４１１本小児放射線学会雑誌､鐘Ｍ１ﾉ且鰄における伽管系/h〃""伽`/"`伽ﾉﾛ"最近の鯵■■■■■■▲■色色■■■白凸■■■■■■■■▲■■●▲■■■■■●巳■■■Ｐ⑪●■■■■●■■●●■■■■■■■

１.〃oslZlMノjVo形WsczZZaﾉ./几Le7･DCﾉztio/zirzC/LiZdrcJzJ
ノｈｚｏＤｅ〕･ひic砂ＲｉｃｈａｒｄＢ・Ｔｏｗl)ｉｎ，Ⅲ.，.，Ｆ､Ａ､Ａ・Ｐ.，Ｆ､八.ＣＲ・ﾉ)ＣＤ(Ｗﾉ)zGnZD／ﾉＣａ(/liD/ＯＫ"/，CAZ/(ﾉﾉ．e",ｓ〃ospZZ(Ｉ／Ｏ／ﾉji〃Ｍ)【(）Ｗ/I
八ｈsかacfl
リ(戸哩ｏ４ＪｑＵ４ノ

Ｔｈｏｌ９７()，ｓａｎｄｌ()8()，ｓｗｃｒｅａｌ)cri()。〔)ｆｒａｌ〕i(１．い℃ｌｏｐｍｅｎｔａｎ〔ｌ宵ｒｏｗｔｈｏｆｉｎｔ〔M･venti()nlllradiologyi】１ｔｈｅｐｅ(liatricp()pulation．Ｉ)ｕＴｉｎｇｔｈｉｓｔｉｎＩｃｔｈｅｔｙｌ〕eｓａｎｄｎｕｍ－ｂｏＴｓ（)「procodul･()Ｈｇ1.0ｗ＆111(ｌｌｊｌ(１１〕o(liatricintel､v(lnLionaIisL1)(!(Ｐａｌ】〕ｅａｎａｃｔｉｖ(１，１()ｍ‐ber（)Ｉｔｈｅｐｈｙｓｉｃｉａｎｔｃａｍａ〔Pljvolvcaring［ｏｒｃｈｉｌｄ1℃ｎ．ＪＩｔｍｖｌ１〔ｎｗｐｒ()cc〔lureswere
inLI･()〔lｕｃｅｄａｎｄ（､(luil〕mentdcvcl()l〕c〔ｌａｎｄｗａｓｍ()difiG(ｌｌｏｒｕＨｅｉｎｃｈｉｌｄｒｅｎ（)１．ａｌｌａｇｏｓａｎｄｓｉ筋Cs，ＡｓａｒｅｓｕｌＬ（)ｌｌｌｌｏＲ()ａｄｖａｎｃｏｓｉｌｌｌｈｏ１９７０'ｓall(１１９８０，ｓｔｈ(､cas(）Ｉ()ａｄｉｎ(9roとlsed〔lramaticallv、Ｓｉｎｃｏｌ９９０Ｌｈｉｓｌ1℃ｎｄｈａｓｉｎｔｅｎｓｉｆｉｅｄａｌｌ(ｌｔｈｅｃａｓｅｌｏｕｄｈａｓ

ｉｎ〔P1℃ａｓｅｄａｇａｉｎｌ〕ｙａｌ〕ｐｒｏｘｉｍａＬ(}lythreof()l〔ｌａｎ〔ｌｗｅａｒｏｎ()ｗｌ)er(()ｒｍｉｎｇａｌｍ()sL3000
pl･()CO(Ｉｕｒｃｓｌ〕Ｃｌ・ｙｏａｌ,、Ｔｈｉｓｉｎｃｌ･Gas()(１．０ｍａｎｄｈａｓａｌｓ(）ｌ〕oen＆lcc()ｍｐａｎｉ(Ｊｄｌ〕ｙａｌｌｉｎ‐
croasingcascc()ｍｌ)ｌ０ｘｉｔｙｅ､９．bilial･vdraillagcall〔ldilatati()、．’Ｉ１ｈｅｒｅｓｕｌｔｉｓＬｈａ１Ｌｔｈｅｐｃ〔liatricintorvoI1ti()ｎａｌｉｓｔｉｓｎｏｗｉｌｗｏｌｖｃ〔ｌｉｎｃｌｌｌ･ｉｎｇｆｏｒｃｘＬｒ〔)ｍｏｌｙｉｌｌｃｈｉｌｄｒｏｎｗｉｔｈｃ()ｍｌ〕lexmc〔lical（１，(ｌｓｕｒｇｉｃａｌｐＴ()1〕ｌｅｍｓ・ｌｌ１ａｄ(liti()ｎｔｏｌｌｌｏｇｒ()ｗｔｈｉｎｉｎｐａＬｉｅｎｔｌ〕ro‐Ｃｅ(ｌｕ１℃ｓｔｈｅｒｃｈａｓｌ)ｃｅｎａｓｉｍｕＩｔａｎ〔､()ｕｓall(Ｉ（lｒａｍａＬｉｃｉｎｃｒｅａｓｅｉｎＬｈｃｎｕｍｂｅｒ（)「pro‐cc〔1ｕ1℃ｓper｢()rmc(ｌｉｎＬｈｅｏｕｔｐａＬｉ(〕ｎＬｓｃｔＬｉｎｇ，
ＩＩｈａｓｂｃｃ()ｍ(〕Cl()ａｌ・ＬｈａｔＬｈｏｉｎ(TGasil1guIili姫lLi()nolthcpediLlLricinLcrvcnLionaｌ
ｓｏｗｉｃｅｓａｎ(ｌａｎｇｉ()９１．ａｐｈｙ/intol･von[i()ｎａｌｓｕｉＬｅｈａｓｓｅｖｏｒａｌａｄｖａｎｔａｇｃｓｉｎｃｌｕｄｉｎｇ：ｓｈ()l･ＬｃｒｈｏｓｐｉＬｍｌｓｔａｙＢ，］ｏｗｏＩ・ｉｎt(}nsitypostpr()〔｡〔)〔ｌｕｒａｌｎｕｒｓｉｎｇｃａｒｅ，alIdI0ssl)osl
pr()(Poduraldisc()ｍｌ.()ｒｔａｎｄｐｒｏｌ〕I(】ｍｓｗｈｃＩ１ｃ()nll)ｕｒｏｄＬ(）ｃｏｍｌ〕ａｒａｂｌｏｏｌ〕ensurgicalpr()Ce〔Iures・Ｉｍａ〔1〔liIiont(）ｔｈｅｓｃａ(ＩｖａｎｔａｇｃｓＬ(）Ｌｈｏｃｈｉｌ〔１tｈ〔!r〔ｌｉｓａｌｏｗｅｒｆｉｎａｎｃｉａｌ
ｃ()ｓＬｔ()thoillstituti()11．Thus，ｉＬｉｓｌｉｋ(小tllalLI1isL1､cndtowardsinLerv()nIi()nal（mini‐
mallyinvasiv(〕）tho1,ａｐｙｗｉｌｌｃ〔)ntinuean(lintcnsi[ｖｉｎｔｈｃ「uturc、Ｔｈｃｌ〕url)()Ｂｅｏｌ
ｔｈｉｓＩ･Ｃｖｉｅｗｉｓｔ(）Ｉ)rｃｓｅｎｔａｎｄ（)vGl･viewｏ「ｓ()ｍ(】（)1．ｔｈｅｎｃｗｃｒａｎ〔ｌｉｍｌ〕()ｒｔａｎｔｎ()ｎ－
ＴａｓｃｕｌａｒｉｎＬｃ１．V(mti()Ｉ１ｓａｎ〔１ｓ()locL(､(ｌｖａｓｃｕｌａｒｉｎｔ()rventi()ｎｓｂｃｉＩ１ｇ］〕Grf()rmcdinthG●■

Dodiatricp()pulaLi()､.

ＫＣ〃【()()r(ZsJlntervelltionalproce〔lures，ｌｎｆａＩ１ｔｓａｎ〔lｃｈｉｌｄｒｅｎ‘
Ｇａｓｔｒｏｉｎｔｅｓｔｉｎａｌｔｒａｃｔ

Ｐｅｒｃｕｔａｎｅｏｕｓｆｅｅｄｉｎｇｔｅｃｈｎｉｑｕｅｓ
Ａ(l()(Ｉｌｌａｔｅｎｕｌ１､iLi()Ｉ１ｉＨｅｓｓｏＩｌ(ｊａｌ「()'・ｌｌｏｒ－ｍａｌｇｒｏｗｔｈａｎｄｄ〔)v(〕ｌｏｐｍｅｎｔ．［ｎｃｈｉｌ(ｌｒｅｎｗｉｔｈ〔`11ronicillnossosorth()geul1willillg
orunal〕let(）しakoiI】ade〔ｌｕａＬｅｃ〔llories
fmd/Ｃｌ、（)LherossGntialioodstulTsc､９．ｍａ－ｌｆｌ１)soI1)Ｉｊｏｎ，sll()rtRllｌｓｙｎｄＩ･()ｍ０，９１．()ｗｔｈ
ｗｉｌｌｓＬ()1〕ｏｒｌ〕r〔)Ｃｅ〔､(１｛lLPlnal)、〔)rnlfIl「ate．
[、ｏｒ〔１０１．forL110s(Pcllil(Irontolhrivc，l1lILri‐､ノ

tioI1al局ｕｐｐｌｅｍｅｎＬ(1(ｉｏｎｉｓｎｅｃｅｓｓａｒｙ・Ｉｎ
ｃｈｉｌ(11℃I1withnoTnllll（Iigestivofunclj()ｎｉｔｉｓｌ)1．(11'()wlI)1ＧＬ(）llljlizothegflstr()il〕Losljr〕ａｌ((;l）tracklbr「cc(Ｉｉｎｇｔｏａｖｏｉｄｈｙｌ〕erali‐
ｍｏＩ１Ｉａｔｉｏｎａｎｄｉｔｓｃ〔)ｍｌ)lications．Ｔ()（ｌｃｃｏｍ－
ｐｌｉｓｈｌｈｏｇｏａｌ（〕「mainLainingnornlfllnulri(i(〕ｎａｌｓＬａｔｌｌｓｉｎｔｈｃｆａｃｏｏｌｓｈｏｌ･Ｌｔｃｒｍｏｒ

ｌ()ｎｇｔ(ｗｍｎｌ１ｌ,riti()１１１１１（lepl･ivati(〕Ｉｌ１Ｈ()v()ralstr(lI0giosmayboolllisLedandLail()ｒｅｄＬｏ
ｔｈｃｉｎ(Iividufll'ｓｎｃｏ(ＬＩｎｏｕｌ･Ｉ〕racticochil‐

ＶｏＬｌ５Ｎｏ」.1999５

ｄｒｅｎｗｈｏａ1℃Ｏｘｐｏｃｔｏｄｔｏｒ()quiroshorttermnuLritionalSUl〕port（1,Orfl1〕prOximate‐lv6weeksorless）ａ1.0advisodtogetLheir
nutritionbycithe]・Ｉ)０１．iphol､alintravenous
alimontaLion，nasogastTic（ＫＯ）tube，nasojejunal（ＮＪ）Ｌｕl)cfoeding()rcombina‐
ｔｉｏｎｓｏｆＬｈｏｓｏｔｏｃｈｎｉ(lllos・ＩＩｏｗ(〕vｏｒ，whon
longorperiodsorIluLri仇ｏＩｗ１ｌｓＬｌｐｐｏｌ､lare
anticil)aLodpo１℃uLallo()l1BgaHtrostomy（ＰＧ）
orpercuLancoMsgasn､｡』()jlln()sLomy（ＰＯＪ）

operaLionperlormodl)vVorneuil、Inl979

Ｉｎｌ８３７ＥｇＧ１)()r９１１１.irstproposodLheolフー
erativegastrosLomy・ＩＩｏｗｏｖｏｒ，ｉＬｗａｓｎｏｔ

successfulaltornaLiv〔）し(）ｔｈｅＳＧ・Inl981

isrecornmended、

ｕｎｔｉ］l876LhK1tVornouil］〕０１ｲormedLho
firstsuccessfulsul､gicalgastrosLomv(ＳＧ）inahuman2ISincothonanumberoｆ

ｓｕｒｇｉｃａｌＬｅｃｌｍｉｑｕｅｓｈａｖＧ１〕Gondoscribed・
Inl897thesurgicaltochｎｉｑｕｅｗａｓｍｏｄｉｆｉｅｄ
ｂｙＳｔａｍｍ３)．ＩＬｉｓｔｈｉｓＬｏｃｈｎｉ(ｌｌｌｃＬｈａｔｈａｓ
ｂｃｃｏｍｅｔｏｄａｙ'ｓｓＬａｎｄａｒｄ・ＴｈＧｉｎｄｉｃａｔｉｏｎｓ
ｆｏｒＳＧｈａｖｏｌ)rogrossivoincroasod、Ａｓａ
ｒｅｓｌｌｌｔｔｈｏＳＧｈａｓ｝)()ｃｏｍｏｏｎｃｏｌＬｈｅｍｏｓｔ

ｃｏｍｍｏｎｌｙｌ)erf()ｒｍ(】(’（)|〕GTalj()nsinLhGpediatricpopulati(〕】１all(ｌｉ円ｃｏｎｈ･'１１ｔ(）thocaro
ofcriticallyillal1dnllLriljol1allydeprived

childrGnofallagesl~“

AnEIlto1､l1ativ(ｎｔｏＳＧｄｉｄｎｏｔａｌ)peaT
untill979、ｏｖｏｒｌ()(）yGnrsflrl,OｒＬ１１ｅｉｎｉＬｉａｌ

SacksandGIoLzcr7・ｉｌ〕tr()ｄｕｃ(jdLheidea

forpercuLaneollsgaSLT()Ht〔)ｍｙ（ＰＧ）ｗｉｔｈ
ｔｈｅｐｕｂｌｉｃａｔｉｏｎｏｆｔｗｏｃａｓ()日ｏ「fIuoro‐
scopicElllyguidc〔ｌｐｌｎｃ(】ｍ()、↓（)「flgastricfeedingtul)ｅｔｈｒｏｕｇｌ１ａｈ()Ａｌ(〕ｄＳＧｓｉｔｅ、
Shortlyljhe1℃ａ『し〔)r，（{flu(I()｢(Ｊ１､，Ｐｏｎｓｋｙ，andlzant8、dGscribo(’（ｍ(１１)()pularizodthcper-

cutaneousel1dosc()｢)ｉｃｇｆｌｓｔｒ()sLomy（ＰｎＧ)．

ＩｎＬｈｅｓｈｏｒＬｔｉｍｃｓｍｃ〔）ＬｈＧｉｎＬｒｏｄｕｃｔｉｏｎ

ｏ「ｔｈｅｌ〕Ｉ２０ｉｔｈａｓｌ)ｃｃｏｍｏａｐｏｌ)ularand

Proshaw9，IollowGd｝)ySacksandcolleagues
inl983wmodi[ｉｏｄＬｈｏＰＥＧｔｅｃｈｎｉｑｕｅｓｏｔｈａｌａＰＧｃｏｕ１．１)()insGl､todunderfluo-

roscopicguidance（ＦＰＧ)．ＯｖｅｒＬｈｅｎｅｘｔ
ｆｅｗｖｅａｒｓａｐｌｅＬｈｏｒａｏ「rGportsappeared
tl1atdocumontedsllccesslulondoscopicII~】6】
ごandfluoroscopicallyrr~22）ｇｕｉｄｅｄｐｌａｃｅｍｅｎｔ

ｏｆｇａｓ[ｒｏｓＬｏｍｖｔｕｂ()ＨｉｌｌａｄｕｌＬｓ・ｌｌｏｗｅｖｅｒ，
littlehadbecllwI･ilﾙＧｎａｂ()ｕｔｔｈｅｓａｆｅｔｙ
ａｎｄｅｌＴｉｃａｃｙｏｒｔｈｏｌ〕〔)rclItfwlI10oustechniqueinchildrel1unLill986who】１KGllorandasso‐

ciaLes23’１℃port〔)。ｌ〕Gillscl･Lio11il1aslnglo

chil〔ＬＩｎ１９８８ｒＰｏｗｌ)inFmdcolleagues24）
descl･ibedthcFmtcgl，a(l(M1ppl･ｏａｃｈｆｏｒＰＧ
ａｎｄＰＧＪｉｎｓＧｌ･Ij〔〕ｌｌａｎ(:１１℃pol･LｏｄｔｈｏfiTstlargesoriosofchil(IronroceivingthesGdo-

し

▽

､

剣

、
、

（

Figl

PercuLl1n(』()u鳥ｇａ篇m･()jGjl1nostomynJ1)e：ａ血IFantogradogastrosLomv
wiLhaLl､iPmRl山11,1℃ＩＣ】】Liondisc(ＲＯＳＳ）iswithinthesLomach(arrowheads)．Amodilied8FjojunosLomv(arrowB）（FrodorickMiller，Cooklnc.）ｉｓin臼OrLodcoflxiallvovera
guidewi1℃（la】へｇｅａｒrow)．
氏四６日木小児放射線学会雑誌

vices（Ｆｉｇ．1)．sinceLhattimenumorous

reporLshavo1)eenpuljlishodconfiTming
thGsaI,otyanduLility〔〕「しhoantegradcand

retrogradePGandl〕〔]Jinchildrcn25~299

ｒｏｇｒａｄｅｏｒａｎＬｅｇｒａｄｅｒｏｕＬｏｉｓｃｈｏsen，thehighlikelihoodofsllccess（84～100％）ａｎｄ
ｌｏｗｒａＬｅｏｌ，maj()1．（2～5％）ａｎｄｍｉｎｏｒ(12～16％）complicationscomparGsfavor‐

