had biliary tumors: 3 cholangiocarcinomas, 2 gall bladder cancers, 1 cystadenocarcinoma, and 1 dysplasia of intrahepatic ducts. Nineteen patients received bilioenteric anastomosis. Retained stones and recurrent stones developed in 3 and 4 patients, respectively. Twenty-six patients had no remaining symptoms; 2 died of operative complication or cholangiocarcinoma; 6 presented symptoms caused by retained stones (n = 2), recurrent stones (n = 2), bile stasis (n = 1), or neuralgia (n = 1). In 4 of the 6 patients, unrelieved posterior duct strictures caused the symptoms. With a mean follow-up period of 4.5 years, 30 patients are symptoms free, and 27 are stone free. In patients with right lobar or bilobar type, intra- and extrahepatic type, and confluence strictures, bilioenteric anastomosis is required. Hepatic resection is a rational treatment for hepatolithiasis, however, meticulous management of biliary tract abnormalities, particularly the posterior duct stricture, is mandatory.

Hepatic resection under the intermittent hepatic vascular exlusion technique (IHVE) was carried out on five patients with liver tumor involving major hepatic vessels which seemed otherwise difficult to resect, and its efficacy was evaluated. The total clamping time was 38 min for 3.8 clampings on average. Division of the right adrenal vein was necessary for a complete hemostasis during hepatic resection under IHVE, which was obtained in four patients. Maneuverability around major vessels was also improved due to IHVE, making the surgery less dangerous. General haemodynamic conditions during IHVE were stable, except for increased vena cava pressure and slightly decreased cardiac output. Postoperative course was uneventful except for pleural effusion in four patients. These results show that IHVE is a useful and safe procedure for hepatic resections, offering a bloodless operative field and improved the maneuverability around major hepatic vessels, in patients with liver cancer involving major hepatic vessels.

When familial adenomatous polyposis (FAP) is diagnosed in a patient, prophylactic surgery must be performed whether colorectal cancer is present or not. Operations for FAP have been performed through a large median abdominal incision or an additional perineal incision, depending on the coexistence of rectal cancer. Recently, we reported a technique of laparoscopic rectal amputation without abdominal skin incision for patients with rectal cancer to minimize postoperative cardiac and respiratory complications [6]. In this article, we report a case of laparoscopically assisted proctocolectomy with ileostomy through a minimal abdominal and perineal skin incision performed by a hand-assisted procedure. The purpose of combining the perineal and laparoscopic approaches is to minimize the skin incision, while retaining a rate of cure and safety equivalent to those of conventional rectal amputation, by using the advantages of laparoscopic procedures, and to facilitate postoperative recovery and improve the quality of life for relatively young patients with FAP.

Surgical outcomes of 151 abdominal operations in aged patients over 80 years old were studied in terms of life-saving significance, improved quality of life (QOL) and postoperative complications. In 102 elective operations, the operation was life-saving in 5, QOL improved in 58, and operative death occurred in 7 patients. In the remaining 49 emergency operations, surgery was lifesaving in 25, QOL improved in 33, and operative death occurred in 13 patients. Forty-one patients with benign disease necessitated emergency surgery, indicating a dominance of severe diseases. Curative resection of malignant tumors provided better QOL. Of the 20 postoperative deaths, 8 patients were caused by serious diseases (cancer in 4 and shock in 4); 6 by operative complications (anastomotic leakage in 4, pancreatitis and hepatic insufficiency in each one); and 6 by complicated diseases (pneumonia in two, cardiovascular disease in two, cerebral infarction in one and sudden death in another one). Though abdominal operation would carry a high risk to aged patients, about 60% of the patients in this series were able to have improved QOL after perioperative managenent could be cleared. It is concluded that opportune and correct operation, as well as cautious perioperative care, provide a better QOL for aged patients over 80 years old.

