気管支鏡検査（LTBS）研究班の報告（2020.8.30更新 計29）
2021年8月1日より犬・猫の呼吸器臨床研究会 VeRMS Study Groupのホームページは独立いたしました。本ページは、2021年7月31日までの情報となります。それ以降の情報は、www.verms.or.jp で更新しております。
犬・猫の呼吸器臨床における気管支鏡検査の適応と症例、診断基準に検する文献レビュー
テーマは、「ラリンゲルマスクを介した喉頭および気管気管支鏡検査800例-Procedure(手順)、Safety（安全性）、Utility（有用性）」、「BALF細胞診300例からの診断基準の再考」、「Interventional bronchoscopyの症例報告（気管/気管支内ステント留置、異物回収、高周波治療など）、各手技の臨床的有用性と合併症」
動物でのラリンゲルマスクの適用
Sakai DM, Martin-Flores M, Jones AK, et al. Laryngeal mask airway and transient hypercapnic hyperpnea for video-endoscopic assessment of unilateral laryngeal paralysis in dogs. Vet Surg 2018;47:543-548.
ラリンゲルマスクおよび一時的な高炭酸ガスによる過呼吸下での片側喉頭麻痺の犬におけるビデオ内視鏡評価
OBJECTIVE: To evaluate the ability to assess laryngeal function and to diagnose unilateral laryngeal paralysis (uLP) via airway endoscopy and carbon dioxide (CO2 ) stimulation.
STUDY DESIGN: Experimental study.
ANIMALS: Six healthy, adult beagles.
METHODS: Dogs were anesthetized with sevoflurane and dexmedetomidine. Laryngeal activity was observed via endoscopy placed through a laryngeal mask airway (LMA). The absolute and normalized glottic gap areas (AGGA and NGGA, respectively) and the glottic length (GL) were measured at inspiration and before and after surgically induced uLP. Measurements were obtained at eupnea and during hypercapnic hyperpnea produced by the administration of CO2 . Values for each hemilarynx were also measured. Video recordings were observed by 2 surgeons who scored function as normal or uLP.
RESULTS: The AGGA and NGGA increased similarly during CO2 administration in intact dogs and in dogs with uLP; the GL increased in dogs with uLP but not in intact dogs. The AGGA and NGGA of the intact hemilarynx increased more than those of the affected hemilarynx in dogs with uLP. uLP was correctly identified more frequently by observers at hypercapnic hyperpnea than during eupnea.
CONCLUSION: The increase in AGGA and NGGA at peak inspiration during CO2 administration was not limited by uLP, but asymmetry in hemilarynx AGGA and NGGA was observed in dogs with uLP. CO2 administration facilitated the identification of uLP.
CLINICAL SIGNIFICANCE: Laryngeal endoscopy through an LMA coupled with administration of CO2 in anesthetized dogs facilitates the observation of arytenoid function and may improve the diagnosis of naturally occurring mild laryngeal paralysis.
コメント：ラリンゲルマスクにおける片側喉頭麻痺の判断には正常犬との比較には高炭酸ガス（ETCO2の上昇）による過呼吸での気管支鏡での観察が判断しやすいと考えられる（とも動物病院 櫻井智敬-2018.11.30）。
Yang TM, Wei QZ, Lu WZ, et al. Three-Way Laryngeal Mask Reduces Anesthesia-Related Stress Responses in Bronchoalveolar Lavage: An Experimental Canine Study. J Coll Physicians Surg Pak 2016;26:250-254.
気管支洗浄におけるThree-Way Laryngeal Maskが麻酔に関連するストレス反応を軽減する：実験犬での研究
OBJECTIVE: To compare the ventilatory effects of the three-way laryngeal mask airway (TLMA) and tracheal tube (TT) on hemodynamics, respiratory function, and stress responses in a canine model during bronchoalveolar lavage (BAL).
STUDY DESIGN: Experimental study.
PLACE AND DURATION OF STUDY: The 303rd Hospital of the Chinese People's Liberation Army in May 2013.
METHODOLOGY: Sixteen dogs were divided into two groups. MAP, SpO2 and HR were recorded before anesthesia (T0), immediately before intubation (T1), during intubation (T2), at 3 (T3) and 10 (T4) minutes after mechanical ventilation, at 10 (T5), 20 (T6), and 30 (T7) minutes during the course of BAL, during extubation (T8), and 3 minutes after extubation (T9). Tidal volume, peak inspiratory airway pressure, and expiratory CO2 pressure were recorded at time points T2, T5, T6, T7, and T8. Stress responses variables, including epinephrine and norepinephrine levels, were examined at time points T0, T2, T3, T5, T8, and T9.
RESULTS: BAL was successfully completed in all animals. In comparison to the TT, the TLMA was capable of maintaining hemodynamic stability and ventilation (p < 0.05), and producing less stress responses (p < 0.05).
CONCLUSION: In a canine model, ventilation with the TLMA was better than the TT during BAL in terms of maintaining effective ventilation and stable hemodynamics, and producing less stress responses.
コメント：TTよりもTLMAによる換気の方がBALの間は良好である。BALに関しては気管挿管ではなくラリンゲルマスクでの麻酔管理が覚醒後に関しても全身状態を良好に保つ可能性がある（とも動物病院 櫻井智敬-2018.11.30）。
Wiederstein I, Moens YP. Guidelines and criteria for the placement of laryngeal mask airways in dogs. Vet Anaesth Analg 2008;35:374-382.