Regardlessofthel､()utoofinsertiollselectedthopercutanoouHappl･()a(】ｈｉｓｈｉｇｈｌｙ
ｓｕｃｃｅｓｓｆｕｌａｎｄｗｅｌｌｓｕｉｔｃｄＬｏｌａｒｇＧｓｅｇ－
ｍｅｎｔｓｏｆｔｈ〔》I〕Odiatricp()I)(１１(lljon・
Ｔｈｏｌ〕orc(ltfmGoustochni(ｌｕｏｓｈａｖｅｄｅｍ‐
onstratodnumGrousfldvantagesovGrthe
operaLivGapl〕roachf()１．９(1sい､ostoillytubo

ablywiLhthc()pcrativoapl)roach3o~31ｌ

insertion・ＩＩ１ｍｏｓｔｉｎｓＬａｎｃｏｓａＰ(｝canbo

ｕｓｏｗａｓｆｏｒｒｅｐｌ〔IcomontofgasLrostomy

insertedunderlocnlanesthesiaandintra‐

tubesinpationLswithostablishedtracks
wｈｉｃｂｈａｄｌ〕eeninsertodsurgicallyor
endoscopically、ShortlvafLeritsinLrodu－
ction1oth()rreportsapl〕Garedsllpporting
ｔｈｅｕｓＧｏ【ＬｈｅＧＢａｎｄｓｔｒｅｓｓｉｎｇｔｈｅｐｏｓｉ－
ｔｉｖｅｆｏａｔｕｒｏＨｏｆＬｈｃｄＧｖｉｃｏａｎｄＬｈＧｈｉｇｈvenoussedationavoi(linggenoralanesthe‐sia，decreasingovGrallprocodureLime，ｒｅ‐sultinginashortorhosl〕itEllsLay・Ａｌsqa

PGismorolLxibloallowingloreasierconversiontoagasLrojejlI､ostomy，hasa
lowercomplicationI,ate，alldislGssoxpensive・AsarosulLoILhosenumGrousadvan‐

tagesthepo1℃uLancousaI)proachl1asbe‐
ｃｏｍｅｔｈｅｐｒ〔)｢〔)rrodl11eLh()。「〔)'､ｔｕｌ)０１)lacc‐
menti11manysituaLions・Whetheru10ret‐

ｌｎｌ９８４，（)all(lel･or，Ｉ)ichfl，ａｎｄ１%ａｎｔｒｅ－

ｐｏｒＬ０ｄｔｈｏｉｎｉｔｉａｌＧｘｐｏriencewiththe

gastl､()RLon1yl)utL()、（(}Ｂ)'2)．Ｔ11(ｊＧＢｉｓａ
ｓｉｍｐｌｃ，ｓｋｉｎｌ(〕vGl，ｎｏｎ-1℃l1uxinggasLro-

stomv（lovicoI1ndisfIsubsLituteIorconven-tionnlgaRI】､(〕stonlynll)０日・ＴｈｏｉｎＬｅｎｄｅｄコ

ｌevGlofpatioIlLsaljslncti(〕1155~59'・ＳｉｎｃｅＬｈａｔ

ｔｉｍｅ１ｔｈｅｕｓｅｏｆ（】ＢＳｆｏｒｌｏｎｇｔｅｒｍｎｕｔｒｉ－
ｔｉｏＩ１ａｌｓｕｌ〕p()I．l１１ａｓｇｒｏｗｎｔｒｅｍｅｎｄｏｕｓｌｙ
ａｎｄｔｈｅ（ＩＢｉｓｌｌ()ｗａｎｉｌ】1pol､しａｎＬｄｅｖｉｃｃ
ｆｏｒｉｎｄｉｖｉｄｕａｌｓｗｈｏｒｏ〔luireprolonged
Ｆ

頭

百

戸

--』

芦●

①
Ｆｉｇ．２Ｇａｓｔｒｏｓｔｏｍｙｂｕｔｔｏｎｓ，Ｔｈｅｔｗｏｔｙｐｅｓｏｆｂｕｔｔｏｎｓａｒｅｓｈｏｗｎ．

a：BalloonretonLion．

b：MushroomLipwithstvlet・BalloontypeeasiGrtoinsort/1℃ｍｏｖＧ
Ｍｕｓｌ１ｒｏｏｍｔｙｐｃｍｏｌ･ｃｓｔａｂｌｏ．

６５

ＶｏＬｌ５Ｎｏ､１，１９９９７

gastrostomvfeedil】９１)ｕｔｗｈｏ（ｌｏｎｏｔｒｅ〔luirG
jojunostomVfeedillg（Fig.2).'''1]issubgroul〕

1980,ｓ［oｒｔｈｏｉｎｓｏｒＬｉｏｎ（)ｆｆｌＩ〕crcutaneous

ＩｔｉｓｌｉｋｅｌｖｔｈａｔｌｈｃａｒＧａｏｆ１)Orcutaneousmi(lIcTm1℃sults（)ｌｔｈｉｓｔ1℃fltmentmoLh-

ｏｆｃｈｉｌｄ１℃ｎａｒｅＩｌｏｔｃｎＩ１ｄｉｄａＬ〔)ｓ１.ｏｒＧＢｓ・

feedingwillconIinｕｅｔｏｅｖｏ１ｖｏｗｉｔｈｍｉｎｉ‐
mallyiIwasivetochni(ll10srGl北1(､ｉｎｇｏｌ)ｅｎｓｕｒｇｏｒｙｉｎｌｎｏｓＬｃａｓ()Ｈ，Ｐｅｒｃｕｔａｎｅｏｕｓｃｅｃｏｓｔｏｍｙ
Ｆｅｃａｌｉｌｌｃ()ntin〔)ｌ１ｃｏｉｓｏｓｌｊｍａＬ〔〕(ｌｔｏｅｌＴ(}ctalloasL3milli()、ｐ(｣()1)|〔）ｉｒｌＬｈｏＵｌｌｉｔｏ(１States、Ｉ１ｏｗｅｖＧｒ，most１.oｒｍｓ（)l、ｔｈｅｒａｌ)yLGchlli(lues・Ａｓｕｌ〕soquG】〕い℃porLbyChait
andcolloflguosgivo：ｕ目Ｌｈ(）Iirstlookat
od，ｉｔｓｃｏｍｐＩｉｃａＬｉｏｎｓ，ｓａ｢etyal1deffectivGnesso91．ｉＬｎｏｗfll)1)(】31,ｓし11〔ｌｔａｌ〕ercutano‐ouscGcost(),ｌ１ｙｉＨａｎＧｊＴｏ〔)liv〔）ｗａｙＬ(）（|e‐livcrnl〕antogra〔Ｉｏｃｎｏｍａｆ()rthepurpose
ofachievinglecalＣ()ntiIl()ｎｃｏａｎｄｉｎｄｅｐｏｎ－
ｄｅｎＬｌｉｖｉｎｇ・
Ｈｅｐａｔｏｂｉｌｉａｒｙｔｅｃｈｎｉｑｕｅｓ

haveboonunsatis｢actol､ｖ・Ｉ)ioLf1rvmodili‐

ＵｌＬｒａｓｏｕｎｄ．ｃ()ｍｐｕｔｏｄｔｏｍｏｇｒａｐｈｙ，

cation，Ｌｈｏｕｓｏｏｌ､slll〕I〕osiLoriGs，ｓｍａｌｌｖｏｌ－
ｕｍｅｅｎｏｍａｓ，all(１１〕ｉｏ｢Ｃｅ〔１１〕ａｃｋｔＧｃｈｎｉ(Ｉｕｏｓ

MRLflI1dI1ucloarmodicincsLudiesnreuｈａｖｅａｌｌｓｈｏｗｎｌｉｍｉｔｏｄｒｏｓｕｌｔｓ・Ｉｎｃｈｉｌ－ｄｒｅｎｆＧｃａｌｉｎｃｏｎｔｉｎｏｎｃｅｉｓａｃｏｎｄｉｔｉｏｎｏｎ‐

ｃｏｕｎｔｏｒｏｄｉｎａｌｌｎｇｅｇｒｏｕｐＨ１)ｕＬｉｓｏｆＬｃｎ
ｔｈｅｒ()sｕｌＬｏｆｓｐｉ】]Ｉ１１ｄｖｓｍｌ〕llisrn、Othor
etiologiosincludingtraum(I，colorGctalor
spinalsurgoryn1ａｙａｌｓｏｌｏａ(１（ｐlocal
soiling・Ｔｏｄａｔｃ，Ｌ11(9ｍ()sい)｢｢()cLivGalldl〕1℃dictil1)l(BmoLh()。【()1.111I11M1gemGnL（)「
Lhesochil(]ｒｅｎｉｓｌｌｓｉＩｌｇｎ］ａｒｇｏｖｏｌｕｍＧｏｎ‐
ｅｍａ、Ｔｈｉｓａｌｌｏｗｓ「ｏｒｃ()ｍｌ)lotcGmpLying
ofLhGcoloI1miniｌ１１ｎｌｉｚｉｎｇｔｈ(）possibilily
ofunprcdicLodall(IhlI111ili｛ｌｌｉｎｇｌ)()woIowlcuation361・AlthougllolTocljv()，ｌ〔ｌｒｇｏｖｏｌｕｍｏ
ｅｎｅｍａｓｄｏｎｏｔａｌｗＨＷｓ1℃sultinconLrol
offecalinconlin(),ｌｃｏｄｕｏＬ(）ｔｈｏｌａｃｋｏｆ

ｐａＬｉｏＩｌｔｃｏｍｐｌｉａｎ〔)０．１，ａ(l(1iti〔)ｎ，ｃｈｉｌｄｒｏｎ
ｗｉｔｈ１〕arosisorl)lll､ａｌｖｓｉｓ（)ｆＩｉｍｂｓａｎｄ／ｏｒｔｒｕｎｋａ1℃ｕｎａｂｌｅｔｏｐｏｌ･（()rmtheprocodurewiLhou［ａｉｄ、ＡｓａｒＧｓｕｌ［oltheseprob‐
ｌｅｍｓＭ〔11one〔ｍ〔ＩＣ()Ⅱ()〔ｌｇｌｌ(』＄（I(wisodan
operation，ｔｈｅａｌ)I)OndicococosLomytoeaso
thepGrformanceandil】crcasotheeflective-ness（)「ｆｍａｎｔｏｇｌ･〔】(Ｉ００ｎｃｍＩ１３７・SinccthoI1

other（)l)〔)l･ativ【｝｛１１)ｐｒ()ach()Ｈｈａｖｏｌ)o(〕1】deve]Cl〕c(ＬＩＩｏｗ(ｗ()1.,ｔｈ(）ｃ()、１１)lica1ionraL(〕
ａｎｄｔｈ(）ｌｌｏｏｄｆｏｒｌｌｎ（)1〕(>、(､ｄｌ)1．()ｃｏｄｕｒｃ｝ｍｓｌｉｍｉＬｅｄＬｈ(lacco”lI1co（)「しhiHal)l)roach・
Ｉｎｌ９９６ＳｈａＩｌ(lling，Ｃｈａｉｌ，IJI】(ｌＲｊｃｈａｌ．(jsreporL〔､(ＩＦ１ｐｉｌｏＩｓｌＩ１ｄｙｕｓｉｎｇｌ)01､cutaI1()olls
cecostomyfortreahnon［ｏ「ｃｈｉｌ(lrenwith
fecalinconLinoncc3い、Thisintorventional
meLho(ｌｉｓａｃ1℃ａＬｉｗｍｏｄｉ１ｉｃａｔｉｏｎｏｆｏｔｈＧｒｌ〕ercuLanoousmeIh(〕(ｌｓｄｃｖ(】lｏｐｅｄｉｎｌｌ１ｃ

sGnsitivemodaliIi〔)ｓ【()rLhodetectiono［

biliary〔lilata{iｏｎ〔ｍ〔lcandemonsLratG
hel〕aLol〕iIiarypnthology、Ｔｏｄａｔｅ，ｔｈｅstan‐dａｒｄｆｏｒｉｍａｇｉｎｇ（luctalanntomyhasbeon
percutalleoustl､allshGpflLi(、Ｃｌ〕()langiogrfl‐phy(ＰｒＰＣ）ａｌｔｈｏｌｌｇｈｉｎｔｈｏｎｅａｒｆｕＬｕｒｅ
ＭＲＣＰ(magneticrosonancocholangiopancreal()gral)by）ｍａｙ１℃1)1ac(）（liagnostiCPT(）ｉｎｔｈｏｌ〕odinLTicp()1)ｕｌ〔ｌＬｉｏｎ、１９，(|()‐
scopicrclrograd(、ｃｈ(山ｍｇｉｏｌ〕(ｌｌｌｃ1℃El[ography（ＥＲＣＰ）islls(〕dw1loI1imagingofl〕oLhthoI)ｉｌｉｎｒｙａｎ(11〕llncrol1ticdu(､ｔｓｉｓｎｏｏｄｏｄ・
IIowovor，ＩｑＲＣｌ）Ｉ１ｌｌＨｏｌｌｌｗｌ７０～90％ｓｕｃ－
ゾ

cossl･(ｌｔｏｉｌｌｄｅｍｏ】1sLratingth(’intrahopElLicbile〔lucts冊~Ｉ３ｊａｓｃ()mparo(ｌ〔(）ＰＴＣ・Ａｌｓｏ、
PTCissucccssflllindeLol､ｍｉｎｉｎｇｔｈｅｓｉｔｅｏｆｏｌ)strucLiol1in95～10〔)％ｏｒｃａｓｅｓａｎｄ[hｅｏｌｊｏｌｏｇｙｏｌｔｈｃ（〕bstrucli()､'ｉｎ９０～96％
ofpatienLswiLhdi1atedil】IrahepaLicbilo
ductS'3~151．IncontrasL，I9RCPismoro
technicallvdif1icu1ｔし(）ｐ〔)rforminchildron，
ｉｓｎｏｔａｖａｉｌａｂｌｏｉｎｎｌｌｈｏｓｐｉｔａｌｓ，ａｎｄｉｓｕｐ
Ｌｏｌ､ｏｕｒｔｉｍｅｓａｓｏｘｐｏｎｓｉｖｏａｓＰＴＣ、Thlls，
fino-necdlePrl､(１ｉｓＬｈＧｓａｌｂＨｔａｎｄｍｏｓｔ

ａｃｃｌｌｌ･'１t(）L0stt(）（Iill'01℃、1,iflI,(’ｉｎｎ．ahcl〕ａＭｃ｢romoxlrnhop〔lticcbol(〕st〔lsis・Ｉｎｃｏｍｌ)i‐ｎａＬｉｏｎｗｉｔｈｐｃ1℃lItflnoousl)iliarydilaLa‐

ｔｉｏｎａｎ(loxternfIlsLcllLing［heseLechniqueshflv(〕ｏｎａｌ)1(】(１ｍiIlinlllllyinvnsivo
theral)i(Ｐｓｔｏｂ(）n1)|)li()。Ｌ(）cllildronwiLhcomplex｝〕iliaryl〕〔ILholoｇｙ，cspeciallvinpost（)pel･aLivepflLionLswiLhhGpf1LicLl･ａｎｓ－ｐｌａｎＬｓ．’｢11eset0()ｈＩ１ｉｑｕｏｓａ1℃wolldoscribodinl〕ｏｌｈａｄｕｌＬｓｆｍ(１（】ｈｉ]〔I]･(】11’Phc1℃｢o1℃，

７

８日本小児放射線学会ﾙﾙ誌

attenLionwillbegiveninthefollowing
paragraphstoneworhGl〕atobiliflryinLer‐
vontions．

