General Session) 公募 WS3 口腔領域の難治性疼痛 公募 WS4 口腔外科領域における内視鏡

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General Session) 公募 WS3 口腔領域の難治性疼痛 公募 WS4 口腔外科領域における内視鏡 English session abstract of the 62nd Congress of the Japanese Society of Oral and Maxillofacial Surgeons (General Session) 公募 WS3 口腔領域の難治性疼痛 公募 WS4 口腔外科領域における内視鏡 OWS3-5)難治性口腔顔面痛における心理的アプローチ OWS4-1)口腔外科領域における内視鏡手術—低侵襲手術 野澤歯科 ¹・都立大塚病院口腔科 ² を目指して— , ○野沢健司 ¹ ²・重政理香 ²・八木澤潤子 ²・市川秀樹 ²・伊藤亜希 ²・ 横浜市立大学大学院医学研究科顎顔面口腔機能制御学 田中潤一 ² ○岩井俊憲・小栗千里・光藤健司・藤内 祝 Psychotherapy of intractable orofacial pain Eendoscopic surgery in oral region: minimally invaisve surgery Nozawa Dental Clinic¹,Dept. of Stomatology, Tokyo Metropolitan Ohtsuka Hospital² Dept. of OMS, Yokohama City Univ. Graduate School of Medicine, Yokohama, Japan , ○ NOZAWA Kenji¹ ²,SHIGEMASA Rika²,YAGISAWA Junko²,ICHIKAWA ○ IWAI Toshinori,OGURI Senri,MITSUDO Kenji,TOHNAI Iwai Hideki²,ITO Aki²,TANAKA Jun-ichi² 近年の外科手術は低侵襲化に向かっており,内視鏡の導入は患者 QOL 【目的】難治性口腔顔面痛をはじめとする慢性痛では,Engle により生物 の向上に寄与しているが,口腔外科領域における内視鏡の導入はこれま - 心理 - 社会モデルという概念が提唱され,その治療にはアロンベックな で顎関節鏡視下手術に限定されてきた.しかし,内視鏡を用いることで どが提唱した適切でない痛み行動や,健康状態の考え方を是正する認知 手術が無切開や小さな傷で行えるので外来局所麻酔手術や短期入院全身 行動療法(CBT)が行われてきた.我々も 10 年ほど前から本療法に追 麻酔手術が可能となり,さらに,皮膚の瘢痕が小さい,顔面神経などの 随しているが,時に問題点と感じることもある.そこで今回,過去 10 年 麻痺が生じないといった手術の低侵襲化が実現でき,患者の QOL は著 間に我々が経験した問題点を考察するとともに,CBT と併用しておこ しく向上する.横浜市立大学附属病院歯科・口腔外科・矯正歯科は顎関 なっているマインドフルネス瞑想にも触れたいと思う. 節鏡視下手術以外の口腔顎顔面外科手術に本邦でいち早く内視鏡を導入 【対象】平成 18 年 4 月から平成 29 年 2 月まで,本院や都立大塚病院口腔 し,内視鏡下唾石摘出術,内視鏡支援下顎下腺摘出術(口内法や皮膚小 科を受診した通常の歯科治療で痛みが取れない 300 名の慢性痛患者であ 切開法),内視鏡下歯根端切除術,内視鏡支援下下顎骨関節突起骨折整 る.これら患者に対して CBT を用いた. 復固定術,内視鏡支援下軟組織囊胞摘出術などを行ってきた.本ワーク 【結果】慢性痛患者は,口腔顔面痛以外の身体症状や痛み行動を呈するこ ショップではこれまでの経験を踏まえ,口腔外科領域における内視鏡手 とが多く,破局化思想を呈していた.自己の健康状態の考え方を是正す 術の適応や工夫,さらに使用する内視鏡や器具などに関しても講演する. る認知療法では,7 割強の患者には有効であるが,自分の感情の気付き に乏しい方(35 名)には,応用が難しく,認知療法後,考え方が是正で きうまくいったと思われた方のなかにも,効果が一時的であった人がい たこと(30 名)などが問題点であった.常に解決法を提案することで依 存的な関係になる(15 名)ことがあった.行動療法(オペラント療法や 行動活性化療法)を用い,痛み行動が改善したケースでは,痛みも軽減 した.さらにマインドフルネス瞑想(気づき)を併用することで痛みに とらわれることが少なくなるばかりでなく,緊張緩和,感情のコントロー ルにも有効であった. 【結論】今まで治療が困難であった慢性痛患者に対して認知療法や行動療 法さらにマインドフルネス瞑想を組み合わせることでほとんどの慢性痛 患者の管理が可能となった. OWS4-2)セミリジッドなプレート固定を用いた下顎枝垂 OWS4-3)当科での口腔外科領域における硬性内視鏡支援 直骨切り術による下顎前方移動の有用性 下手術の現状 高知医療センター歯科口腔外科 大阪急性期・総合医療センター口腔外科 ○原 慎吾・三次正春・須藤皓士・綾京太郎・立石善久・立本行宏 ○金山宏幸・石原 修・山田龍平・大竹一平・矢田光絵・泉山大介・ Variation of plate fixation for mandibular advancement with intraoral 桐生 萌・井口三津紀・中野晋太郎・谷口弘樹 vertical ramus osteotomy using endoscopically assisted