A case of hepatocellular carcinoma (HCC) in which the patient repeatedly underwent minimally invasive hepatic procedures is reported. The patient was a 71-year-old man who underwent transthoracic microwave coagulation therapy (MCT) for initial HCC nodules in segment VIII and subsequent laparoscopic MCT for small intrahepatic recurrent nodules in the left hepatic lobe. At this writing, the patient was alive and well without tumor recurrence 29 months after the initial surgery. Minimally invasive hepatic surgery alleviates perihepatic adhesion and allows subsequent laparoscopic surgery in the case of intrahepatic HCC recurrence.

Neutrophil activation initiates myocardial ischemia/reperfusion (I/R) injuries. The aim of this study is to evaluate the in vitro functions of an anti-neutrophil monoclonal antibody, Urge-8, and its therapeutic efficacy against myocardial ischemia (MI) in rats. We measured in vitro functions of rat neutrophils including chemotactic activity, superoxide production, phagocytic function, and neutrophil degranulation. MI was induced in Wistar rats by clamping the left coronary artery for 1 h. Rats received either isotype-negative control IgG1 (control group, n = 20), 250 µg/kg of Urge-8 before (pre-treatment group, n = 20) or after (post-treatment group, n = 20) MI. The three groups were compared during the first 24 h after reperfusion with respect to changes in mean arterial pressure, heart rate, body temperature, biochemistry, serum cytokines, myocardial neutrophil infiltration, survival rate, and size of MI. Urge-8 effectively suppressed in vitro functions of rat neutrophils including chemotactic activity, superoxide production, phagocytic function, and neutrophil degranulation. The Urge-8 treated groups showed higher levels of arterial pressure and survival rate, lower values of interleukin-6 and interleukin-8, lower grade of myocardial neutrophil infiltration, and smaller MI size as compared to the control group. In conclusion, Urge-8 is effective against myocardial I/R injury by suppressing certain functions and myocardial infiltration of neutrophils in rats.

Combined liver-intestine transplantation is an evolving procedure, and auxiliary liver transplantation has several advantages over standard orthotopic liver transplantation. We present a new model of combined intestine-auxiliary liver transplantation in rats. Total small bowel and 60% liver were harvested en bloc. An aortic segment that contained the celiac axis and superior mesenteric artery ensured blood supply to the graft. Venous drainage of the grafted intestine was achieved via the intact portal vein of the graft. The infrahepatic vena cava was cut at different levels during the modification period and at the oblique level of the left renal vein in consecutive series. Revascularization was accomplished by end-to-side anastomosis of the aorta and of the infrahepatic vena cava. The recipient small bowel was resected and the intestine continuity restored by anastomosis. Total operation time averaged 130 min. The overall survival rate of 3 months in the consecutive series was 80% (16/20). Exploratory laparatomy and histologic study in 3 rats on 90 days after transplantation revealed normal and viable grafts. Liver function was normal and both grafted liver and intestine showed normal histologic architectures in 5 rats observed for 12 months after transplantation. The present model is reproducible and allows preclinical research on several aspects of experimental combined intestine-auxiliary liver transplantation.

Objective: To assess the feasibility of cure of early gastric cancer by the endoscopic procedure done through a temporary gastrostomy and to use it to treat patients with various severe complications. Design: Prospective study. Setting: University hospital, Japan. Subjects: Four patients who required gastric mucosal resection for early gastric cancer. Main outcome measures: Ease of the procedure, cure rate, safety under epidural anaesthesia, and outcome. Results: All patients had the procedure under epidural anaesthesia without pain or complaints during operation. Mean operation time was 120 minutes (60-200). Histological examination showed that the surgical margin was free of tumour in 3 of the cases. One patient who had microscopic invasion of lymph nodes subsequently underwent second-look conventional gastrectomy with lymphadenectomy. Postoperative recovery was rapid, and all patients were discharged from the hospital uneventfully. Conclusion: This organ-preserving procedure enables good visualisation ...