Ｔｒａｎｓｈｅｐａｔｉｃｃｅｎｔｒａｌｌｉｎｅｐｌａｃｅｍｅｎｔ
Ｓｉｎｃｅｉｔｓｉｎｔｒｏｄｕｃｔｉｏｎｉｎｌ９８９ｔhosafety
andGfficacyofpercllLanoouscel1n･ａｌｌｉｎｅ
ｐｌａｃｅｍｅｎｔｉｎａｄｕｌＬａｎｄｐｅｄｉａLricpaLiGnts
byintorventionalradiologistsusingim‐
age-guidedtechniqueshasbeenwelldoc-

umentedI5~50)．Ｔｈｅａｄｖａｎｔａｇｅｓｏｆｔｈｏｐｅｒ－

ｃｕｔａｎｅｏｕｓｔｅｃｈｎｉｑｕｏｉｎｃｌｕｄｅａｈｉｇｈｓｕｃ－cessratebecauseoftheabilitytouｓｅｉｍａｇｉｎｇｇｕｉｄａｎｃＧＩｏｒｎｅｅｄｌｅａｎｄｇｕｉｄｅ‐
wiroplacemonL，promptrecognitiollofcaLh‐
etermalpositionwithLheabilityLoeasilv
repositionthecatheterproperly，rolaLivelv
instantaneousidentificaLionofcomplica‐
LionS，ｌｏｗｅｒｃｏｓｔｓ1℃laljvetosurgicnllyplacedcentrallines，andtheabiliLyto
provideviablealternaLiveslorplacement
ofcentraｌｌｉｎｅｓｉｎｐａｔｉｅｎｔｓｉｎｗｈｏｍｓｔａｎ－
ｄａｒｄｒｏｕｔｅｓａｒｅｎｏｌｏｎｇｅｒａｖａｉｌａｌ)IC・In
l991，Ｋａｕｆｍａｎ，ｅｔａｌ，reportedinsorLion
ofacentralcatheterviathetranshGpatic

approach51)．Ｗｅｈａｖｅａｄａｌ〕tedthisLechniquoforinsertionolcontralvenouscath‐etersandplacementoflarge-boredialysis

catheLers52)．
Ｖａｓｃｕｌａｒａｃｃｏｓｓｉｎｔｏｔｈｅｉｎ｢oriorvena

oFlvaisaccomplishedusingeiLheI・general
anGsthesia，ｉｎＬｕｂａｔｉｏｎｗｉｔｈｓｕｌ〕sequentparalysisandsedation，ｏｒｉｎｔｒａｖＧｎｏｕｓｓｅ‐
dationandlocalanesthesia・TholaLteris

proferredwheneverpossible・HepnLicvein
accossisaccomplishじdusingroal-timelllLrasoundguidanco、Ａｂｉｏｐｓｙｇｕｉｄｅｉｓ
ｆｉＬｔｅｄｔｏｔｈｅｕｌｔｒａｓｏｕｎｄｔｒａｎｓｄｕｃＧｒａｎｄａ

ＣｈｉｂａｎｅｅｄｌｅｏｒｓｈｅａＩｈｅｄｎｅｅｄｌｅｉｓｇｕｉｄｅｄ
ｉｎｔothemosLvertical（usuallyright）hepa‐
ｌｊｃｖｅｉｎＷｉｔｈｔｈｅｎｏｏｄｌｅｉｎｐｌａｃｅａｇｕidewil､()（usllHllyaglidowire）ismaneuveredil〕Ｌｏｔｈｅｒｉｇｈｔａｔｒｉｕｍａｎｄｔｈｅｔｒａｃｋｉｓｄilatedsothatapeel-awaysheaLhcanbe
inserted、AftGrthecatheterlengthismea‐
suredusingaguidGwireadou1)ｌｏｌｕｍｅｎ５～７１１、tulmG1edcaL11Gtol・ｏｒｐｏｒｔｉｓｉｎｓｏｒｔｅｄ(Ｆｉｇ．3)．Ilphoresisordialvsisisnecessaryalargebore(7～11.5F）catheterissubstiluLedforthecentralｌｉｎｅｕｓｉｎｇｔｈｏｓａｍｅ
Ｌｏｃｈｎｉｑｕｅ、
ＷｅｈａｖｅｆｏｕｎｄｔｈｉｓａｐｐｒｏａｃｈＬｏｌ〕elife
savinginmanysituations、ThotGchniqueissal､ｅｅｖｅｎｉｎｃｈｉｌｄｒｏｎｗｈｏａｒｅｃｏａｇｕｌｏ‐l)alllic・InallcaseswhenthecenLralcathe－
し〔)ｒｏｒｌａｒＲｅｂｏｒｅｃａｔｈｅｔｅｒｉｓｒｏｍｏｖｅｄｔhｅ

可
■

ＡＶ

■

Ｆｉｇ．３
ChildwiLhbiliarvatresiawith
occludedcentralveins、VGnousＬ
８accessacheivodbytranshcpａｌｊｃ
ｐｕｎｃｔｕ1℃ｏｆｈＧｐａＬｉｃｖｅｉｎｕｎ(ｌｏｒＵＳｇｕｉｄ〔Inc０．Ｃ－ｌｉｎｅｔｉｐａＬｂａｓ(）ofrighlatrium（arrowhea(１）ＶｏＬ１５Ｎｏ､1.19999

trackisembolizedwilhgelloampleｄｇｅｔｓ
ｏＴｃｏｉｌｓｉｎｏＴｄｅｒｔｏａｃｈｉｏｖＧｈＧｍｏｓｔａｓｉｓ．

Transjugularliverbiopsy
Thoimportancoofdiagnosticliverbiop‐
sｙｉｎｔｈｅｍａｎａｇｏｍｏｎｔ（)（１）ediatricpa‐

tientswithsoverolivel・dis〔}as〔）orlivol・transplantsiswoll-r(〕cognizodn3)，Cnfortu‐

nately，ｓｕｂｇｒｏｕｐｓｏｆｃｈｉｌ〔11℃、（ｌｒｅａｔｒｉｓｋ
ｆｏｒｓｏｌ､iousl〕ｌｅｏｄｉｎｇａｎｄａｒｏｌｌｏｔｃａｎｄｉｄａＬ‐
esforthoconventionflltranshopaｔｉｃｌ〕iol〕‐
sies・Thefirsttransjugularliverbiopsｙ
ｗａｓｐｅｒｆｏｒｍｅｄｉｎａｈｕｍａｎｐａＵＧｎｔｉｎｌ９６７
ｂｙＷｅｉｎｅｒｏｔａｌ５Ｉ)．ＳｅｖｅｒａｌｌａｒｇｅｓｅｒｉＧｓ
ｈａｖｅｓｉｎｃｅｂｅＧnreportedwhichconfirm
thesafｅｔｖａｎｄｌｌｓｏｌｕｌｎｅｓｓｏｆＬｈｅｔｒａｎ－ｓｊugularapproachintheadulLpopulation55~56)．ＴｈｅｔｈｏｏｒｙｂｅｈｉｎｄｔｈｉｓｔｅｃｈｎｉｑｕＧ
ｉｓｔｈａｔａｌｌｙｂｌｏｅ(Iil1gassociato(lwithLhebiopsywillbedirectlyｉｎＬｏｔｈＧｖａｓｃｕｌａｒｓｐａｃｅａｎｄｃａｕｓｅｎｏｈｅｍｏｄｖｎａｍｉｃｐｒｏｂ‐
ｌｅｍｓｌｎｌ９９２，ＦｕｒｕｙａｅｔａＬ（]emonstrated
LhatLh()Lransjugulal'ｗａｓｓａｆｃＥｍｄｅｌＴ()ctiveinchildren57)．'ｌ１ｈｉｓｗａｓｃｏｎ｢ｉｒｍｅｄｌ)yBergeyandcolloaguosinl998・
InpatientswiLhseveroc()flgulopathy
and/orlT1assiveaHciL(〕ｓａｎｄｌ)()sRil〕Ｉｙｃｈｉｌ‐drenwithsegmGntallivertransplaｎＬｓｔｈｅ
ｓｔａｎｄａｒｄｔｒａｎｓｃｌｌＬａｎｅｏｕsapproachis
conn､flindicatecLl)01〕ｅｎｄｉｎｇonoperaLor
preferGncetwoapl〕ｒｏａｃｈｅｓｍａｖｂｅｃｏｎｓｉｄ‐
ered：LhetransjugularandthGtranshepaticwilI11〕osL-pTocodllralh､ackembolization、ＩｎｏｌｌｒＩ)l･acLicGLI10Lranshcl〕ａＬｉｃ
ｒｏｕｔｅｗｉｔｌ１ｓｕｂｓＧｑｕｏｎｔｔｒａｃｋｅｍｌ〕olizaLion
ischosonwhenLhochildｈａｓａｎｅａｒｎｏｒ－

ｍａｌｏｒｌ)arLi2111ycorlUcLablecoagulapathy
withth(〕ＰＴ，Ｉ〕'１,'１１，ａｎｄ’九ｌｌｃｌｅｔｖａｌｕＧｓ
ｎｅａｒｎｏＴｍａＬＩｎchildrenwiLhsignificant
uncorrectablecoagulopaLｈｉｏｓｏｒｌ)latolet
levelbelow30,()0(〕LheLransjllgularrouteisprGl'erred（Fig.4)．Despitothedisad‐vantagesofincroasedproceduretiｍｅ・
ｓｍａｌｌｅｒａｎｄ/ｏｒ「ragmentedcorebiopsy
samples，ｈｉｇｈｅｒｃｏｓＬ，ａｎｄＬｈｅｎｅｅｄｆｏｒ
ｍｏｒｏｈｉｇｈｌｙｔｒａｉｌ】0．personｌ１ｏｌｗｈｅｎｃｏｍ－
ｐａｒｅｄｔｏｐｅｒｃｕ〔ｎｎｅｏｕｓｌｉｖｏｒｌ)iopsy、Lrans‐venous（transjugularorLransfemoral）
liverｌ〕iopsyo｢[Cl･sanelTectivoandsafe
techni(lｌ１ｏＬｏ（)bLllinlivor・Lissu〔Ｐｆｏｒｄｉａｇ‐nosLicl〕urpososinLhislligh-riskpaLient
populaLion・ThoLransjugularapproachmaya1sｏｂｏｕｓｏｆｕｌｉｎＬｈｉｓｓａｍＧｇｒｏｕｐｏ［
ｐａＬｉｅｎｔｓｗｈｅｎｕ１ｏｒｏｉｓａｎｅｅｄＬｏｍｏａｓｕ1℃

「

、▲

▼へ
▲

▲

Ｆｉｇ．4

10-ｙｅａｒ－ｏｌ(」「emalosIaulsposLliverLrans[)lflnLationwithanuncor‐
rectabl(ｊｃｏａｇｕｌｏｌ〕ａｔｈｙａｎｄａｂｎｏｒ－
ｍａｌｌｉｖｏｒｌｕｎｃＬｉonLosts・Tran-sjugularlivorl〕iol)syusinga
Quick-C()rotransjugularbiopsy
needle（Cook，Inc.，Ｂ]oomington，
1Ｎ)．〔)uidosheaLhinproximal
middlehGpaLicvein（arrows）withbiopsynoodledel)Ioycd．（arrowhead）

９

l(）’'水小児放射線1紫会雑継ｈｅｐａＬｉｃｖｅｉｎｗｅｄｇｅｐ1℃ｓｓｕｒｅｓａｎｄ/orperIol･ｍａｎｈｅｌ)aLicvenoglY1mfor〔1iagnosticl)ｕ'1〕()ＳＧＳ．（)Lhorless（ｌｏｌｎｒｎｏｎｌ･(!ns()nsto
usethetransjugulal､ａ]〕proachinclud()failodconvenLionalpercutanoouslivcrbiopsy・
massiveobosiLy，ｓｍａｌｌ，cirrhoLiclivGrandsituaLionsinwhichcxcessivo1】IGO(lingI〕]ａｙＯＣＣｕＴａＳａ1℃ＳＵｌＬＯｌｐｅ1℃(雌,ｎＯＯＵＳｌ)iopsy，ｓｕｃｈＥ１ｓｓｕｓｌ)ｏｃＬｃｄｖａｓｃｕｌａｒＬｕｍｏｒ、ＯｎｃｏｆｔｈｏｍａｉｎｃｏｎＬｒａｉｎｄｉｃｌｌｌｉ()nsLo

trnnsjugularbiopsyisnmedicallvllnsLa‐
1)ｌｅｃｈｉｌｄ・AnoLhersignilicantcon[l･ａｉｎｄｉ‐
ログ

caLi()ｎｉｓｏｃｃｌｕｓｉｏｎｏ「ａｎｖｏｌＬｈｏｖ(》ｉｎｓ
ｗｈｉｃｈｎｏＧ(:ｌＬｏｌ)ＧＩ,lY1voI･sｅｄｉｌ１（)1．(1()】・ｔｏl)()lｲ()ｒｍｔｈｅｂｉｏｐｓｙ，Ｈｌｌｃｂａｓｔｈ(）ｉIIL(】rllal
jugularvoins,ＳＶＣｏｒｈｅｐａｔｉｃｖｏｉｎｓｉｎｔｈｅ
ｃａｓｏｏｆＬｈetransjugularapproach，()ｒｌｈｅ
ｆｅｍｏｒａｌｖｏｉｎｓ，ＩＶＣｏｒｌ〕opaticv〔}i,]ｓｉ】〕Lhecas心（)fLhoLlY1llsl0m()1．ｎｌａｐｐｒｏａｃｂ．（ｌｌｌｒ(!｢ｕｌｕｌｕＹ１ｓｏｕｎｄｏｘａｍｉｌｌａｌｉ()ｎｏｆｔｈｃｓ(）｜〕aLients
isolwiouslymandatorv、ＰｒｉｏｒｔｏｔｈｅｐｒｏｃｏｄｌｌｒｏＰＴ・ＰＴ'｢，ＩＩｇｌ〕，
IlctandplflLolotsvaluo局arerollLiI]()1ｙｏｂ‐tain(」。．Ifnocossary，｝)lo()。[〕ro(ｌｕ〔幅ａｒｅａ(Iministe１℃doiLherl)rｉｏｒＬｏｏｒ（Iul･ingthe
procGdure、Ｏｎｅｏｌ・ｔｗｏｕｌｌｉｔｓ（)「Ｉ)l(ＢＣ'ｓ
ａ1℃ｏ1,.01℃ｄｉｎｔｈＧｏｖｏＩｌｔｏｆａｓｅｒｉ()ｕｓｌ)ｌｃｅｄ－

ｉｎｇｃｏｍｌ〕licaLion．Ｓｉｎ(〕Ginfoctiollsc〔)ｍｐｌｉ－ｃａ{jonsarevervra1℃！｝)rophylacLican[il〕i〔)tic；rlrenotroutinoIygiven・ＩＩ１１ｌＴ()sLcasosgGn(】ｗ１１ｌｌｎｅｓＬｈ()島inissGlGctodbecauseofthoneo(ｌｆｏｒＬｈｃｐａＬｉｅｎｔu

ＬｏｒｅｍａｉｎｍｏｔｉｏｎｌＧｓｓａｎｄｍａｉｎｔａｉｎａｒｅｌ‐

ativolyuncomforLableposition「ｏｒｌ～２
１１()ｌｌｒＲ．U1Lrasol1n(ｌｏｘｆ１ｌｌ】inaLion（)「ｌｈｃｌｉｖ－〔､ｒｉｓｐｅｌＴｏｒｍｏｄｔｏ（)ｖｆｌｌｕＭｏＬｈｅｌＶ(Ｉ１ｈｅｐ－
ａＬｉｃｖｏｉｎｓ，ａｎｄoverallhopaLicsizcand
thickness・TherightinLGrnaljugularvoin
isLｈｏｐ1℃ferredontrysiLG，ｌｒＬｈｅｒｉｇｈｌｉｎ‐
し()rnaljugularveinis（)ccludo(１（〕「（)Lher-

ovoraguidewire・Ｕｌ１(１０１.｢luoroscol)ｉｃｇｕｉｄ‐(lll(､eLh(〕ｗｉ1℃ａｎｄ（．、[｣〕(､Lerar(ＩｍａJ】ｉｐｕｌａｔ－
Ｉ､(Ｉｉｎｔ(）｜｣】ｃｒｉｇＩ１ｔｈ(ﾘ)ｎＬｉｃｖｅｉｎ．’｢ｈ(、ＪＢ－］
ｃａＬｈｃＬｃｒｉｓＬｈＧｎｏｘｃｈａｎｇｅｄｆｏｒａｌ()ｎｇ７Ｆ
ｏｒ９Ｆｖａｓｃｕｌａｒｓｈ〔$[1tｈ・Ｔｈｅｓｈ()ａＬｈｉｓａｄ‐ｖａｎｃｏｄ３ｏｒ４ｃⅡｌｉｎｔｏｔｈｅｒｉｇｈｔｈｏｌ〕aticveinwllichke(ﾘ〕ｓｉＬｉＩ１ａｒ(11flLivclyp()sL(､ｒｉｏｒｐｏ‐
日ilj()、，ｈ()l)()｢ullywilI1（)noughiI1t()rveI1ing
hel〕ａｌｉｃｌ)ａ1℃ｎｃｈｙｍａｔ(）boasafcdistance｢1､ｏｍＬｈｃａｎｔｅｒｉｏｒｌｉｖ(､1．capsulc、八IlhepaLicvenogrPlmisLh(〕Ilperforn1()(ＬＦｏｌ－
ｌｏｗｉｎｇｌｈｏｖｏｎｏｇｒａｍｔｈｏｗｉｒｏｉ５１℃ｍｏｖｅｄ
ａｎｄａ７ＦＣｏｌａｐｉｎｔ(）ｍｃｔｆＩｌｓｈｅａｔｈｉｓｌ〕ｌａｃｅｄｉｎＬ(）Ｌ１１ｅｈｏ１)ａｔｉｃｖｏｉｎｖｉａｔｈ【lvfls(Dularsll(ｗｌｔｈａｌ１℃Ⅱｄｙｉｎｌ)〔)siti()ｎ．’I１ｈｏ（)(Lll〕il11p
sho(ｌＬｈｉｓａ(ｌｗｍｃｅｄｓｏｔｈａｔｔｈｃｔｉｐｉｓｐｒｏ－
ｔｒuding「ｒｏｍＬｈｏｄｉｓｔａｌｃｎｄｏｆｌｈｃｖａｓｃｕ‐
Ｉｎｒｓｈｏａｔｈｌ)ｙａｌ〕l)roximnLGlvlclll・Ａｎｌ８
ｇｌ１ｕｇｃＣ()()|〈Qllick-c()r(）｝)iopsy11(,()(Ⅱｃｉｓｎ(lvancodullLilthotil〕（)ｌＬｈｅｎｏｏ(ｌｌｃｉｓａＬ
Ｌ１１(〕endofLheshcaLll・ＴｈｅｓｈｏａＩｈｉｓｔｈｅｎｒｏｍＬｏｄａｎｔｃｒｉｏｒｌｙａｎｄｌｈｅｂｉｏｐＨｙｎｅｅｄｌｅ
ｌ１〔Iva】)ｃｅｄｓｏＬｈｎＬｔｌｌ(）［jl）protrll(lGRfl･om
Lh(）（111ｄｏ１．ＬｈｏｓｈｏｎＩ｣］ｌ)ｙａｌ〕ｐｌ､()ximatoly
O,５clu・Ａ１)iopsyistbclllaken・Ａｍ【ｌｘｉｍｕｍ()ｆＬｈｌ･ｅｅｐａｓｓｅｓａｒ(）ｍａ〔I(】ｔｏｍｉｎｉｍｉｚ(】thepoLoIllial（)１１〕ostol〕0】･ａｔｉｖｅｃｏｍｌ〕licaLions〔)、c(ｊｔｈｅｂｉｏｐｓｙｌｌ〔ISI)ｅＧｎｏｂｔａｉＩ１ｏｄＬｈｅ
ＣｏｌａＩ〕ｉｎＬｏｓｈｅａｔｈｉｓＩ℃moved、Ｐｒｉｏｒｔｏｌ､('ｍ()ｖｉｎｇｌｈｅｓｈ〔)ａＬｈｌｌｌ)()st-biol〕sycoIltrast
il1j(》ｃｔｉｏｎｉｓｄｏｎｃＬ(）cll()ckfol．（wll)sularl)or((〕ration、whichoccursinal〕I〕roximately