intraoral semi-rigid The clinical benefits of endoscope-assisted oral surgery internal fixation OMS, Osaka General Medical Center, Osaka, Japan Dept. of OMS, Kochi Health Sciences Center, Kochi-city, Japan ○ KANAYAMA Hiroyuki,ISHIHARA Osamu,YAMADA Ryuhei,OTAKE Ippei, ○ HARA Shingo,MITSUGI Masaharu,SUDO Koji,AYA Kyotaro,TATEISHI YADA Mitsue,IZUMIYAMA Daisuke,KIRIU Megumi,IGUCHI Mitsuki,NAKANO Yoshihisa,TATEMOTO Yukihiro Shintaro,TANIGUCHI Hiroki Objectives: The purpose of the present study was to evaluate the 【緒言】当科では口腔外科領域の手術において積極的に内視鏡を活用して safety and efficacy associated with mandibular advancement by いる.今回,内視鏡使用の現状について報告するとともに,口腔外科領 intraoral vertical ramus osteotomy(IVRO)with endoscopically 域における内視鏡支援下手術の有用性について考察する .【対象と方法】 assisted intraoral rigid or semi-rigid internal fixation. Methods: The 対象は昨年度,当科にて全身麻酔下に硬性内視鏡支援下手術を施行した study sample included all patients who had undergone an mandibular 症例とし,術式や予後等について検討した.【結果】当科では硬性内視鏡 advancement by IVRO procedure with endoscopically assisted intraoral を使用しており,先端の角度は症例に応じて使い分けている.適応術式 plate fixation from September 2008 to May 2012. A mandibular は主に深部の腫瘍・囊胞摘出術,歯根端切除術,顎変形症における骨切 advancement by IVRO with endoscopically assisted intraoral rigid 術,顔面骨折観血的整復術,顎関節受動術であった.歯根端切除術では or semi-rigid internal fixation was used for mandibular advancement. 顕微鏡で観察が困難な部位は硬性内視鏡を使用し良好な術野を確保でき The patients were analyzed prospectively, with more than 2 years た.また,顎変形症では下顎後縁部や上顎後方部も明視下に手術操作が of follow-up, and were evaluated in terms of functional results, 可能であり,顔面骨折においては特に blowout fracture を伴う症例にお postoperative complications,and skeletal stability. Findings: A total of いて血腫除去や整復の段階で眼窩深部の十分な観察や確実な手術操作が 14 patients(bilateral, 7 patients with class II; unilateral, 7 patients with 可能であった.【結論】内視鏡使用により盲目下での手術ステップを失く asymmetry)were included in the present study. The average degree すことで術者のみならず介助者や指導者も的確な介助や指示が可能とな of mandibular advancement was 5.5 ± 1.9 mm(range, 3-9 mm). り,安全性および確実性の向上につながる.また,動画として録画する Both the occlusal relationship and facial appearance in all patients ことで術者の良質なフィードバックが可能となり,手技の向上や若手医 were significantly improved by the surgical-orthodontic treatment, 師育成に寄与するところも大きいと考えられた . with no major harmful clinical symptoms. In addition, one-screw semi- rigid fixation could control postoperative passive condylar seating. Conclusion: This study showed that mandibular advancement by IVRO with endoscopically assisted, intraoral semi-rigid internal fixation offers a promising treatment alternative for patients with skeletal class II malocclusion or facial asymmetry. 