Objectives: The number of patients with end-stage renal disease undergoing open heart surgery continues to grow. We evaluated continuous ambulatory peritoneal dialysis and the extracorporeal ultrafiltration method during cardiopulmonary bypass in the management of these difficult patients.Methods: These 2 methods were used in 4 patients with renal failure who underwent open heart surgery between July 1997 and March 1999. Preoperative continuous ambulatory peritoneal dialysis was conducted using standard protocols. Extracorporeal ultrafiltration method was used only during cardiopulmonary bypass. Continuous ambulatory peritoneal dialysis was initiated upon arrival at the intensive care unit. Mean follow-up was 12 months.Results: Postoperative blood urea nitrogen and creatinine concentrations were lower than preoperative concentrations. No patients required hemodialysis. All 4 patients were discharged to their homes. No deaths occurred.Conclusions: Continuous ambulatory peritoneal dialysis and extracorporeal ultrafiltration method are combined to treat patients with end-stage renal disease who require open heart surgery. This combination is simple, and does not require specialized personnel, and obviates the hemodynamic instability associated with hemodialysis.

Blue rubber bleb nevus syndrome is characterized by gastrointestinal and cutaneous hemangiomas and gastrointestinal bleeding causing anemia. We report a unique case of this syndrome in an adult woman. It was associated with congenital heart disease, for which the patient underwent surgery at 12 months of age, and cutaneous hemangiomas, for which surgery was performed later in childhood. Gastrointestinal bleeding was diagnosed and treated when she was 21 years of age after a workup for iron deficiency anemia. Successful total resection of all gastrointestinal hemangiomas was performed by minimally invasive surgery with gastric, small intestinal, and colonic fiberscopy and laparoscopy. The postoperative course was uneventful. The patient could walk the day after surgery, and she was discharged from the hospital 14 days after surgery. Our experience and findings given in other reports suggest that total resection of hemangiomas should be the final goal and that minimal skin incision is preferable for this benign disease, with multiendoscope-assisted treatment to ensure that any hemangiomas remaining in the gastrointestinal tract are not overlooked.

This perfusion model enables a pharmacokinetic study of enteral absorption and hepatic metabolic rate simultaneously. FK 506 is absorbed mainly via the proximal small intestine and metabolized rapidly by the liver during single passage. These results may lead to further analyses of absorption and metabolism of FK 506 under various conditions.

We report herein the first known case of early gastric cancer with synchronous liver metastasis forming a portal tumorous embolism. A 62-year-old man was found to have multiple liver tumors and a portal tumorous embolism by ultrasonography. A gastroscopy subsequently showed Borrmann type III-like gastric cancer in the antrum. His carbohydrate antigen (CA) 19-9 level was elevated to 8280 U/ml, but the alpha-fetoprotein level was within normal limits. A laparotomy revealed multiple liver metastasis and subpyrolic lymph-node enlargement; a distal partial gastrectomy with group 1 lymph-node dissection for the gastric cancer in the antrum, and cannulation of the proper hepatic artery for postoperative chemotherapy were performed. Histopathologically, the cancer was found to be a medullary type well-differentiated adenocarcinoma. Subpyrolic lymph node metastasis was noted, but cancer invasion was localized to only the mucosal and submucosal layers of the stomach. Thus, the patient was diagnosed as having early gastric cancer. Adjuvant chemotherapy given through the cannula suppressed further elevation of CA19-9 levels, and a total of 26 Gy irradiation to a liver tumor, which had caused ascites by pressing on the inferior vena cava, diminished the ascites. The patient was able to remain at home with treatment for 7 months after radiation therapy, but finally died of cancer with jaundice 13 months after his operation. Therefore, although adjuvant chemotherapy and radiation therapy contributed to improving his quality of life, it could not prolong survival.

Background: Percutaneous microwave coagulation therapy (PMCT) is effective for small liver tumors. To enhance the radicality of PMCT, we developed a sequential coagulation technique. Methods: After inserting the first guide-needle under sonography, multiple needles were placed through a disk-type introducer that was devised to guide needle puncture at regular intervals, and microwaves were irradiated. Six patients, including 4 with hepatocellular carcinoma and 2 with liver metastasis, underwent this technique for tumors of 15 to 80 mm in diameter. Results: This technique can coagulate an area up to 60 mm in diameter in one session. Insertion of multiple needles, ranging from 2 to 11, was successful without complications. Three patients undergoing curative PMCT developed no tumor recurrence. The other 3 received incomplete PMCT due to the large size and location of the tumor. Conclusions: This preliminary study indicates the efficacy of this technique to facilitate and secure PMCT in selected patients with liver tumors.