3､５％olcases釣)，allh()ughclinicnllysig-ni｢ｉｃａｎＬｂｌｅｅｄｉｎｇｈ【lsbeenrol〕()ｒｔｅｄｉｎ()Illy（).３５％（)「ｃns()s、ｌ「exLravnS(l(j()ｎｉｓｉ(10,(j1．ｉｅｄＬｈｅｎＧＧｄｌ(ｊＬｌ､ｆｌｃｋｍａｙｌ)００ｍ－１)olizodwithGelfoam（UpjohnCo.，Kalamazoo,Ｍ１）ormeLalcoils,TraI1sjugularl)iopsysuccesslllllyol)しａｉｎｓａｄｅｑｕｎＬｏ１ｉｖｅｒｌｊｓｓｌｌｏｉ、９１℃aterth(､１１９５％ｏｆl)〔11j(１，ts52.58】・

wisenoLsuital)leforfIccess，Ｌｈ(〕Ｉ(}｢ｔｉｎｔｃｒ‐

FailcdaLLompLsf1th･ansjugulf1l・Ｉ)iopsy

naljugularvoinora[omoralveinInnyl〕ear(）ｌｌｎｃｏｍｍｏｎ，１)ｕｔｗｈｅｎｔｈ〔)ｖ（ｌｏｏｃｃｕｒ

llsed・TheseallcrnativcsiLesm〔ｌｋｏｔｈｅｌ〕ｒｏｃｏｄｕｒｏｍｏｒｏｃｏｍｌ〕licntedtocllnically・
Ｕｓｉｎｇｒｅａｌ－ＩｉｍｃＵＳｇｕｉｄａｎｃｃ，nlll8
gnugeneedleisinsGrtodintoｔｈｏｊｌ】gularvoil】llsingSoldingel・ｔｏ(B11ni(ｌｕｏ、rPll(】I1Gc(１１〔Ｐｉｓｏｘｃｈａｎｇｅｄｆｏｒａ５ＦＪＢ－ｌｃｆ１I110ter/、

ｔｌｌｏｙａｒｏｕｓｕａⅡｙ1℃laL(】(ＩｔｏｄｉｌＴｉｃｌｌｌｔａｎａｔｏ－ｍｙｌ〕reventingpullclur(ｊｏＩｔｈ〔）ｉＩ]LcrnaI
jugularvein，Ｉ〕revolItingcannulaIi《jnofthello1)ａｔｉｃｖＧｉｎｓ，Ｃｌ、rotri(ｌｖａｌｏｆａｎａ(1ｃｑｕａｔｅＷ)lIImO1ivOrtiss1,(,Iiu･58)．InpaticI1l,Rwith
smalLhard,cirrholicliversn〔)し()nlvis

ＶｏＬｌ５Ｎｏ､１，１９９９１１

LhorL）ａｌｏｗｅｒｓｕｃｃｏｓｓｒａｔＧｉｎ（)ｂＬａｉｎｉｎｇ

Calve-Perthesdisoflsetonnmeafew・〔Idc(luateliveTtissuo，ｂｕｔｔｈｅｒｉｓｋｏｆｐｏｒ－｢oraLingth(llivorcapsulcwithitsatton‐
ｄａｎＬｂｌｅｅｄｉｎｇｃｏｍｐｌｉｃａｔｉｏｎｓｉｓｈｉｇher、Arouljnopost-biopsychestXrayisｔａｋｏｎｉｎａｌｌｃｈｉｌｄｒｏｎｔｏａｃｃｅｓｓｌｏｒｃomplicaLions・Ａ１ｔｈｏｕｇｈｉｎａｓｍａｌｌｎｕｍｂｃｒｏｆｃａｓｅｓ
Ｕｌ(ｊｓｙｍｌ〕ｔｏｍｓｍａｙｇｒｎ(Iuallydisal〕ｐｃａｒ
ｏｖｏｒｌｏｎｇｐｅｒｉｏｄｏｌｔｉｍｃ，Lheonlycurativeal)I〕roachiscoml〕lGLeol)CrativoremovaL
Traditionally，Ｅ１ｗｉｄｏｓｕｒｇｉｃａｌｅｘｃｉｓｉｏｎｉｓ
ｎｅｃＧｓｓａｒｙＩｏｒＧｍｏｖｏＬｈｅｌｏｓｉｏｎａｎｄｒｏｄｕｃｅ
Lhopotellljal［ｏｒ】℃curl･Once、ｒｌ１ｈｉｓａ１〕‐
pr()ａｃｈｈａｓＩ)eenrcquiro(lbocauseolLhG
inabilitvtodireclｌｙｖｉｓｌｌａｌｉｚＧＬｈｏｔｕｍｏｒ
ｎｉｄｌｌｓａＬｌｈｏ（ｊｍ(！（)ｆｓｕ】･gery．Ｍ()ｒｏｒｏ‐ｃｏｎｔｌｙＣＴｇｕｉｄｏｄｉｎｓｅｒｔｉｏｎｏｆａＫｉｒｓｃｈｎｃｒ

Ｎｅｗｐｒｏｃｅｄｕｒｅｓ
Ｏｓｔｏｏｉｄｏｓｔｅｏｍａｗａｓinitiallv（lescril〕ＧｄｂｙＪｎ｢feinl93559B、’1,ｈｉｓｂｏｎｉｇｎｂｏｎｅｔｕ－
ｍｏｒｉｓＬｈ〔）ＬＭｒｄｍｏｓＬｃ(〕ｍｍｏｎｌ)rimarybenignbonotumorinchildrenbohindosteochondroInaandnon-ossifyingfil)roma
inlrGquency・Ｉｔｉｓｌｏｕｎｄｉｎｌ1％ｏｆｃａｓｅｓ
ａｎｄｏｃｃｕｒｓ２～３ｔｉｍｅｓｍｏｒｏｌｒｅｑｌｌｏｎｔｌｙｉｎ
ｍａｌｏｓ・Ｔｈｏｌｅｓｉｏｎｉｓｌｎｏｓｔｏｌ､tondiagnosod
inlM1tienLsrangingfrom5～２４ｙｏａｒｓｏ（
age・InteresLingly，ｉｔｉｓｕｎｃｏｍｍｏｎｉｎＬｈｅｐｒｅｓｃｈｏｏｌ（ｌｇｅｇｒｏｕｌ）ａｃｃｏｕｎｔｉｎｇ（Ｃｌ・〔〕ｎｌｙ

３％ofallosteoidostcomacasesoo1、

Ａｌｌ｣]()ｕｇｈｔｈｅｌｏｎｇｌ〕ｏｎｅｓａｒｅｌｌｌｅｍｏｓＬ
ｃｏｍｍｏｎｓｉｔｅｏｆｉｎｖolvement1anyl)ｏｎｅｃａｎ
ｂｏｃ[fected・Ｔｈｅｍｏｓｔｃｏｍｍｏｎｌｙｉｎｖｏｌｖｏｄ
ｂｏｎｅｓｉｎｃｌｕｄｅＬｌ〕Ｇｆｅｍｕｒ，ｔｉｂｉａ，humerlls，

ａｎｄｌｕｍ１)flrspiI1〔〕、１，ｍ〔)HLpaIjonLspElin
istheiniLialｓｙｍｐｔｏｍｗｈｉｃｈｉｓｏｎＧｎｍｏｒ(】intellsoaLｎｉｇｈＬＩｎ３()～75％ｏｆｃａｓｏｓ
ｔｈｅｄｉｓｃｏｍ｢ortisrelievedbysalicvlaLes，
ｈｏｗover，１)ｏｔｈｔｙｌＧｎｏｌａＩ１ｄｉ１〕llprol〕hinmaybeelTocLive・Ｌｏｃａｌｔｅｎ(lernessisalso
usuP111yprosentuponpalpation・
Ｐｌａｉｎskoletalradiographsusuallyre‐vea］ａｓ、（〕１１，ｓｈａｌ､I)lydefiI1ed，（〕ccelItl､ｉｃ，rｏｕｎｄｔｏｏｖａｌｌｖｔｉｃlesionwithreactive⑭

ｂｏｎｏ．ＩLscharnclcriHLicfonLuroisally‐per(ｌｅｎｓｅｄｎｉｄｕｓｍａｄｅｕｌ〕ｏｆｓｌ〕ｏｎｇｙｈｙ‐
ｐｅｒｖａｓｃｕｌａｒｌｏｃｕｓｕｐｔｏｌ５ｃｍｉｎ（liameLel､、
Ｉｎ８０～90％ofcasGsthelesionislocatedwithiｎｔｈｏｃｏｒｔｅｘ、Gonerallvtheroisthicklaminarporiostealnewl)oneformationadj(ｌｃｏｎｔｌ(）|,holosi()n．Into1･esljngly，ｌ)()‐riostoalroactionisoftcnminimalｏｒａｂ－

ｓｅｎＩｗｈｅｎｌｏ円ｉｏｎｓｎｒ(）ｌｏｃａｌ〔)ｄｉｎｌ｣〕ｅｍｏｌ,a‐ｑＰｗｉ]､(〕ｉｎＬｏＬｈｅｌｅｓｉｏｌ１ｈａｓＲｌｓｏｓｌ〕owntobe

elTecLiveforaccurateinLraoporaLivolo‐calization・Unfortunately，thesomethodS
arcimpo1{ectandincompleLoresection
stiUoccu１，s．

ＦｏｒｙｏａｒｓＣＴｓｃａｎｓｈｆｗｅｂｅｏｎｕＬｉｌｉｚｅｄ
tｏ（liagn()ｓｃａｗｉｄｏｖａｒｉ()|,ｙｏｆｌ)()ｎｉｇｎｆｍ(ｌｍａｌｉｇｎａｎｔｂｏｎｏｔｕｍｏｒｓａｎｄｔｏｐｌａｎａｎｄｇｕｉ(IepercutanGousbon(、ｂｉｏｐｓｙａｎｄｓｕｒ‐
gicalprocoduros・’1,hｕｓ，ｉｔｉｓｌｏｇｉｃａｌＬｏｕｓｏ
Ｃ'l1IoidcntifvLheni(lu6（)「anosLeoidoste‐

ｏｍａ，ｉｄｏｌｌｔｉｆｙｆｌｓａｆｅｒ()ｕｔｅｆｏｒｉｔｓｔｒｅａｔ－ｍ(ｌｎｌ,，ａｎ(ｌＬｏｇｕｉ(１０ＲＩｊＭ()ＶＡＬｌｌｓｉｎｇａｐ1℃‐
cisionteclmique、Additionally，ＣＴｈａｓｔｈｅａ(１V【lntagoovorslll､ｇｉｃａｌｌ･()ｍｏｖａｌｏｆ１)ｏｉｎｇ
ａｂｌｏｔｏａｃｃｕｒａｔｅｌｙｇｕｉｄｅｔｈｅｔｕｍｏｒｒｅ－ｍ()ｖｎｌｉＩｌｒＧａｌ－Ｌｉｍｏｗｉｔｈｉｎｔｅｒｖａｌｉｍａｇｉｎｇ
ａｎｄｉｍｍｏｄｉａｔｅｌｙｋｎｏｗｉｆｔｈｏｌｏｓｉｏｎｈａｓ

ｂｅｏＩｌｃｏｍｌ)letelyromoved．
ｌ、］989,ＤｏｙｌｏａｎｄＫｉｎｇｄｅｓｃｒｉｂｏｄ２
ｐａ(i(〕ｎｔｓｉＩｌｗｈｏｍｏｓｔｅｏｉｄｏｓｔｅｏｍａｓｗｅｒ(】removedpercutaneously61)．Ｉｎｌ９９０・Votoall(lcolloElguesllsinga「１℃chandLechni(ｌｕ〔】succGssfullyoxcised7ol91esionsｕｓｉｎｇ
ＣＴｇｕｉｄａｎｃｅ６２)．Ｉｎｌ９９５，『l1owbinandasso‐
ci〔ltGsreportedacoaxialnpproachｆｏｒＣＴ
ｇｕｉ(10．】℃moval63)．ＴｈｅｓｅａｕｔｈｏｒｓｓＬｒｅｓｓＧｄ
ｔｈａｔｔｈｉｓｍＧｔｈｏｄｅｎｈａｎｃｏｄｐｒｅｃｉｓｉｏｎａｎｄ
池xibilil,ｙｉｎｌ･()ｕＬ(）｜〕Ｉａｎｌｌｉｎｇ・Ｓｉｎｃｅｌ,ｈａｔ
ｔｉｍｅＲｏｓＧｎｔｈａｌａｎｄｃｏｌｌｅａｇｕｅｓｈａｖＧｒｃ－
ｐｏｌ､todal)latioIl（)「ｔｈｅｎi(1Ｉｌｓｕｓｉｎｇａｒａｄｉ(）

physisesl)()cｉａｌｌｙｉｎｔｈｅｆｏｍｏｒａｌｎｅｃｋ・In
youngchildren（＜５years）andthosowith
atypicalsymptomsoLherdiagnoscsmavbc
consideredclinicallvincluding；osteomyc‐

fro〔luencycoagulationtechniqueoI)．Ｔｈｏｒｅ
ｈａｖｃｎｏｗｌ)eensevcralroI)ｏｒＬｓｖａｌｉｄａｔｉｎｇ

litis，neuromllsculardisoase，ａｎ(ｌＬｏｇｇ－

ＣＴｇｕｉｄｅｄｒｅｍｏｖａｌｍａｙｌ〕ethopreforredｔｈｉｓａｐｌ)r()ａｃｈｔｏｗａｒｄｓｒｏｍｏｖａｌｏｆｔｈＧｓｏ
ｂｏｎｉｇｎｂ()Ｉ１ｅＬｕｍ()1,ｓａｎ(Ｉｉｔａｐｌ〕ｃａｒｓｔｈａｌ〃

１２１Ｊ本小児放射線学会雑誌

ａｐｐ１､ｏａｃｈｉｎｍａｎｙｉｎｓｔａｎｃｅｓ．

Ｎ(）spociall)aLi〔)ｎＬｌ)1℃par(1ti()l1isreqllil､G(Ｌ’1,ｈｅｌ)roccdlll･(）ｉｓｐ()lｲ()rnl()(Ｉｆｌｓａｎｏｕｔｌ)aIientwhenovel､possible．『l1lloc11ildisko1)ｔＮＰＯａｓｐｏｒｈｏｓｐｉＬａｌｌ〕ｏｌｉｃｙｌ)riorLo
theprocedure、ＡｌｌｃｈｉｌｄｒＯｎａｒｅｂｅｇｕｎｏｎ

ａｎＬｉｂｉｏＬｉcｓａｎｄｍａｉｎＬａｉｎｅｄｏｎＬｈｏｄｒｕｇ

ｌｌｌｌ１ｃｏｍｐｌｏ１ｅｌｖｔｈｏｔｒａｃｋｓｈ()111(lpass

tllr()ｌｌｇｌｌｔｈＧｂａｃｌ〈wflll「()ｒｆ，（ｌｉｓＬｎｎｃｅａｌ)－
１)｢()ｘｉ１ＭＩ,〔)lｙ１．５Ｌｉｍ()ｓｔｈｏ（1ｗｌｍ(､|,(１１．ofthclosi()]1．ＷｈｏｎＬｈｏｔｒａｃｋｉｓｏ「dGsired

longtllb()ｔｈｔｈｅｐｉｎ/ｗｉｒｅａｎｄＬｒｅｌ)ｈｉｎｅｍａｙｌ)eremovedwithinbloc、Ｔｈｅｓｐｅｃｉ－ｍ()ｎｉｓＬｈｏｎｒｅｍｏｖｅｄ「ｒｏｍｔｈｏｌ１ｃｃｄｌＧａｎｄ

