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We experienced 63 patients with non‑inflammatory disease who underwent single‑incision laparoscopic cholecystectomy (TANKO‑LC. Herein we report the procedure of operation and the short‑term results. We compared 63 cases of TANKO‑LC with 109 cases of non‑inflammatory conventional laparoscopic cholecystectomy (S‑LC within the same period. At first our standard procedure was to insert multiple trocars in the abdominal cavity through a single wound；now we insert only a single trocar all cases. In the 63 cases investigation 3 cases required trocar addition and one case converted to open surgery. Intra and postoperative complications were recognized in 2 cases (port‑site infection. No significant complications were recognized. In comparing the TANKO‑LC group and the S‑LC group the operation time was intentionally longer in the TANKO‑LC group (TANKO‑LC group：118 min S‑LC group：90 min but there were no differences in the blood loss the rates of intra and postoperative complications and the conversion rate. Laparoscopic cholecystectomy is a standard operation for gallbladder removal but single‑incision laparoscopic cholecystectomy is considered a useful operation with the same low operative complication rate yet more satisfactory cosmetic results.

Colovesical fistula (CVF) resulting from colon diverticulosis is a comparatively rare disease, and neither the diagnosis nor treatment has been established. Our experience with CVF due to sigmoid diverticulitis over a 9-year period was reviewed to clarify the clinical presentation and diagnostic confirmation. Ten patients with CVF were identified in this period, and chief complaints, laboratory findings, presenting symptoms, diagnostic investigations, and subsequent treatments were reviewed. Preoperative urinalysis showing bacteriuria (100%) was the most common presentation, followed by fecaluria (40%), abdominal pain (40%), pneumaturia (30%), hematuria (30%), pain on urination (30%), pollakiuria (10%), and dysuria (10%). The abilities of various preoperative investigations to identify CVF were: computed tomography (CT), 88.9%; magnetic resonance imaging, 40%; cystoscopy, 30%, and gastrografin irrigoscopy, 22.2%. Colonoscopy (0%) was not diagnostic. Bowel resection was performed in nine of ten patients. When inflammation was intense, covering ileostomy was performed, and an omental plasty was placed between the bowel anastomosis and bladder. When CVF is suspected, we recommend CT followed by colonoscopy and cystoscopy as a first-line investigation to rule out malignancy as a cause. Other modalities should only be used if the diagnosis is in doubt or additional information is needed to plan operative management. Primary colic anastomosis appears to be safely performed by applying omental plasty and covering ileostomy.

目的. 本検討の目的は, 臨床病期I,II期の高齢者非小細胞肺癌に対して行なわれた実地治療を, 外科治療を中心に検討し, この患者群に対する臨床研究課題を提案することである. 方法. 1996年8月から2003年7月まで, 当院で治療を受けた臨床病期I,II期非小細胞肺癌206例を対象とした. 75歳以上を高齢者, 75歳未満を非高齢者とし, その治療内容を比較した. 結果. 206例中, 高齢者は54例26.2%, 非高齢者は152例73.8%であった. 高齢者の72.2%が手術を受けたが, その割合は非高齢者 (77.6%) と差はなかった. 高齢者の25.6%に術前合併症があり, 非高齢者 (14.4%) よりやや多い傾向にあった. 高齢者では, 胸腔鏡下手術や胸筋温存手術など低侵襲なアプローチが好んで用いられたが (P=0.036), 非高齢者と同様に肺葉切除が主に行なわれていた. 術後合併症は高齢者の25.6%に発生し, 非高齢者 (14.4%) より多い傾向にあった (P=0.107). 術前合併症を有しない高齢者でも, その25.0%に術後合併症が発生した. 高齢者の術後合併症は標準開胸, 肺葉切除例に集中した. 高齢者の術後予後 (3年生存率, 74.4±10.8%) は非高齢者 (87.0±4.2%) と差がなかった (P=0.711). 結語. 高齢者でも臨床病期I,II期の非小細胞肺癌に対しては, 非高齢者とほぼ同じ頻度で手術が行なわれていた. 高齢者では術前合併症がなくても標準開胸, 肺葉切除を受けた患者に高い頻度で術後合併症が発生していた. 高齢者に対する低侵襲アプローチ, 縮小手術が, 術後成績を悪化させることなく術後合併症を減らすことができるかどうか, 今後のprospectiveな研究が必要と考えた.

右下腹部痛のため来院した75歳の女性に対し,緊急開腹手術を施行し回腸末端より50cm口側の小腸腸間膜付着側に小腸憩室と膿瘍を認めた.この部を周囲の小腸とともに切除した.病理組織所見では,憩室内腔は小腸粘膜で被覆され憩室壁は粘膜筋板,粘膜下層,平滑筋層から構成されており真性憩室と診断された.小腸の先天性真性憩室の多くはMeckel憩室であるが,本症例では憩室は小腸腸間膜付着側に存在し,周囲小腸と筋層を共有していることから重複腸管と考えられた.

Radiofrequency ablation (RFA) therapy combined with hepatectomy was performed in 5 patients with synchronous liver metastases of colorectal cancer. RFA of liver metastases was performed using a Cool-tip electrode (Radionics; Burlington, MA, USA). The ablation time used in each session varied according to the tumor size and intraoperative impedance. In 2 patients, hepatectomy and resection of the colorectal primary lesion were performed synchronously. In patients with multiple liver metastases, relative curative resection was performed using the complementary RFA. In the other 3 patients, synchronous hepatectomy was considered difficult and systematic chemotherapy was performed after resection of the colorectal primary lesion. After systematic chemotherapy, the range of hepatectomy was restricted for liver injury, but relative curative resection was performed using RFA therapy. Computed tomography performed after hepatectomy showed that the region that underwent RFA appeared necrotic with a safety margin. The average observation period was 25 months (maximal survival period, 50 months) and 3 of the patients are alive.

A 58-year-old man, who had a history of chronic type B hepatitis, was diagnosed as hepatocellular carcinoma with tumor thrombi in the inferior vena cava. He underwent resection of central bisegments and tumor thrombi, while postoperative chest CT demonstrated multiple lung metastases. Following 2 courses of chemotherapy using 5-FU, mitoxantrone, and CDDP (FMP therapy), multiple lung nodules disappeared and alpha-fetoprotein returned to the normal level. FMP therapy thus proved effective for a case of distant metastases of hepatocellular carcinoma.

Sentinel node navigation surgery (SNNS) for lung caner has not yet been established. Sentinel node (SN) identification using dye or radioisotope has been developed; however, the SN identification rate was less than 50% in the dye method and use of radioisotopes is strongly restricted in Japan. The novel method using a CT or MRI contrast medium are expected. A study of local immune reaction for lung cancer in SN is also a very interesting issue.