For the purpose of prophylactic treatment of splenic aneurysms, both examinations and treatments should be minimally invasive. Here, we report a case of a patient who underwent three-dimensional arterial computed tomography (CT) and laparoscope-assisted splenectomy with aneurysm resection as a combination of minimally invasive examination and treatment.

The effects of low dose FK506 therapy (0.1 mg/ kg/day x 1 day) on graft survivals were analyzed, and the feasibility of splenectomy was assessed. ACI strain liver grafts were orthotopically implanted into LEW male rat recipients. In the control group, the survival period was 10.4 +/- 1.4 days. In the group treated with splenectomy, the survival period was 13.4 +/- 2.0 days. In the groups with low dose FK506 therapy, the survival periods were 22.7 +/- 6.7 and 39.7 +/- 6.3 days with or without splenectomy, respectively. Rats in the group with average dose FK506 (1.0 mg/kg/day x 7 days) survived more than 100 days. In summary, the effect of low dose FK506 therapy was relatively limited. Splenectomy by itself was marginally effective; however, this effect was enhanced when combined with low dose FK506 therapy.

Laparoscopic cholecystectomy (LC) has become one of the options for the treatment of acute cholecystitis as surgeons gain facility with this procedure. However, acute suppurative cholecystitis is still a severe condition, because a high mortality rate still exists. In the early years (1991 to 1992), 4 patients were operated on without a preceding percutaneous transhepatic gallbladder drainage (PTGBD) at our hospital, however, one patient died of septic shock after a laparoscopic cholecystectomy. Conversion to open surgery was performed on two patients. However, in later years (1992 to 1995), 14 patients were operated on with preceding PTGBDs safely. Here, we report the safeness and significance of the combination therapy of PTGBD and LC for patients with severe acute suppurative cholecystitis.

In spite of the development of techniques for liver resection, preoperative evaluation of hepatic functional reserve and some other therapeutic options such as transcatheter arterial embolization (TAE) and percutaneous ethanol injection therapy (PEIT), liver failure after surgery is sometimes observed. Some patients, who have small liver cancers (under 2 cm in diameter) are diagnosed by various tests, but hepatic resection is not an option for the subset who have lowered hepatic functional reserve. Conventionally, such cases have been treated by TAE and/or PEIT. For the tumors in segments 7 or 8, as termed by Couinaud, which are located just beneath the diaphragm and are difficult to investigate by ultrasonography (US), or to perform PEIT, we have recently applied laparoscopic microwave coagulo-necrotic therapy (LMCNT) with the guidance of US and in some cases, thoracoscopic MCNT (TMCNT), which is performed across the diaphragm to necrotize the tumor, again with the help of US. Here, we report some cases treated by this technique, and the intraoperative color doppler US, which helps evaluate the effectiveness of MCNT.

Acute pancreatitis sometimes leads to pancreatic abscess with a high mortality rate when appropriate drainage is not applied. Pancreatic pseudocysts are also major complications of pancreatitis, which usually need to be treated only when they are symptomatic; they sometimes lead to disseminated intravascular coagulopathy or intraabdominal bleeding if they maturate. Conventional pancreatic drainage operations have sometimes been so invasive that they cannot be applied for severe cases with renal failure and disseminated intravascular coagulopathy. To avoid the risks of conventional drainage operations for pancreatic abscesses, a low invasive and effective percutaneous drainage technique guided by a laparoscope was developed and employed to a high-risk patient with post-pancreatitic pancreatic abscess. After the operation, leukocytosis and high fever improved dramatically. One year after discharge from the hospital, no recurrence of abscesses or leukocytosis have been found. Thus, this technique should be considered as a first option for the pancreatic drainage operation.