Ｌｈｃｄｒｕｇｓｆｏｒａｔｌｅａｓｔ３ｄａｙｓａ脈ｒＬｈｏｏｓ‐
しe()i(’（)SIO()ｍａｉｓｒｏｍｏｖｏｄ、Ｉｔｉｓ（)ｕ１，１)roIer‐
ｏｎｃｏｔｏｐｏｒｆｏｒｍａｌｌＣＴｇｌｌｉ(１０(１１℃movals
undGrgenoralanesth〔)sia・Cl1ildronwiLh
osLooi(ｌｏｓｔｅｏｍａｓｌｅｓｓｔｈａｎ２ｃｍｓｉｎｌｅｎｇｔｈａＩ〕(Iinanreadilyaccossil)Ｉｅｌｏｃｆｌｌｊｏ,】aresche(ｌｕｌｅｄｌｏｒａｐｐｌ･oximaLGly2hollrs・Ｐａ‐
LientswithlargetumoTs，multiplclCsions，ｓ〔)ＩＩｌＬ()])aLhologylo1.1℃vｉｅｗ（Ｆｉｇ．5）

ａｎｄ/ｏｒ［ｈｏｓｅｉｎｕｎｕｓｕａｌｏｒｄｉ｢１．icultloca-

is（lischargedtohom〔，wilhthoinstructions「ornonwGighlbearing「ｏＴａｂｏｕｔ６
ｗ()(lks．’ＰｈＧｐａｔｉｅｎｔｉ５ｆｌｓｋｏｄｔｏ1℃nlrnfor

tionsrequiremoroLimｅｔｏｒｏｍｏｖｏ・Ｗｅ
ｈａｖｃ「(〕ｕｌ}ｄｔｈａｔＬｈｅｌｌｓｅｏｆｌ)(〕ｗｏｒＬｏｏｌｓ
ｗｉｌ１Ｒｈ()１．１，Glll,hGproco(1111．ａｌｌｊＩｌ１０ｎｓｌｌ１ｌｌｃｈ
ａ５０％rlI1disespecial1yusGfull,()「1℃、(〕valoflargerlesionsandthosewithmarked
poriosLoalthickening．
’「ａｐｒｉｏｒＣＴｉｓｎｏｔａｖａｉｌａｂｌｃｏｌ､ｈａｓｎｏＬｂｏｏ】］１〕orformediLisimporLantlo()l〕Laina
higll（lllaliLyGxaminationLocoI1｢irllM1Lion
thodiagnosis，measul･ｅｔｂｅｓｉ脇ｅ（)ｆｔｈｅｌｅ‐sion，ａｎ〔ｌｐｌａｎｔｈｅｓａｌｅｓｔａｎｄｅａｓｉｏｓｔｒｏｕｔｅｔｏａｌ〕l)roachthelcsion、Ｏｎｔｈｏｄａｙ（)fpercutano〔)ｕｓｒｅｍｏｖａｌａｌｉｍｉｔｏ(ｌＣｒｌ１ｉｓｐｅｒ－ｌｏｒｍ(】(ｌｔｈｒｏｕｇｈｔｈｏｒｏｇｉｏＩ１ｏ「ｉｎ[〔)r〔)ｓＬａｎｄ
ｔｈＧｓｋｉｎｏｎｔｒｙｓｉｔｅｉｓｍａｒｋｅｄｗｉｉｈｉｌ)deli‐ｂｌｅｉｎｋ・ＯａｒｅｉｓＬａｋｅｎｔｏａｖｏｉｄｔｈｏｖｉｃｉｎｉｔＶ
ｏfanervoorvascularstrucLuro・SkinpreparaLionisaccomplishoduｓｉｎｇｆｌｃｏｍ‐

ハハ(,ｒＬｈｅｌｏｓｉｏｌｌｉｓＩ･(9ｍ()v()(ｌａｎｏＬｈｅｒ

ｌｉｍｉｔｅ〔ｌＣＴｉｓｐｏｒ｢(〕rl1lo(１（(）ｃｏｎｌｉｌ･ｍｔｈｅｔ()tfll】℃ｍｏｖａＬＲｏｇａＴｄｌｅｓｓ（)Ｉｗｈｏｌ｣〕01．ｏｒ､()Isomoscleroticmargins（)１１１１()ｗａｌｌｒｅ－ｍ〔liI］Ｉｈ〔、Lrackall(］ｔｕｍｏ】・cavilyisaggrossivolvscrappedusinganglodcurettes．
Ａ｢しｏｒ1℃covorvfromanesthosinLhochild【)xnl1linl1n()ｌｌｉｌ１ａｌ)()'１１１，Ｗ(）ｗｃ(}kHflndis

aclivclyl,(〕ｌｌｏｗＧｄｌｉｏｒ６ｔ〔）８Ｗo()ｋｓ、lLis
grfllilyingLoknowthatinmostinstances[ｈｃｃｈｉｌｄｉｓｐａｉｎｆｒｅＧｉｍｍｅｄｉａＬＧｌｖａｆｔｅｒ
ｃｏｌ１１１)lelionoftheprocedllreaI1〔ｌｈａｓｌｉｍ－ｉＬ〔】(１１〕()月Ｌｐｒｏｃｅｄｕｒａｌ（liscomlorL
InnlQsLcflsesInin〔〕ｒ〔１，〔Ilgosi〔Ｉｗｉｔｈ
Ｌｙｌ(】、【)１，ｉｌ)ｕｐｌ､oph(１ｎｏｒａｓｐｉｒｉｌｌｉｓａｌｌＬｈａｔ
ｉｓｎｏｃ“sarv,Occasionally1al1a1℃oLicanal‐
gosiciBneededforalewdaysl〕ｕｔｔｈｉｓｉｓ(ｈ〔）cxco1)ｔｊｏｎＬｏＬｈｏｌ･ulc・ＴｈｏｆｌＩ１Ｍｂｉｏｔｉｃｃ()voragoismail1taillcd「ｏｒａＬ()Ｌａｌｏｆ５
ｄｎｙｓａｎ(ldiscontinｕｅｄｕｎｌｏｓｓａＩ１ｉｎ｢ectiouscomplicationarisos・Ｔｒａｃｈｅａｌｓｔｅｎｔｉｎｇ})inaLi()、（)「betadil1(】solulj()'１ａｌｌ(Ｉａｌｃ()hｏＬ

ＳＩ(】I11j】1ｇｏｌｔｈ(）Lrach()Cl)｢()llcl1i｛ｌ１ｔｒｏ(〕ｉｓＡｓｍａｌｌ（approximnL〔)ly5111111）illciHi()ｌｌｉｓ
ｍａｄｏｕｓｉｎｇａ＃ｌ１ｓｃａｌｐｅｌｌ)lad(）andLho
incisionisbluntlydissectedtoL11ebony
sur｢ace・ＡｐｉｎｏｒＫ－ｗｉｒｅｉｓｉｎｓｏｒＬＧｄｖｉａ

Ｉｌ()wlicflsil)ｌｅｆｏ「ｔｈ(、trcaIln()１１［（)「ｓい、ic-

Iu1℃ｓｉｎｖｏｌｖｉｎｇｔｈｃｐｃｄｉａＬｒｉｃａｉｒｗａｖ・In
l974，MontgomeryroporLedthousoofsiliconostonLs55l・Ｓｉｎｃｅｔｈａｌｔｉｍｏｓｅｖｅｒａｌ

ｔｈｃｓｋinincisionanddirectodLowardsLheｔｙｐｏｓｏｆｐｌａｓＩｉｃｓＬｏｎｔｓｈａｖｏ１)Ｇｏｎｕｓｏｄｆｏｒ

contel．ｏ「LhGlesion．（〕ｎｃｅＬ１]ｅｌｊｉｌｌ/ｗｉ１℃isconto】℃(］ｏｖＧｒＬｈｅｌｅｓｉｏｎａｎｄｃ()nfil､ｍｅ(１１〕ｙs(､sIlIi'・ＭｃＩａｌｌｉｃｓＬ(〕ｎｔｓｗｅ１℃（１０Ｖ()l()pcdforｉＬｉｓｈａＩ１ｌｍｅｒｏｄｉｎＬｏＬｈｅｌ)ｏｎｏｗｉＬｈａｍｅｔａｌ

Ll･()(lln1(ｌｎｔｏｆｖａｓｃｕｌｆ〕l・stelIosos、１１()ｗever，

ｍＲ１１０Ｉｕｎｔｉｌｔｈｅｐｉｎ／I<-wirelea(1ｉｎｇｅｄｇＧｉｓ〔l(ljaconLorthroughtheloSion、Ａｃｏｒｅｏ「ｂｏｎ〔、ｉｎｃｌｕｄｉｎｇＬｈＧ１Ｇｓｉｏｎｉｓｌ｣]〔)ｎｒｅ－
ｍｏｖｅｄｌｌｓｉｎｇａｔｒｏｌ〕ｈｉｎＧｏｆａｌ〕})l･opriate
sizo・Ｉｎｏｒｄｅｒｔｏｒｅｍｏｖｅｔｈｃｏｓｌｏｏｉｄｏｓteo-/２

ｔ１１(jLro11Lmont（)「lrflchc()1〕r()l】cllifl1steno-iＬ（lｕｉｃｋｌｙｈａｓｂＧｃｏｍｏ（､vidcntthflLthesed(､ｖｉｃｏｓｃｏｕｌｄｂｅｕｓｅｄＬｏｔｒｏａＩｓｉricLuresi】ｗ()lvillgoLhe「sitos・Inl9861Wallacoandcollo〔lguesreporlodLhGuseluln()ｓｓｏｌｅｘ－ｌ〕ａｎｄａ１〕ｌｏｍｃＬａｌｓｔｅｎｌｓｌｏｒ［1℃ａｔｍｅｎｔｏｆ

ＶｏＬ１５Ｎｏ,１．１９９９１３

Ｌ

A〆

「
。’Ｉ
ｈ

！

'&

夢‘

－－

￣

ｌＬ

Ｕ

畷 ~ﾖｰｰ:麹…
非Ｆｉ９５

Ａ６－ｙｅａｒ－０１ｄｂｏｙｐｒｅｓｅｎｔｉｎｇｗｉｔｈｐａｉｎ
ｗｈｉｃｈｗｏｒｓｅＩ１ｓａｔｎｉｇｈｔｔｙｐｉｃａｌｏｆｏｓｔｅｏｉｄ
ｏｓｔｅｏｍａａ：ＥｘｕＵｍｉｔｙ（)ｒＰＩ･(〕ｖｏａｌｓａｐｒ()ｘｉｍａｌｔｊｌ)i(ｌｌｌｌｉ〔I1Is（llrl'()wlloa〔1s）wilhLhickporisL()ａ１１℃flclj()、．
ｂ：Afte１．１()cnliz(lLi()ｎａｓｔｉｌｌｅｌｎａｎｌ〕ｉｎ］〕。‐
siLion〔)(ｌａ〔ljaconLLonidus（arrows)．
c：LesionrclllovcdusingaLrephineoｖｅｒ
ｔｈｅｐｉｎ・Fivc-vearI()１１〔)ｗ－ｕｐｗｉＬｈｏｕｔ
ｒｏｃｕｌ､ｒｏｎｃＧ．

stenosesｌｂｌｌ()ｗｉｌ１ｇＬｒａｃｈｏｏｌ)１.()Ilchialre-

constTucljon57'．Ｓinc(Ｐｔｈｏｎ１ｓｃｖ〔〕ｒａｌｇｒ()ups
havedescTil)e(］LhcsuccosshllIl1c(､ｍｅｎｔ

ｏｆｍＧｔａｌｌｉｃｓｔｃｎＬｓｌ()rLroflLmoIlL（)「（Ｉｖａｒｉ－

ｅｔｖｏｆｃｏｎ(Iili()nｓ・Ｗｌ１０ｎｆｍａｉｌｗｌＷｓＬｏｎｏ－■Ｊｓｉｓｉｓｉ(10,1ti｢i(!(ｌｌＩ１(〕ｒＧＩｌｌ･(｝【1Ｖ〔ｌｒｉ(,Lvol
qjtherapGulj(、（)1)|i()llsavail【１１)|(！［()l・IjlGirt]､ｅａＬｍ(】ｎＬｌｌｌ･()Ilcl1()Ｓｃ()1)ｙｗｉＩｌ１（Iilllli()、，laserLhcM1)ｙ，（)11(|()|)r()I1chi(１１１℃H()ＣＭ()、，fluoroscol)icaⅡｙｇｕｉ(ｌｃｄｂｎｌＩ()()1１（Iilati(〕、，ａｎｄｓｔｅｎｔｉＩ１ｇａ１１ｍａｖｌ)()hell〕llIl〔l〔)1)c、(lingonrheclinicfllsGLting、Ｔｈｏｒｅｌａｔｉｖｅｉｎｄｉ‐bd

cationsforcn(ｊｈｔｈ〔)rapoutical〕]〕roachchangoswiLhLochnicaladvancGs・Ａｔ［ｈｅｃｕｒｒｅｎｔＬｉｍ(〕sllrgicalresocti()ｎｏｌａｎａｉｒ‐ｗａｖｓｎ､icLu1℃ｉｓ】℃commondodwhonever￣

possil)１０．ＩＩｏｗｏｖｏｒ，ｓｕｒｇｅｒｙｉｓｎｏＬａｌｗａｖｓ
ｆｅａｓｉｂｌｏ１)ｏｃｆ１ｕｓｏｏｆｉｔｈｅｌ()cationo［thosLenosi日、ｐ()sｔ（)1)()rativGrocu1､''０，c〔)(s)，and
acllildwll(）ｉＨＩｌ()ｔａｓｕｌ･ｇｉｃｎｌｃ〔１，(li(ｌａｔｅｄｕｅｔｏｔｈ(、ｓｗ()l･ｉｌｙｏｌｕＩ１(l(》1,1yillg（lisease，
ｏｒａｎｌＩｌ１ｃ(〕r1℃しｌＬａｌ)ｌｏｃｏａｇｕｌ()1)ａｔｈｙ・Ｔｈｕｓ，
ｉｎｌｈＧｓｅｓ〔)Ｌｉｉｎｇｓｌ)ａｌｌｏｏｎｄｉｌａｔＭｉｏｎｗｉＬｈｏｒ
ｗｉＬｈｏｕｌｓｔｃｎＬｉｌｌｇｍａｙｂｅａｌｉｆｏｓａｖｉｎｇｐｒｏ－
cedure．’Ｐｈｅｒｉｓｋｓａｎｄｔｅｃｈｎｉｃ〔lllimita-

tionso「surgicfl1resecti〔〕ｎａｎｄＬｒａｃｈｅｏ－
１３

ＭＥ1本小児放射線学会雑誌
bronchialroconstructionmakGtheｕｓｅｏｆ

profile，Gxpandability，floxibility，andthe

ｓｔｅｎＬｓａｎｄｏＬｈｅｒｔｅｃｈｎｉｑｕｅｓａppealingfor
managom〔)l1tofchesedilTicultpatients・
ＴｈｅｕｓｏｏｆｓｔｅｎＬｓｒｅｐｒｅｓｅＩ１ｔｓａｎａｄvancein
thomanagemontofoL110rwiseil1operable
paLienLs、
SiliconestenLswo１℃iniLiallydesigned

abilitytobecoveredvia〔)l)iLhelialization・
ＲｅｇａｒｄｌｃｓｓｏｆｔｙｐｏｍｏＬａｌｓｔｅｎｔｓｈａｖeLhinnerwallswiLhsignificaｎＬｌｙｌａｒｇｅｒｉｎｎｅｒｄｉａｍｅｔｅＴｓｔｈａｌ〕equivalonisizedsilicone
stents・MetallicstentsarGlowprofileandeasilyinseTtedacrossasLricLurewithout
significantljrauma、Ｂｏｃａｕｓｅｏｆｌ,heiropen
moslld(BsignmetalstenLscaJ11)eplaced
acrossa｝)rachialoriginwithouLobstruｃｔ－
ｉｎｇｉｔ、Ｆｉｎａｌｌｙ，ｍｅｔａｌｌｉｃｓｔＧｎｌｓｎｒｅｍｏｒｅ
ｓｔａｂｌｏａｎｄａ1℃lesslikelytodislodge・ThesephysicalcharactGrisLicsreducethe
amounLofspecializedcareｒｏｑｕiredafter
stentplacement．
ＩｎｓｐｉｔｅｏｆＬｈｅｐｏｓｉｔｉｖｅｆｅａｔｕｒｅｓｏｆｍetal
stentsdisadvantagesdoexist・Ingeneral，
metalstentscanbodeployedaccurately・Ｈｏｗｏｖｅｒ１ｏｎｏｃｃａｓｉｏｎｔｈｅｙｍａｙｂｅｉnadvortenL1ymalpositjoned，Ｉ「Lhisoccurs，roposiLioningmaybo（1if【ｉｃｕｌＬｏｒｉｍｐｏｓｓｉ‐
b１０．Ａ1s。，ｔｈｅｏｐｅｎｍｅｓｈ（lesigndoesnot
protectagainsLtisｓｕｏｉｎｇｒｏｗＬｈｉｎｔｏｔｈｅ
ｌｕｍｏｎａｎｄｓｔｅｎｔｃｏｍｐ]℃ssion・Perhaps
covGredsLenLswillllo1pｉ】】somesiLuaLions，however，ｎｏｏｘｐｏ１,ioI1coisavailable
toallswGrLhiｓｑｕＧＨＬｉｏｎ,ｌｎｔｈＧｌｏｎｇｔｅｒｍ
ｉｒｌｊｈｏｓＬｏｎＬｉｓｌｌｏｌｏｎｇｏＩ・needodoritis
causingproblems，iLmaybedifficultor
impossibletoremove・ＡｌＬｈｏｕｇｈｓｔｅｎｔｒｅ－

foruseasT-Lubｅｓａｎｄｗｏｒ(）modil'iｅｄｆｏｒ

ｕｓｅｉｎｏｌＪｈｏｒａ1℃as、’１１ｏｄａｙｔｈｏＤｕｍｏｎｓｔｅｎＬｉＳｍｏｓｔｗｉｄｅｌｙｌ1s(ｘｌｓｉ]ｉｃｏｌ１Ｇｏｎｄｏ‐
proslJhosisu6)．SiliconosL(〕】,ｔＨｗｏｒｏ「ｉｒｓｔｔｏ
ｂｅｕｓｏｄｉｎｔＩ１ｅａｉｒｗａｙ〔lIl(ｌｏｌＴ〔)rseveral
advantagos，SiliconostentsareeasilyinserｔｅｄａｎｄｃａｎｂｅｍｏｄｉｆｉＧｄｉｎｔｏａｖａｒｉｅｔｙ
ｏｒｓｈａｐｅｓａｎｄｌｅｎｇｔｈｓａｎ〔laregenerallv
welltoleratod・Theyareofficaciousfor
treatmentolinflammatoryandmalignaI1tstricLllres．Ｔｈｅｌ〕lasticprovontsin‐
growLholgranulationLissu〔ｌａｎｄＬｕｍｏｒ
ゾ