187 62口腔外科_一般演題_0914.indd 187 2017/09/14 22:00:32 臨床 1 臨床 2 NO2-3)薬剤関連顎骨壊死の治療法に関する多施設共同 NO2-4)唾液中代謝物による口腔がんスクリーニングに 研究:傾向スコアマッチング法による解析 関する研究 長崎大学大学院医歯薬学総合研究科口腔腫瘍治療学分野 ¹・日本医科歯 山形大学医学部歯科・口腔形成外科学講座 科連携医療研究グループ(JCDM)² ○石川恵生・北畠健一朗・菅野絢子・山森 郁・遊佐和之・飯野光喜 ○林田 咲 ¹,²・梅田正博 ¹,² Identification of salivarymetabolomic biomarkers for oral cancer screening A multicenter retrospective study for treatment strategy of medication- Dept. of Dentistry, oral and Maxillofacial-plastic Surgery, Faculty of Medicine, Yamagata related osteonecrosis of the jaws(MRONJ):propensity score matching Univ., Yamagata, Japan analysis ○ ISHIKAWA Shigeo,KITABATAKE Kenichiro,SUGANO Ayako,YAMAMORI Iku,YUSA Kazuyuki,IINO Mitsuyoshi Dept. of Clinical Oral Oncology, Nagasaki Univ. Graduate School of Biomedical Sciences¹, Japan Cooperative Dentistry with Medicine Group² ○ HAYASHIDA Saki¹,²,UMEDA Masahiro¹,² 唾液は,非侵襲的かつ簡便に採取できる生体材料である.そのため近年 唾液試料を用いて,疾患のスクリーニングに応用する研究報告が増えて 【緒言】薬剤関連顎骨壊死(MRONJ)の治療法は確立していない.治療 いる.本研究において,我々は唾液中の代謝物を測定し,口腔がんのス についてランダム化比較試験を行うことは適切ではないため,観察研究 クリーニングに応用できる可能性について検討を行った.また唾液中の によりエビデンスを出すことが必要である.今回われわれは多数例の後 代謝物だけでなく切除したがん組織と安全域として切除した健常組織の ろ向き調査を行い,治療法について検討した.【対象と方法】8 施設で治 代謝物も測定することで,唾液中代謝物と組織中代謝物との関連性も調 療を行った MRONJ 患者 378 例について,18 項目の因子について後ろ向 査した.対象は,口腔がん患者 24 名と健常者 44 名である.対象者から きに調査を行い,治療経過との関連性について検討した.さらに保存 / それぞれ安静時唾液を採取し,また口腔がん患者からは,切除した腫瘍 外科療法の優劣,および休薬の有効性については傾向スコアマッチング 組織と,腫瘍の中心から最も離れた健常組織の一部を採取し,キャピラ 法による解析を行った.【結果】1)保存療法が 213 例,外科療法が 165 リー電気泳動・質量分析法(CE-MS)による代謝物の網羅的測定を行った. 例に行われていた.2)保存療法の治癒率は骨粗鬆症:54%,悪性腫瘍: 健常者と口腔がん患者を比較したところ,45 種類の唾液中代謝物が統計 7%,外科療法では骨粗鬆症:93%,悪性腫瘍:56% であり,外科療法の 学的な有意差を認め,また健常組織と腫瘍部分においては 85 種類の代謝 治療成績が優れていた.3)治療成績に関連する因子は,全 378 例の多変 物に統計学的な有意差をみとめた.上記のうち組織と唾液で共通の代謝 量解析で疾患(骨粗鬆症 / 悪性腫瘍),アルブミン値,治療法(保存 / 外 物は 17 種類であり,17 種類のうち相関の高いものから代謝物 2 つを選 科)の 3 因子であった.5)保存 / 外科で傾向スコアマッチングを行うと 択 し(Pipecolate,S-adenosylmethionine(SAM)),Receiver operating 222 例がマッチし,外科療法の治癒率が有意に高かった.6)外科療法群 characteristic curves(ROC曲線)を作成し,Area under the curve(AUC) 165 例では腐骨除去よりも周囲骨も含めた切除のほうが治癒率は有意に を算出したところ 0.827 と比較的高値を示した. 唾液という非侵襲性, 高かった.7)休薬の有無でマッチングを行うと 178 例がマッチし,休薬 簡便性に優れた生体材料を用いて口腔がんを高精度にスクリーニングで の有無は治癒率に影響しなかった.【結論】治療としては周囲骨も含めた きる可能性が示唆された. 骨切除が推奨される.