Ex situ hepatic surgery, in which a diseased liver is resected from outside the body, was first reported in 1988. This study investigates the hemostatic changes occurring during such surgery in two cases. During the anhepatic period of more than 5 hours, veno-venous bypass without heparin was performed. The tests included platelet count, prothrombin activity (PT), partial thromboplastin time (PTT), fibrinogen (Fbg), factor II (F.II), factor V (F.V), and thromboelastography (TEG). Three to 4 hours after entering the anhepatic phase, marked fibrinolysis and a fall in the values of PT, Fbg and F.V. were observed. Every parameter temporarily deteriorated immediately after revascularization of the graft, however, all returned to almost normal values within 1-2 hours after hepatic reperfusion except for F.V and platelets. In conclusion, the coagulopathy during ex situ hepatic surgery is caused by the marked fibrinolysis and depletion of hemostatic factors which develop 3-4 hours after the onset of the anhepatic phase.

To our knowledge, we introduce a new technique to treat a patient with hepatocellular carcinoma having a main tumor and a small satellite nodule in segments IV and VI, respectively. The liver was laparoscopically mobilized; the dissection line was adequately exposed through a 12-cm anterior thoracic incision. Segment VI was resected without hilar dissection or parenchymal compression. The satellite nodule was coagulated with microwaves. The patient had an uneventful postoperative recovery. This technique potentially alleviates postoperative adhesion and allows a minimally invasive surgery. Arch Surg. 1997;132:206-208

胆管狭窄をともなう慢性膵炎6例を検討した.1) 黄疸は4例でみられ, うち3例は自然消退したが, 1例は胆管完全閉塞に対し経皮的胆管ドレナージを要した. 2) 胆管炎・胆嚢炎は5例, 胆石は3例に認められ, 胆汁細菌培養は60%で陽性であった. 3) 胆管像は全例で総胆管拡張をともない, 膵内胆管しめつけ2例, 不整狭窄2例, 圧排1例, 完全閉塞1例が認められた. 4) 胆道・膵同時バイパス4例 (Double Roux-Y2, ρloop, Roux-Y 1, 胆管十二指腸吻合兼嚢胞空腸吻合1例), 胆管十二指腸吻合1例 (空腸間置法), 膵十二指腸切除1例を行い良好な成績を得た. 以上より胆管狭窄をともなった慢性膵炎は胆汁うっ滞・胆道系炎症を高率に合併するため, 症例に応じた適切な胆道再建術を要するものと考えられた.

胃癌患者54例をDisease free group (II群) 21例, Localized group (III群) 11例, Regional group (IV群) 7例, Metastatic group (V群) 14例に分け, 良性疾患22例 (I群) とともにリンパ球subsets (OKT3, OKT4, OKT8, OKIal, Leu7) を検討した. 1) 比率ではII, IV群でOKT4+細胞が42.7±9.67%, 40.9±7.37%と低く, OKIal+細胞がV群で23.1±12.3%と高い以外, 差が認められなかった. 2) 絶対数ではリンパ球減少に伴ない, Leu7+細胞以外の各分画がIV, V群で減少していた. 特にOKT3+, OKT4+, OKT8+細胞数減少が著明であった. 以上より, 進行胃癌患者ではリンパ球subsetsの比率の異常よりむしろ絶対数減少 (特にT細胞系) が著明で, これが細胞性免疫能低下に関与していることが示唆された.

胃癌に対する胃全摘兼摘脾を施行した4例に対し, 平均21%重量の脾自家移植により脾温存を試み以下の成績を得た. 1) 脾自家移植にともなう合併症は認められなかった. 2) 術後の脾シンチで全例に生着を確認し, 移植脾による網内系貧食能が認められた. 3) 術後血清IgMの低下は認められず, 縫合不全例では, 著しい上昇を認めた. 4) 術後血小板は一過性に増加したが, その後術前値に復した. 以上本法による胃癌手術は, 癌の根治切除の原則を満たしつつ脾機能を温存するという安全で有用な術式と考えられる.