ｉｎＬｏｔｈｏぃ･flchea］ｏｒｌ)r(〕】1chinllumenal-

thoughLllo1℃ｉｓｔｉｓｓｌｌｏｇｌｂｗＬｂｂＧｔｗｅｅｎｔｈｅｓＬｏｎＬａｎｄａｉｒｗａｙｗａｌｌ・Pel､ｈａｐｓＬｈｅｂｉｇ‐
gestndvanLageofLhismatorialisｉＬｓｅａｓｅｏｆｒｏｍｏｖａＬＵｎｆｏｒｔｕｎａｌ,01ｙ，（1iRadvantages
alsooxistal】(１ｔe】〕。ｔ(）ol11w〔)ｉｇｌ１ｔ１〕〔〕advan‐ljagos・SiliconostoI1tsa1℃nI1on-LapGred，
high-1ricljollmatori(ｌＬ１ｔｓｃｏｎｓｔｌ詞uction
makesitdilTiclIl“ｏｐｏｓｉｌｉｏｎｉｎｉｎｄｉｖｉｄｕ－
ａｌｓｗｉＬｈｔｉghtsLrictu】℃s・illaddition，
plasLicsLentsarel)ronetodisplacement
andexpulsionｒｒｏｍｔｈｏａｉｒｗａｙａｎｄｍｕｓｔｌ)ecarofullysuturGdinl〕lace，Ｉｎａｄｄｉｔｉｏｎ，
thestontshaverelaLivelythickwaｌｌａｎｄ
ｎａｒｒｏｗｌｕｍｅｎｓａｎｄａｒｅａｌ〕しｔ(〕obsLruct
withmucusandothorsecTe[ions・Thisis

espoci〔lllypro1〕ｌＧｍａＬｉｃｉｎｃｈｉｌ(lronwith
smallorairways・ＳｉｎｃｅＬｈｅsostentsare
solidIhoyintorfo1℃ｗｉＬｈｎｏｌ･malmucociliaryflcljonａｎｄｃｌｅａｒａｎｃｅｏ「secrotionsandroquirocollsLanLpullnonarvLoileL、Ａｌｓｏ，

ｍｏｖａｌｉｓｎｏｔｒｅｃｏｍｍｅｎｄｅｄ，FillerandcollGagueshaveremovedllo【３０stentsin

apediaLricpopulation68)．ＴｈｅｙｒｅｐｏｒＬＬｈａｔ

ｒｏｍｏｖａｌｕｓｉｎｇａＬｗｉｓｔｉｎｇａｎｄｗｉｔｈｄｒａｗａｌ
ｃａｎｂＧａｃｃｏｍｐｌｉｓｈｅｄｉｌｌｌＧｓｓＬｈｆｌＬ３０ｓｅｃ－
ｏｎ(ＩｓＲｏｌ,ｈａｔsignilicf1nLaiTwflyobstruc‐
LiondoosnoLoccur、Ａｓｍａｌｌａｍｏｕｎｔｏｆ

ｍｕｃｏｓ('１１〕ｌｏＧｄｉｎｇｉｓｎｏＬｏｄｉｌ１ａｌｌｃａｓｅｓ
ｗｈｉchstol〕pedsponLanoouslyinafew
minuL0s・ＴｈｅｓＧａｕＬｈｏ１．ｓ（ｌｉｄｎｏＬｏｔｈａｔｏｎｅ

bocflusoofiLconstructionL1]osiliconoｃｈｉｌ(１（licdaLflLLcml〕しc〔ｌｓｔｃＩｌＬｒｅｍｏｖａｌｂｅ‐sLollLc(11}ＩｌｏＬ１)〔】ｕso(ｌｉｆａｌｃｓｉ()ｎｃｌ､ossGsa

callsoitwasweldodinLoLhoLrachｅａｌｗａｌｌ

brol】chi〔lIori｢ａｃｏｓｉｎｃｏｉＬｗ()ｕｌ(１１℃ｓｕｌＬｉｎｌ)ｙｌｉｌ)rolIs1℃acLi()ｎ．Nfl田ｈ〔)『ａｎ(IassociaL-

ｏｂｓｔｒｕｃＬｉｏｎｏ１ａｌｕｎｇｓＧｇｍ(HnLrl1hlls，whencs〔lcscribc1℃ｍｏｖａｌｏｌ，（)iantl11℃ｏｓｔｅｎｔｓ

L1sedsiliconestentston(Ｉｔｏｌ)０ａｓｈortLermａｓａｌ〕rocesssimilartorollingspaghettｉ
ｏｎａｌｂｒｋ，ｂｕｔｍｕｃｈｍｏ１℃ｄｉｌＴｉｃｕｌｔａｎｄ

solution．

。V1etallicstGntshavesoveralE1dvantages

oversiliconestenisespccial]ｙｔｈｅｉｒｌｏｗ
J‘

ｔｉｍｅｃｏｎｓｕｍｉｎｇ592．ＯｔｈＧｒｓｈａｖｅｒｅｍｏｖｅｄ
Ｐａｌｍａｚａｎｄｗａｌｌstontsbycuttingthem

ＶｏＬ１５Ｎｏ､1，１９９９１５

withlasersLoalTccIremovaL’１１ｂｕｓ，ｎｌ－

Luro，ａｎ(ｌａｉｒｗａｖｃ()mprcssion、Ｔｈｅｌｉｓｔｏｆ
ｉｎ(licati〔)ｌ１ｓｆｏｒｗｌｌｉｃｈｐｌａｃｏｍｅｎｔｏｆａｓｔｅｎｔ

Ｌｈｏｕｇｈｓｏｍ〔ｈｓＬｏｎｔｓｈａｖｅｂＧｅｎ1℃ｌｎｏｖ()ｄｉｔ
ｉｓｃｌｃａｒＬｌｌａｔ［ｈ(）ｃｌｌＩ･rel】tgellcl･ｌ１ｌｊｏｎ（)［ｓｔｅｎｔｓａｒｏｉｎｔｅｎｄｅｄＬｏｌ)ｅｐｅｌ･ｍａｎｏｎＬ
Ｔｈｃｒ()｢or０，ｉｔｍａｙｌ〕〔、Ｌｈｃｌ)Ｌ１ｓｔｓｔｗ１ｔｏｇｙＬｏ
ａｖｏｉ(Ｉｒｅｍ()ｖａｌｗｈ〔､、(Worpossible・
Ａｉｒｗａｖｏｌ〕slrucIjonu,)responsivoto
medical〔)】・surgicfllLheral〕ｙｉｓＬｈＬ１ｉｎ‐
dicf1Iionl､Cl・stonLplacemoI11inchildIlood(Fig.6)．Ｔｈｅｍｏｓ【commoncondilionsro(ｌｕｉｌ･i11gsteJ1tiIls〔)rLi()ｎａｒ(）ｌｎａｌａＣｉａ，ＳＬｌ･ic-

目

nlHybeclTicaci(〕ｕＲｉｎＬＩ１〔）ｐｅｄｉａｔｒｉｃｌ)()1)11‐
ｌａｔｉｏＩ１ｓｅｅｍｓｔｏｌ)ｅ９１℃ｗｉｎ９．Ingeneral，ｉｎ
ｓｐｉｔ〔】ｏｆｔｂＧａｕｕｒ〔）ｏｆ１ｈｉｓ（horapGuticol〕Li〔)、，［｣１０１ｏｎｇＬｅｒｍｅｆ｢ＧｃＬｏｆｓＬＧｎｔｉｎｇａＩ１
ａｉｒｗａｖｉｎａｇｒｏｗｉｎｇｃｈｉｌｄｉｓｓｔｉｌｌｕｎｋｎｏｗｎ・
ＴｌｌｕｓａｔｔｈｉｓＬｉｍ〔)，ｉＬｉｓｍｙ「o01iI1gthatslcnt
pl〔ｌｃｅｍｅｌｌｔｓｈｏｕｌｄｌ)ｅ1℃sorve〔ｌｌｍｏｒＬｒＧａｔ－
ｍｃｎｔｏｆｃｏｎｄｉｔｉｏｎｓｔｈａｔａ1℃notrosponding
toconvoI1ti()nfIIfol･ｍｓ（)１．mflllageme】Ⅶ

■｡

:!:１１

Fig6

2-vear-oldmal(）withcongenitalheart
disefls(）aI1dsoveretracheomalncia

secon(1ａｒｙＬ(）oxtrinHiccoml)１℃ssion
lroml1ighaorticarch、
Faile(laorLopoxy・VontilaL()ｒｄｅｌ〕ｏｎ‐(Ｉ０ｎｔｌｌｎｔｉｌｓＬｏｎｔｉｎｓ()rLod・Ａｓｏｃ()ndPalmazsLon［beingpositioned（ａ)．
BothRlelllsinp()siLi()、（１）)．
壱

Ｐ

／

7面目「

列

」

岸。

iｌ

【■

１５

１６日本小児放射線学会雑誌

ＡｌｔｈｏｕｇｈｉｎｔｉｍｅｉＬｍａｙ｝)ｅｓｂｏｗｎｔｈａｔ

ofrecurrGntsLricturGsThus，ｉｎｔｈｅｓｅｓｔｅｎｔｉｎｇｏｆａｃｈｉｌｄ'ｓａｉｒｗａｙｉｓｓａｆｅ，effective，ａｎ(］Ｉｈｅａｐｌ〕roacholochoicoiLisprobａｂｌｙｗｉｓｅａｔｔｈｉｓｔｉｍｏＬｏｔａｋｅａｃｏｎｓerva-

ｃｈｉｌｄｒｃｎｐｌａｃｏｍｏｎｔｏｆａｍＧtallicstentmayl)ｅ【lrclaLivoconm､ailldication・Ｉｎ
ｔｈｉｓｓｕｌ)groupmedicfllLherapy，asilicone
orcovo1℃(ImGLalstentmaybepreferable、
Soriouscomplicationsfromstentshave
beenreportedincludingmassivefatal
hGmoptysisrosultingf]､ｏｍｐｏｎｅｔｒａｔｉｏｎｏｆ
ａＯｉａｎＬｕｒｃｏＺｓｔＧｎLiI1Loapulmonary
arL()ｒｙｆｍｄｄ(〕voloI)mollL（)labrachio-

tiveviewunLilmoroinfol･mationbecomes

available、IIavingsaidLhis，ithasalreadv
becomeobviousLhattracheobronchialstentiｎｇｍａｙｂｅｌｉｌ､osavingincertainsit‐
uationsan(ｌｍａｙｂｏｏ｢｢ｏｒodLopaLients
whosoconditiollsa１℃ｌｌｏｔａｍ〔}ｎａｂｌｅｔｏ
ｓｕｒｇｏｒｙ、

Ｔｈｅｐ1℃liminaryroslIltsolLracheo‐

bronchialstenLing6a69）ｓｕｇｇｏｓｔｓＬｈｃｌｏｎｇ
ｔｅｒｍｒｅｓｕｌｔｓｏｆａｉｒｗａｖｓｔｅｎｔｉｎｇｄｏｐｅｎｄｓ
ｕｐｏｎｔｈｅｕｎｄｅrlyingetio1ogyo『LhestricturG、Ｉｎｐａtientswithnarrowingsecondarytofibrosis1thosowithh､acheobronchomalacia（)rextrinsiccompressionstent‐
iｎｇｉｓａｎ（)xcellontLhornpGl1ticoption・

IIowovor，childrenwiLhfil)]･oinllammatorv
ゴ

disoasewiLhacLivoinl､ｌａｍｍａｌｊ()１１andproliIerati〔)、。「granulaLioI1ti烏ｓｕｏｕｓｌ】ally
havepoorresulLs・Ｔｈｅｓｅｌ〕ａＬｉｅｎｔｓｈａｖｅａ
ｈｉｇｈｉｎｃｉｄｅｎｃｅｏｆｌ･estenosiswhichmay
nGcessitaLosLｏｎＬｒｅｍ()vａｌｌｎｌｈｅｓｏｉｎｄｉｖｉ‐

ｄｕａｌｓｉｔｉｓｍａｙｌ)Ｇ１)oｓＬＬｏ（loMyil1sertion()|､ａｍ()し〔ｌｌｌｉｃｓｔｃｎｔｕｎ(ｊＩｔｈ(｝ｉＩ〕11nmmation

subsidesifpossil)１０．１［sLontillgisnecessaryduringthisacuLGphasoasilicone
stentｃｏｕｌｄbeinitiallyplacedLlntilthe
inflammationsubsidessincothisLypeｏｆ
ｓｔｅｎＬｄｏＧｓｎｏｔａｌｌｏｗｉｎｇｒｏｗｔｈｏ「granulationtissue・ＬａｔｅｒａｍｅtallicsLontcanbe

insertodifneededltFlppearsthaLplace‐
ｍｅｎｔｏ「ａｍｃｔａｌｓｔｅｎＬｆ()ｒｔｒｏＩＩｔｍｅｎＬｏｆａｎ

ａｉｒｗａｙｓＬｒｉｃｔｕrocanboaccomplishedsafelyalldeIfecLivelyinLhevasLmajority
ofcases・ContraindicaLionstothcp]ａｃｅｍｅｎｔｏｆａ
ｓｔｏｎＬｉｎｔｈｅａｉｒｗａｙｏｌ､achildaredifficult
toolucidatoａＬＬｈｉｓＬｉｍｏｄｌｌｏｔｏＬｈｅｌａｃｋｏ｛cel)hlllic-い,ａｃｈｏａｌｆｉｓＬｕｌａ１ｏ１・Ｉｎｍｙｏｐｉｎｉｏｎ，ＧｉａｎｔｕｒｃｏＺｓＬｏｎｔｓｗｉｔｈｈｏｏｋｓｓｈｏｕｌｄｂｅ