治療的休薬をしても治療率の向上はみられず行う べきではない. NO2-5)邦人口腔扁平上皮癌に対する大規模遺伝子変異 NO3-1)次世代シーケンサーによる血中循環腫瘍細胞 解析 (CTCs)の遺伝子変異プロファイリング 東海大学医学部外科学系口腔外科学 ¹・東海大学医学部基礎医学系分子 国立がん研究センター研究所早期診断バイオマーカー開発部門 ¹・東京 生命科学 ² 歯科大学口腔顎顔面外科学講座 ²・国立研究開発法人日本医療研究開発 ○青山謙一 ¹,²・太田嘉英 ¹・内堀雅博 ¹,²・梶原景正 ²・木村 穣 ² 機構 CREST³ Mutational landscape of Japanese oral squamous cell carcinoma ○鬼谷 薫 ¹,²・柴原孝彦 ²・本田一文 ¹,³ Dept. of OMS, Tokai Univ. School of Medicine, Kanagawa, Japan¹,Dept. of Molecular Life Next-generation sequencing of circulating tumor cells isolated from Science, Tokai Univ. School of Medicine, Kanagawa, Japan² , , peripheral blood of patients with head and neck and gastrointestinal cancer ○ AOYAM Ken-ichi¹ ²,OTA Yosihide¹,UCHIBORI Masahiro¹ ²,KAJIWARA Division of Early Detection for Cancer, National Cancer Center Research Institute, Kagemasa²,KIMURA Minoru² Tokyo, Japan¹,Dept. of OMS, Tokyo Dental College, Tokyo, Japan²,Japan Agency for Medical Research and Development(AMED)CREST, Tokyo, Japan³ 【緒言】近年,諸外国において口腔扁平上皮癌(OSCC)を含めた頭頸部 ○ ONIDANI Kaoru¹,²,SHIBAHARA Takahiko²,HONDA Kazufumi¹,³ 扁平上皮癌(HNSCC)の臨床標本に対する大規模遺伝子解析が報告さ れているが(Science 2011 他),本邦ではなされていない.本研究は邦 Introduction: Recently, precision medicine has gained attention for the prediction of 人 OSCC の遺伝学的特徴を明らかにすることを目的とした.【対象と方 therapeutic strategies in individual patients. Because the biological behavior of 法】一次治療として手術療法を行った 2011 年 5 月から 2012 年 11 月の tumor cells has changed over time according to the pressures from treatment, real-time monitoring of tumor biology is needed to provide suitable information OSCC 新鮮例 74 例とし,切除標本より腫瘍内部およびコントロールとし for choosing the most effective therapy for each patient. Circulating tumor て周囲正常粘膜を採取した.HNSCC のドライバー変異として同定され cells(CTCs)can reflect current tumor status from primary sites and ている遺伝子(Nature 2015)に加え,米国人およびアジア人の HNSCC metastases from the bloodstream without invasive testing. In the current CTCs capture platforms of flow cytometry, gradient centrifugation, filtration, に対する大規模遺伝子解析で高頻度に変異が報告されているものとし and droplets have been employed. A novel label-free inertial microfluidics た.遺伝子数は 76 とし,502,696 塩基とした(各遺伝子のコード領域 approach(MFA)based on biomechanical properties has been developed at National Singapore University(Hou et al, Sci Rep 2013),and is able のカバー率は 99.99%以上).平均カバレッジは腫瘍部で×200,正常部 to capture CTCs independent of EpCAM expression. To identify genomic で× 100 とした.【結果】TP53(33.8%),CDKN2A(19.5%),CASP8 alterations in CTCs as basic data for precision medicine, we investigated the (6.5%),FAT1(10.4%),PTEN(5.2%),SYNE2(5.2%)など,諸外 genomic profiling of CTCs using next-generation sequencing(NGS). Methods: 国の HNSCC で高頻度に変異が報告されている遺伝子については,同様
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