ｕｓｅｄｗｉＬｈｅｘＬｒｅｍＧｃａｕＬｉｏｎｉｎｔｈetracheobronchialtreeofchildren・ＴｏｄａｙｏｎｅｏｆｔｈｅｍｏｓＬｄｉｆｆｉｃｕｌｔｑｕｅｓ－
ｔｉｏｎｓｔｏａｎＳｗｅｒｉｓｗｈｅＬｈＧｒＬｏｕｓｅａｓｔｅｎｔｉｎａｇｒｏｗｉｎｇａｉｒｗａｙ・Ｔｈｏｒｅａｒｅｎｏｌｏｎｇ
ｔｅｒｍｓｔｕｄｉｅｓｉｎｃｈildronavailabletoassessthooｆｆＧｃｔｏｆａｓｔｏ１ｌｔｏｎＬｈｅｃｉｒｃｕｍｆｅr-entia］ａｎｄlongitudillalgrowLhoftheair‐
ｗａｙ．’ｌ１ｈｕｓ，ｉｔｓｅｅｍｓｐｒｕｄｏｎｔｔｏａｖｏｉｄ
ｓｔｅｎｔｉｎｓｅrLionespociallythosedevices
LhaＬｍｉｇｈＬｂｅｍｏｒｅｌｉｋｅｌｙｔｏＬｅｔｈｅｒｏｒｉｎ－
ｊｕ１℃P1growingtracheol)ronchialtree・It
iscurrentlyourpracljcｏｔｏｓｅｌｅｃｔ・ｏｎｌｖ
Ｌｈｏｓｅｃｈｉｌｄｒｅｎｗｈｏｈｌｗｏｓｏｖｅ1℃ｓｙｍｐｔｏｍｓ
ａｎ(Ｉｗｈ(）ｈａｖｅＩＱａｉｌｏｄｃ()１Ｗ()１１ljonalthGrapyl〕elo1℃consi(leringiI1serijono［ametallic
sLenLInLhoseseverelvalfGctodchildren
U

wiLhtl､acheobronchialstricturesballoon

dilationisLheinitialLherapyofchoice、
BalloondilaLionwillberepeatedifrestenosisｏｃｃｕｒｓａｓｌｏｎｇａｓＰＴＡｒｅｌｉｅｖｅｓｔｈｅchild'ｓｓｙｍｐｔｏｍｓ・Ｓｔｅｎｔｉｎｇｉｓｕｔｉｌｉｚｅｄｉｆ
ＰＴＡｉｓｕｎｓｌｌccessfulinallGviatingsymptomｓｏｒｓｙｍｐｔｏｍａＬｉｃ１℃sL()nosisoccursral)idly、１ｎｔｈｅｒａｒｅｃｈｉｌｄｗｉＩｈｔｒａｃｈｅｏ－ｍａｌaciawhoisventilaLordepondantprｉ－
ｍａｒｙｓｔｅｎｔｉｎｇｉｓＬｈｏｐｒｏｃｅｄｕｌ､ｅｏｆｃｈｏｉｃｅ・
InLGrventionalprocedurosappearｓｔｏ
ｈａｖ〔）１１｢)plicationinvirulallyallareasoｆ

tions，ＯｈｉｌｄｒｅｎｗｉＬｈｔｈｏｃｏｍｂｉｎａｔｉｏｎｏｆａ

Ｌｈｏ１)ody．’Ｉ１ｈｏｐＧｄｉａｈ､icintorventionalistnowl〕ｌａｙｓａｎｉｍｐｏｌ･ｔａｎＬＩ･()１０ｉｎＬｈｅｄｉａｇ－ｎｏｓｉｓａｎｄＬｈｏｒａｐｙｏｆcl1ildroIlofallages
andsizcs、Ｔｈｃｕｓｅｏ「thescminimallyin‐
vasiveapl〕roachesisbothsafeandcost

ｍucosa1proliferativeprocossandatra-

elTectiveandshouldbeconsideredwhen-cheobronchialstricu1roｈａｖＧａｈｉｇｈｒｉｓｋ

everpossible．

exporiellcowiLhthistocllni(111()．IIowever，
pationLswiL11al)roac11iI1I｣１０ｉⅡ】Ｌｅｇｒｉｔｙｏｆ
ａｎａｉｒｗａｙｗａｌｌｍａｙｌ)ｏｍｏｒｕＩ〕ｒｏｎｃＬｏ
ｓｔｅｎｔｏｒｏｓｉｏｎａｎｄｓｅｃｏｎｄｎｒｙcomplica-

1６Ｖ()1.15Ｎ().１，１９９９１７

ＡｃｋｎｏｗｌｏｄｇＧｍｅｎＬ：’1,ｈｅａｕｌｈｏｒｗｏｕｌｄｌｉｋｏ
ｔｏｔｈａｎｋＤｏｂｏｒａｈＰｒｉａｔｋｏ「orhorassis‐
ｌｎｌｌｃＯ．

●Referencesl）Walk()ＴＬＧ虹：Ｌ、LStaL()､，Ｌｍ(I1hc
fil･ｓｔ５ｕｃｃｅｓｓｆｕｌｇａＨｌ,r()ｓｔｏＩ１ｗｉｎＡｍ〔Irica，

ＳｕｒｇＧｙＩｌａｎｄ（)bsll98l；１５８：387-388.

l:l）（!al〕ｐｅｌｌＭＳ、（+()(ｌｉｌＡ：Amullic(ｍｔ(､Ｔｃａｓｅ（DonL1･()１１ｃｄ＆Ｌｕ(ｌｙｏｆｐｃｒｃｕｔａｎｅｏｕｓ〔ｍ〔lo-HcopicgaHLroBtomyinllIV-so1･Ｃｌ〕()siLiv〔、Ｉ〕ati(１，【ｓ・ＡｍＪ（ＩａｓｎＤ０ｎＬｅ1.011993；８８：２()59-2066,

15）ｌｌｕｌｌＭＡ，RowlingsJ，ＭｕｒｒａｖＦＥ，ｅｔａｌ：
Ａｕ(ｌｉｔｏｌｌ()ng-termenLCralnutriti()ｎｂｙｌ)orcuLane()uｓｅｎ〔ICSC()】)icgasLrostomy，
Ｌａｎｃｃｔｌ９９３，３４１：869-871.

2）Ｖ()rncu川１：（)1)servation（1()ｇａ月trostomicl)Tati(ｌｕ(､ｃａｖ(､ｃＲｕｃｃ〔)ｓｌ〕ｏｕｒｕｍｒｏｔｒｅｃｅ臼s-16）WollmallBS，ｌ)'Ａｇ()sIjnollB，Ｎａｌｕｓ－ｐｌ〕ａｇｏ・BullPtinAcedM〔､。’〕ａｒｉｓ，ｌ９７６ｉ

ｔｉｏｎａｌｅｖａｌｕａＬｉｏｎａｎ〔lmeta-analysisof
tlleliLol･aljul､e，Ｒａ[liologyl995；９７：６９９－

mcntic2ltl･icielinlI･ａｎｃｂｉｓ－ｓａｂｌｃ〔ＩＣＩ,〔)Cs()－

２５：1023-1038.

3）Ashcr()ＩＩａｎ(１１１()1.(!ｒ：（】haptc１．２小Losi()11ｓ（〕ftll(､slomach．Ｐ()(liatri〔、Sur質cry（2ｃｄ）281)-30い6.1〕vl〕udgcon,I)L,Ｗ､I).Saun(1()1.s
Ｃ()mpany，1983.

Ｊ）Gaudcr〔u】・ＭＷＬ：Gastr()st()mytecllni‐〔ｌｕｅｓＬ１ｎ(１．小'ices、ＳｕｒｇＣｌｉｎＮｏ（ｈＡｎｌｅｒｌ９ｌ)２；７２：１２８５－１２９９．

５）ＦｌａｋｅＡＷ，Ｓｈ()pencC，ZicglerMM：人咋

tirefluxgastrointc日Ｌｉｎａｌ５ｕｒｇｃｒｙｉｎＬｈｅｌｌ(､ｕｌ･Cl()giicallyhan(Iical〕I)〔Ⅲ〔]（'hil(１．１〕0(Ｉｉ－ａｔｌ･ＳｕｒｇｌｎＬｌ９９１；６：９２－()し６）Ｔ()ro月iaI〕ＭＩＬＲｏｍｂｃａｕＪＬ：Ｆ(､edingl》ｙｔｕｂｅｅｎｔｅｒｏｓｔ()ｍｖ・ＳｕｒｇＧｙｎｅｃｏｌ（)l)ｓｔｅＬ
ｌ９８０Ｉｌ５０：９１８－９２７．

７）Ｓａｃｋｓｌ〕Ａ，Glotz(､Ｔｌ)Ｊ：Ｐ〔､r〔､utalle()ｕｓｌ･cestKlblishm(､､ｔｏ「『Ce(lillggaslr()st()ｍｉ(ns、SurgOryl971〕；８５：５７５－５７６．

８）（lauder()ｒＭＷＩ』，ｌ)onskJ・ＪＬ，ｌｚａｎｔＲＪ
Ｊｒ：（ｊａ筒tl･ｏｓｔｏｍｖｗｉｔｈｏｕＬｌａｐａｌ,()t()ｍｙ：Ａｌ)(､ｒｃｕｔａｌｗｏｕｓｏｎｄ()scopi(、ｔｅｃｈｎｉｑｕ(､、Ｊ１)ＯｄＳｕＴｇｌ９８０；１５：872-875.

9）Ｉ)reshawRM：ApercuLan〔x)ｕｓ、(Dth()〔１１.()1．ｉｎs〔】rLingal.e〔xlinggE1月tr()s↓()ｍｙＬｕｌ)(》・Ｓｕｒｇ（Ｈｙｎａｎ〔１（)bsLl981；１５２：（)59-6(;０．

１０）ＳａｃｋｓＢＡ、ＶｉｎｅｓｌｌＳ，Ｉ〕111(,s11.8ｍ［AAI，ｅｔａｌ：ＡＩＩ〔)、-()I)crativeLechlliqu〔、「()ｒ（､HLal)－ｌｉｓｈｍｃｎＬｏｆａｇａｓｔｒ()st()ｍｙｉｎＬｈ(､ｄｏｇ、Ｉｎ－
ｗｓＬＲａ(ＩｉｏｌｌＩ)８３；１８：485-487.

11）SLellat(）ＪＡ，Gau〔ler〔ｎｒＭＷＬ：Ｉ〕crcut跡
Ｍｏｕｓｏｎｄｏｓ〔､Cl〕icgrastI･()月L()ｍｙｉｎＬｈｃｃａＩＩ－

ｃＣｌ・paLicnt・ＴｈｅＡｍｃｒｉ(､aｌｌＳｕｒｇｌ９８８ｊ
５．１：、'１９－１２２．

１２）ｌ)()ｎｓｋｙＪＬ，Gau(ｌｏＴｃｒＭＷＬ、Stollllt(）ＪＡ：Ｉ〕０１℃ｕｔａＩ]ｏｏｕｓｅｎｄ(〕SCCI〕i〔9ｇａｓＬｒｏｓＩｏｍｖ、

ＡｒｃｈＳｕｌ,ｇｌ９８３ｌｌｌ８：９１３－９１４．

１３）ｌ《irbvl)Ｆ､（】ｒａｉｇＲＭ，THang'Tl(，ｏ此１１：

Pcrcutalle()ｕｓ（ｍ〔l()s〔P()l)icgastr〔)HtomioH：

Ａｐｒ()sl〕ｅｃｔｉｖｅｅｖａｌｕａＬｉｏｎａｎ(１１．eviewoI
Il1【>IiterLlLurC、ＪＰＩ９Ｎ１９８６；１０：155-15()．

ＷｉｇｌｅＪＲ、ｃｔａｌ：Radiologic、cndoscopic

Zlndsurgi〔ｌａｌｇａｓい･()sＬｏｍｖＩＡｎｉｎｓｔｉＬｕ－
70.1.

17）ＷｉｌｌＪＳ，OglesbyJT：ｌ〕ercuLancouHgas‐

Ｌｌ､Cs【()ｍｙ・Ｉｔａ(liol()ｇｙｌ９８３；１４９：449-453.
18）ＩｌｏＣＳ，ＧＩ･ａｙＲＲ，Ｇ()]dlingerM，ｃＬａｌ：
Per(DulaneousgastrosLomyfor（､ｎＬｃｒａｌ
ｌｅｅｄｉｎｇ、Ｒａl(li〔)ｌｏｇｙｌ９８５；１５６：３４９－３５Ｌ
ｌ９）（ｌｒａｙＲＲ，ＳｔＬｏＬ１ｉｓＥＬ，（】I･()ｓｍａｎｌｌ：
Per()uLane()ｕｓｇａ月LrosLomyan(lgasLroje‐
jun()sL()ｍｙ・BritJRadi()11987；６０：ｌ()67１０７０．

２()）VanS(〕H1ncl11)(ｗｇｌＩ]，WitIjch（}Ｒ，Cal)rCrOa（)Ｒ，〔ｌｔａｌ：ｌ〕〔u1℃ｕLane()usgastr()stomyandgastr()(1nter()s【()ｍｙ：２．ClinicalGxperience・
ＡＪＲｌ９８６８５８１-586.

21）（)，KeclToF，CarrascoCIL（)harnsangavej（､，（1Ｌｔ１１：Ｉ〕〔)rcuLaIl()(-)u月〔Ｉｒａｉｎａｇ(:ａｎ〔ｌ「ee(linggastrosL()miosinlOOpationts・Ｒａｄｉ(〕ｌｏｇｙｌ９８９；１７２：３４１－３．１３．
２２）IlicksMILSurrattRS，ＰｉｃｕｓＤ，ｅｔａｌ：
ト､Iuol･oscol)icallyguide〔IgasLr()ｓｔｏｍｙａｎｄｌｇａｓＬｒ()〔'nLer()ＢＬｏｍｙａｎａｌｙｓｉｓｏｆｌ５８〔`()nsec‐

uLivecases，ＡＪＲ１９９０；１５４：725-728.
23）ＫＯⅡ(､ｒＭＳ，ＬａｉＳ，Wagncl．ｌ)Ｋ：Ｐor(IuLaneousgastr()ｓｔｏｍｙｉｎａｃｈｉｌｄ，Ｒａ(li()ｌｏｇｙ
ｌ９８６；１６０：２６１－２６２．

２１）’1,ｏｗｂｉｎＲＢ，ＢａｌｌＷＳ血，ＢｉｓｓｅｔＧＡＩＩＩ：Ｉ〕ercullme()usgaHLrostomyandgastr()je‐junostomyiI1cllil〔11．ｅｎ：Antcgra(1cal)‐ｌ〕roach、Ｒａｄｉ()log)’１９８８；１６８：173-176.

25）（】arelL：Pedi&lLricgast1･osLomyandgastrojojunostomy、SeminlnlGrvRa(ｌｉｏｌｌ９９１；８：２１０－２１３．

２６）（)ｏｒＶｌ)Ａ，FitzgCraldJF，（】()ｌｌｅｎＭＤ：Ｉ〕Cl･cut1lne()ｕｓ、()､－０１〕。()scopicgaHLrosto-

mvin（､hildrcn・ＡＪＲｌ９８８：１５１：995-997.
27）Mal(ｌｅｎＩ２Ｓ・IIicksハｌｎＰｉｃｕｓＤ、ｅｔａｌ：
Ｆｌｕ()r()H()Cl)i(，ａⅡｙｇｕｉ〔１０．１〕orcumneou5gas-

tr()st()ｍｙｉｎｃｌｌｉｌ〔1r０，．ＪＶＩＲ１９９２；３：６７３
－６７７．

1７

１８１]本小児放射線学会Ⅲm誌

28）ＫｉｎＨＳＪ，Ｃｈａｉｔｌ〕(;，ｌ)ａｎｅｍ２ｌｎＡ，（ｎｌａｌ：
Ｒｅｔｒ()gradcpercuLal1e()ｕｓｇａｓｕ､ＯＳＩ()､ｗ：
Ａｐｌ､()月】)ectiv(1ｓｔｕ(ｌｙｉｎ５７ｃｈｉｌ(lrcn、ＩＤ(ｉｄｉ－ａＬｒＲａｄｉｏｌｌ９９３；２３：23-25.
29）Ｔ()ｗ})ｉｎＲＢ、ChK1i［Ｉ）：Ｉ〕ercuLanpousFee（lingTcclmi(luGs，ＳｅｍｉｎｌｎｔＰｍ'()、ｌ(&ldi()１
１９９１；８：21.1-216.

30）（Ｉｆ１１ａｔＳＡ，〔lcrigl(1)，ｌ)()１．te１．．１Ａ，（)ｔａｌ：
Ｍａｎａｇｅｍｅｎｔｏｆ１)ｒｃｍａｔｕｒｏｒ()、(ｗａｌｏｆ
Ｌｌｌｅｌ〕０１.cuLano()ｕＨｇａＨｕ･ｏｓｔｏｍｙ、ＡｎＩ１Ｓｕｒｇｒｌ９９０；５６：733-736.

31）ＳｈａｌｌｍａｎＲＷ，Ｎ()rfuctRG，IIar(lache
JM：Ｉ〕ercutane()u５（〕、。()scopicgastr()gto‐
ｍｙ「eedin冴［ｕｂｏｍｉｇｒａＬｉｏｎｉｎｔｈ(！ａl〕‐（l()ｍｉｎａｌｗａⅡ，（j8lsLroillLOstIIn(l()Ｈ１()８８；
３」：367-368.

32）（lau〔l〔ｌｒｅｒＭＷＬ，［)icha（111,1鉦ｌ１１ｔＲＪ血：Thegastrost()ｍｙ‘ｌｂｕｔｔｏｎ”：ＡＳｉｍｌＪｌｃ、
ｓｋｉｎｌ(，vol，、()ｎ－ｒｃｌｌｕｘｉｎｇｄ(wiccfol、Ｉ()ｎｇ－
ｔｅｌ･monteralrecdingH・Ｊ１】〔）diaLrSurgll)８４：
ｌ(〕：803-805.

Ｉ':、(l()scopicretr()ｇ】･ａ。(ｌｃｈｏｌａｎｇｉｏｌ〕ancreatography（ＥＲＣI)）inpatientswitl1jaun‐〔li(!(、ａｎｄｓｕ月l)(!〔】し(１．１)iliaryol)sい･ｕｃＬｉｏｎ．
Ａ(1'ｌ１ＡＣｌｌｉｒＳｂａｎｄｌ９８４；１５０：657-663.

-11）’１１Cl〕illRS，Vogelzt1ngRL､ＧｏｒｅｌｔＭ，ｅｔａｌ：Ａｃｏｍｌ)aralivestu〔ｌｙｏｆｃ()ｍｐｕＬｃｄＬ(〕－

ｍｏｇｌ･al〕ｈｙａｎｄｌｉＲＣＩ〕inpancrcalicobiliilrydiseaso．〔)Ｔ：ＴＩ１ｅＪｏｕｒｎａｌｏｆ（ｊｏｍ‐Ｉ)ｕ[〔)ｄｒＩ１ｏｍ()gral)l]ｙｌ９８７；１１：261-266．
`12）JalldcrIII〕，Gf111)raitl】Ｊ，Ａｌ(|r()t〔ｌＪＳ：
Ｉ〕or(,ｕＬａｎｅ()ｕｓｔｒ８ｌｎｓｈｅｌ】ａｔｉｃｃｈ()ｌａｎｇｉｏｇｒａ－Ｉ〕ｈｙｕｓｉｎｇＬｈｅＣｈｉｌ)aneedle：（】()ｍｌ)arison
withretrogl･ａｄｃｐａｎｃｌ･eatocholecystogra】)h)'、SoulllornMedicalJoul･nall980；
７３（１）：415-121.
43）JuUiju〔latal〕，Ｉ〕alavatanaC，Chi〔nmchaisri（１，ｅ此１１：Tlleaccuracyo「l)０１℃uL1Lneoustranshepaticch()langi()gral)bｙ（１）.Ｔ､Ｃ）
ＵｓｉｌｌｇＬｈ〔】（)ｈｉｂａｌ]eo〔１１(）ｉｎｔｈｃｄｉａｇｎｏｓｉｓ（)「ｌ(､ｖｃｌａｎ(ｌｃａｕｓｅｏｌ・cholestasis・Ａｕs‐

LralH1月ｉａｎＲｆ１(|i()l()gryl986；Vol・ＸＸＸ(1)．

33）（}aud(､1．ｅｒＭＬ，（)ＩＨｅｎＭＭ，Stcll81to'''八．Ｇｔ

Ｊ１）（)r()ｎａｎＪＪ：Ｔｈ(１ｉｍａｇｉｎｇｏ１．１)iliaIyob‐

ａｌ：FCC(Iingga5ll･()目ｔｏｍｖｂｕｔｔ()nｓ：Ｅｘｐｅ－

日Lru(､Lion・SeminarsinUltrasoun(１，ＣＴ，

ｒｉ('ｎ(Ｐｃａｎｄｒｏｃｏｍｍ〔hndations・Ｊ１〕(､ｄｉａｔｒ

ｌｌｎｄＭＲ１９８４：５(･Ｉ）：376-398.
J5），IuUijudataP，Ｉ〕alavatanaC，（､hiemchaisl･ｉＣ，ｅ血１１：ｌ〕()１℃utaneoust1.2lI1slloI〕aLic（!h()ＩａｎｇｉｏｇｒａｐｈｙｗｉｔｂｔｈｃＣｈｉｌ)anccdleinpaLi(ｌｎＬｓｗｉｔｌ１ｌ)iliarycalculi・Ｒａ(Ii()logy

Ｓｕｒｇｌ９８８：２３：2.1-28.
3`1）FoutcllI〕Ｇ，’I1allj〔QrL（{Ａ，Gaill()ｓＪＡ，ｅｔａｌ：’1111('gasい､()ｓｔｏｍｙｌ〕ｕ【Lｏｎ：ＡＩ)I･()H1)GcLivcassessm(ｌＩ１ｔ（)1.ｔｈｅｓ８１｢ety，Ｈｕ(､〔'ｃｓＨａｎｄｓｌ〕octrumofusc．（laHlrointestliI〕d()ＳＣＩ()８９：
３５：11--Ｍ．

35）Al-MdllkiT，Lang(’１．Ｊ()，Thoml)s()ｎＶ，ｅｔａｌ：ＡＩ)rosp(’０tive〔､Vａｌｕａｔｉｏｎ（)「Ｌｈｃｌ)ulton
gK1str()sLomyiI〕（l11il(lrCn・ＣＪＳｌＩ)９１；３`ｌ：
217-250.

36）Bll1iI･ＧＫ，Ｄｊ()nlicK，Ｆ１･aser（}()、(){＆１１：
ＴｈＯｂ()ｗｅｌｍａｎａｇＣｍｅｎｔｔｕｂｃ：Ａ、〔､ITectivcmoansfol、ｃ()ｎＩｒ〔)ｌＩｉｎｇｌ･ｏｃａｌｉｎｃ()nLi‐、〔)､cc・ＪＰｃｄｉａｔｒＳｕｒｇｌ９９２；２７：’2691272.

37）MaloncPS，Rallsl(､ｙ１，(’１，１(i〔､ｌｖｌＩＭ：Ｉ〕l･eliminaryl･cport：『I1heanLc1grad(、〔,()ｎ－ｔｉｎｏｎ〔1ｅｅｎｅｍａ・ＬＨｍｃｅｔｌ９９０；３３６：１２１７－
１２１８．

３８）ShLLn(llillgB，（】lllliLP(LRicllilr〔ｌＨＩＩＦ：Ｉ〕Ｃｌ･(､ｕｔａｎｃ()usceCo局Ｌｏｍ),：ＡｎｏＷｔＣ(ｌ１ｎｉｑ‐
11(ｈｉｌｌｔｌ１ｅｍｉｌｎａｇ(､ｍｏｎｌ（)1,1℃〔ｌａｌｉｎ(Ⅲ()I11i‐
I1cncC・ＪＰＯ(li【１t'､Ｓｕｒｇｌ９９６；３１：５(）1-537.
39）Ｃｈａｉｌｌ〕Ｃ、Shan(llingB､Ｒｉ〔oh8w(ｌｓｌＬＣｌａｌ：Ｉ〕(､1℃utKln(〕ol1scecosLomy：Ａｌ)I･Cs‐
Ｉ〕OcLiwstu(ＩＶＯ「tllclrcatmelut〔)ｆｆｅｃａｌｉｎ(PontinGnccillcllil〔１１.〔'１１：ＲＸｉ(|i()１１１)()７；２()３：６２１－６２１．

１０）Ｋｕｌｌｍａｎｌｉ，Ｂ(》I･〔､１１Ｋ，TarI〕ilKllD，（】［ａｌ：1８l983：１－１６：6.13-615.

.16）JohnsonLJ，Ｍａｕ１･ＯＭＡ，Ｊａ(ｌｕｅｓＰＦ：
１t【ｌｄｉ()logiclml(､〔)ｍｅｎｔ（)「IIi(1ｋｍａｎ（､atｈ(1tors，Ｒａｄｉｏｌｌ９８０；１７０：１()07-1[)09.

.17）ｌｌｕｌルIIB，IIuntcl．（)S，ＬｕｉｋｅｎＧＡ：Ｔｈｃ（】r()H11()ｎｇ〔!&lLh(LL(!ｒ：Ｉｎｉｔｉａｌ（､ｘＩ〕oriencc
l1I1(ＩＯａｒｌｖｌ･(】sultH（)「ｉｎｌａｇｅ－ｇｌｌｉｄｅｄｌ)ｌａｃｅ－ｍｅｎＬ・Ｒａｄｉ()ｌｌ９ｌ)２；８５：803-807.

18）}､Ｏｒｎａｎｄｏ（)，Ｊｕｌ･上lrskyL，Ｙ(!(ｌｌｉｃｋａＪ，ｅｔ
ａｌ：ＳｕｂｃｌａｖｉａｎｃｏｎＬｒａｌｖｏｎｏｕｓｃ&ltheter

insel･Ｌｉｏｎ：Ａｎｇｉ()interventionalL〔)〔､ｈｎｉ〔lue．
Ｓ(､ｍｉｎｉｎｌｎＬｃｒｖ(､ｎＬＲａ(ｌｉｏｌｌＩ)９１；８：７８－81.

49）（､()ckl)ｕｒｎＪＦ，Eynon（１Ａ，ＶｉｒｊｉＮ，(､ｔａｌ：
Inscrtion（)ｆｌｌｉｃｋｍａｎｃｅｎｔｒａｌｖｅｎｏｕｓ（1aL1M1LerslJyuHilI宵ａｎｇｉｏｇｒａｌ]ｈｊｃｔｅｃｈ－ｎｉｑｕ(､ｓｉｎｐａｌｉｅｎＬｓｗｉＬｈｈｅｍａＬ()Ｉｏｇｉｃｄｉｓ‐（)1．(l(11.H・ＡＪＲ１()９２；１５９：１２１－１２`1.
50）（l()utail-Flaudハ1Ｆ，ＳｒｅｚＭ，Ｂ〔ＰｒｇＡ，ｅｔａｌ：（Ｙｅｎｔｒａｌｖｅｎ()uscaLheter-r('1ａｔ()ｄｃｏｍ‐Ｉ)licaLionsilln(9ＷｂＣｌ･ｎｓａｎｄｉｎｆａｎＬｓ：Ａ
587-Ｃａｓｃｓｕｌ､1,ｅＶ・ＪＰＣ(IiatrSurgl991；
２６：６４５－６５()．

51）ＫａｕｆｍａｎＪＡ，（】r(nenficldAJ，FiLzl)K1trick
GF：’I1ranBh(〕ｐｆｌｔｉｃｃａｎｎｕｌａｔｉ()、（)ｆｔｈ(Ⅲｉｎ‐ＶｏＬｌ５Ｎｏ’1，１９９９１９「eｒｉｏｒｖｃｎａ（､ａｖｌｌ，ＪＶｌＲ１９Ｉ〕ｌ；２：３３１－(恥1.

52）BergeyE，San(､Ｓ，Ｋａｙｅ，ｅｔａｌ：Ｉ〕cdiatric
LransvenoLlsliwrl)iopsy，ＪＶｌＲＩ()９８；９：829-832.

53）ＷａｌｋｃｒＷＡ、KrivitW，Sharl）IIL：Necdlo
biopsyofth(ⅡlivoI・ｉｎｉｎｌ､ａｎ〔Ｗｖ＆ｌｎｄｃｌｌｉｌ〔]－
ｈ()o〔１．１〕cdiat１．１９６７；．10：9.16-95()．

51）WeinerM，llana｢ｅｅＷＮ：ＡＩ･〔nvi〔,ｗｏｒ
い･anRjugularch()langiogI･al〕hy、Radi()ｌ（)ｌｉｎＮ()I･【ｈＡｍｌ９７０；８：53-68.

55）Lobrecl)，（l()l(11.ａｒｂＧ，Ｉ〕cg()し［（１，（ｎｌａｌ：
rI1ransv(ｎｎ()usIiv(Ａｒｂｉｏｐｓｙ：八、（'ｘｌｊ(､ri(ｍｃｅｂａｓｅｄ（)、ｌ()()０１１０１〕atic（issu(）ｓａｍｐｌｉｎｇ
ｗｉｌｈｔｈｉｓｌ)r()ccdure・Gastl･()(､ｎt〔`r()logy
l982；８２：338-3ｌ０．

５６）Ｌｉ[ＬｌｅＡＦ，Zajk〔)ＡＢ，Ｏｒｏｎｓｌ)I）：’l1rans‐
jugularliv〔ｌｒｌ)i()psy：Ａｐｒ()Hpoctjvcstudv
ilル１３１)ati〔nl1Iswillll,ｈｅｑｕｉｃｋ－ｃ()｢(１１)ICI〕synee(]肥ＪＶｌｌｓ(、Intel･ｖＲａ(]i()’１９９６；７：127-131.

57）ＦｕｒｕｖａＫＮ，BllｒｒｏｗｓＰＥ，Phillil〕ｓＭＪ，ｏｔ
ａｌ：Tran局jugularliverl)iopsyinchil‐ｄｒｅｎ・IIel)aLo]()ｑＪ１９９２；１５：１()36-10`12.
58）ＭｃＡｆｆｏｅＪＩｌ，Ｉ(cclTeEB．Ｌ(M’１ｔ(】，ｃＬａｌ：
Transjugultlrliverbiopsy、IIcl〕at()ｌｏｇｙ
ｌ９９２；１５：726-732.

59）ＪａｆｆｃｌｌＬ：（)Hto()idosLe()ｍＩｌ：Ａ１)olliglloBte()l)ｌａｓＩｉｃＬｕｍｏｒｃｏｍｐ()so(’（)「（)HLC()i(ｌａｎ(’＆ｌｔｙＩ)i(1ａｌｂ()、(》・ＡｒｃｈＳｕｒｇｌ９３５；３１：
709-728.

60）Ｉ(ａｗ〔､l)ＩｕｎｌＮＬＬｃｈｍａｎＷＩｆＢａｓｈＪ，ｅＬ
ａｌ：GranLAI)．（､linOrth()】〕ａｎ〔lRclatc〔lResca1℃ｈｌｌ〕Ｏ３ｉ２９６：218-22.1.
61）ＤｏｙｌｅＴ，ＫｉｎｇＫ：Ｉ〕ercutan(､()u5removal（)fostcoi(loHto()ｍａｕｓｉｌｌｇＣＴ〔〕()ntrol、
ＣｌｉｎＲａ(ｌｉｏｌｌｌ)８９；１０：５１４－５１７．

62）Ｖ()t(）ＳＪ，（)()()ｋＡＪ，Weill(Ｕｒｌ)Ｓ，Ｕｔａｌ：’I1reatm〔'ｎＬ（)「ＯＢ[ｃｏｉｄｏｓｔｅｏｍａ１ｗｃｏｍｐｕＬ－
ｅｄｔｏｍｏｇｒＬ１１)ｈｙｂｙｇｕｉｄｅｄｃｘｃｉｓｉｏｎｉｎｔｈｅｐｃ(liaLricl〕alienL、ＪＰｅｄｉａＬｒ（)rthol〕１９９０；
１０：５１０－５１３．

６３）'１１()ｗｌ)ｉｎＲ，Ｉ(ｆｗｅＲ，Mez2lMI》，Ｏｔａ］：
OsLGoi〔Ｉｏ５Ｉ〔､()ｍａ：PcrcuLaneouHIDxcisi()ｎｕｓｉｎｇａＣ'Ｉ１－ｇｕｉｄｅｄｃｏａｘｉａｌｔ〔1ｃｈｎｉｑｕｅ・ＡＪＲ１９９５；ｌ(Ｍ：945-949.

6.1）Ｒ(〕sonLhllll)，lIornicekF，Ｗ()I｢(》Ｍ，ｅｔａｌ：Ｉ〕('1．〔､utall(､()ｕｓｒａ〔liofrc(ｌｕｅｎｃｙｃｏａｇｕ－
ｌａｌｉ()、（)「（)stc〔)i〔ｌｏｓｔｅｏｍａ（!()ｍｌ〕ａｒｅｄｗｉＬｈ〔)peraljvo（ｒｅａＬｍｅｎＬＪＢｏｎ(’&'11(ｌＪｏｉｎｔ
Ｓｕｒｇｌ９９８；80-Ａ（６）：815-821.
65）Montg()ｍｃｒｖＷＷ：Silic()neLrachealTLube．Ａ、、（)t()lRhinolLaryng()１１９７４；８３：
７１－７５．

６６）Ｉ)ｕｍ()ｎＪＦ：Ａ（IcdicaL(}(１ｔl･a(Bl1e()ｂｒ()ｎ－ｃｈｉａｌｓＬ(､、し（ｌｈＯｓＬＩ９９０；９７：328-332.

67）Wallac()ＭＪ，（､harnsangavojC，ＯｇａｗａＫ，ｏｔａｌ：Tra〔Ｐｈ(Ｄｏｂｒｏｎｃｈｉａｌｌｒ(x､：Ｅｘｐａｎｄ－ａｌ)ｌｅｍｅｔａｌｌｉｃｓｔｃｎｔｓｕｓｅｄｉｎｏｘｐｏｒｉｍｅｎｔａｌ【１，(lclillical【lpl〕licaLion・Ｒａ(liologyl986；
１５８：３０９－３１２．

６８）ＦｉｌｌｅｒＲＭ，ＦｏｒＬｅＶ，Cllaill〕ITracheo‐
１〕r()ｎ〔､ｌｌｉｌｌｌｓＬｅｌｌｔｉｎｇｆｏｒｌｈｅｈ･eａｌｍｅｎＬｏｆ
ａｉｒｗａｖ（)1)息t１．ｕ(ltion・Ｊ１〕ｅｄｉａＬｒＳｕｒｇｌ９９８；
３３：３０１－３１Ｌ

69）NashefSAM，Ｄｌ･ｏｍｅｒＣ，Ｖ(ullyJ，ｅＬａｌ：
ＩＤｘ]〕ａｎ(IingwiI･(’ｓｔｅｎｔｓｉｎｂ(InignLracho()‐｝)r()ｎｃｈｉａｌ（liscase：ＩｎｄｉｃａＬｉｏｎｓａｎｄｃｏｍ‐

pliCali()ns．Ａ】】ｎＴｈｏｒａｃＳｕｒｇｌ９９２；５１：
937-9.10.

70）Mavna１．Ｍ，ＬｏｐｅｚＬ，Ｇ()１．１．ｉｚｌ八ｅＬａｌ：
Ｍａｓｓｉｖｃｌ)rllchiocephalical･toryl)lOeding（1ｕ〔’Ｌ(）（ｌｉａｌ〕Ｌｕ1℃(）Lraclloal＆ｔｏｎＬＪＶＩｌＲ
ｌ９９３；．ｌ：281)－２９１．

/,