イヌでのラリンゲルマスクの配置におけるガイドラインおよび基準
OBJECTIVE: To evaluate the criteria for the insertion and correct placement of the laryngeal mask airway (LMA) in dogs.
STUDY DESIGN：Prospective descriptive clinical study.
ANIMALS: Thirty healthy dogs (ASA I or II) of different breeds, age 0.33-7.0 years (2.8 +/- 2.1; mean +/- SD), weight 2.2-59.0 kg (23.9 +/- 14.4), anaesthetized for elective surgery.
MATERIALS AND METHODS: The dogs were sedated with intravenous (IV) medetomidine (10 microg kg(-1)) and butorphanol (0.2 mg kg(-1)). If considered necessary, IV propofol (1 mg kg(-1) over 30 seconds) was administered until the LMA was inserted and positioned correctly. The position of the LMA was evaluated using predefined criteria for its insertion and inflation of the cuff, together with the ability to ventilate the dogs through the LMA.
RESULTS: The criteria for insertion, inflation and ventilation which indicated a clinically optimal position of the LMA and its seal around the larynx were met in 19 dogs (63.3%). The dogs could be manually ventilated with inspiratory peak pressures of 10 cm H(2)O without capnographic or audible evidence of leakage. In 11 dogs (36.7%), the LMA was positioned suboptimally with leakage during manual ventilation with inspiratory peak pressures not exceeding 10 cmH(2)O. There was no evidence of breed-related differences in LMA placement and position.
CONCLUSIONS AND CLINICAL RELEVANCE: The technique for the insertion of the LMA using predefined criteria to evaluate a correct positioning and a seal led to a successful placement in dogs of both brachycephalic and nonbrachycephalic breeds. The LMA, in most of the dogs, was easily placed, well tolerated and offered a useful less invasive means of securing the upper airway.
コメント1：ラリンゲルマスクの正確な位置決めおよび密着度を評価するために所定の基準を用いた技術は、短頭種および非短頭種でラリンゲルマスクの配置に成功した（ほさか動物病院 菅沼鉄平-2018.12.20）。
コメント2：著者は左側横臥位による喉頭鏡を用いたラリンゲルマスク挿入で正確な挿入ができている。アメリカでのデータのため対象犬が大型犬のため日本の対象の犬となるのは小型犬のため同様の挿入ができるかは症例が必要（とも動物病院 櫻井智敬-2019.06.30）。
Wiederstein I, Auer U, Moens Y. Laryngeal mask airway insertion requires less propofol than endotracheal intubation in dogs. Vet Anaesth Analg 2006;33:201-206.
犬においてラリンゲルマスクでの挿管は気管チューブ挿管に比較してプロポフォールの使用量を減らす
OBJECTIVE: To compare the doses of propofol required for insertion of the laryngeal mask airway (LMA) with those for endotracheal intubation in sedated dogs.
STUDY DESIGN: Randomized prospective clinical study. Animals Sixty healthy dogs aged 0.33-8.5 (3.0 +/- 2.3, mean +/- SD) years, weighing 2.2-59.0 (23.4 +/- 13.6, mean +/- SD) kg, presented for elective surgery requiring inhalation anaesthesia.
METHODS: Animals were randomly assigned to receive either a LMA or an endotracheal tube. Pre-anaesthetic medication was intravenous (IV) glycopyrrolate (0.01 mg kg(-1)) medetomidine (10 microg kg(-1)) and butorphanol (0.2 mg kg(-1)). Repeated IV propofol injections (1 mg kg(-1) in 30 seconds) were given until LMA insertion or endotracheal intubation was achieved, when the presence or absence of laryngospasm, the respiratory rate (fr) and the total dose of propofol used were recorded.
RESULTS: The total propofol dose (mean +/- SD) required for LMA insertion (0.53 +/- 0.51 mg kg(-1)) was significantly lower than for endotracheal intubation (1.43 +/- 0.57 mg kg(-1)). The LMA could be inserted without propofol in 47% of dogs; the remainder needed a single 1 mg kg(-1) bolus (n = 30). Endotracheal intubation was possible without propofol in 3.3% of the dogs, 47% needed one bolus and 50% required two injections (n = 30). The f(r) (mean +/- SD) was 18 +/- 6 and 15 +/- 7 minute(-1) after LMA insertion and intubation, respectively.
CONCLUSION AND CLINICAL RELEVANCE: Laryngeal mask airway insertion requires less propofol than endotracheal intubation in sedated dogs therefore propofol-induced cardiorespiratory depression is likely to be less severe. The LMA is well tolerated and offers a less invasive means of securing the upper airway.
コメント：ドミトール使用下ではあるが気管挿管に比較してラリンゲルマスクがプロポフォールの使用量がかなり減少することは麻酔管理からの点においても血圧低下や呼吸抑制を軽減できると考えられる（とも動物病院 櫻井智敬-2018.11.30）。
動物での気管支鏡の臨床適用および合併症
Woods KS, Defarges AM, Abrams-Ogg AC, et al. Comparison of manual and suction pump aspiration techniques for performing bronchoalveolar lavage in 18 dogs with respiratory tract disease. J Vet Intern Med 2014;28:1398-1404.
呼吸器疾患犬18頭における、BALFの手動吸引（MA）とサクション吸引（SPA）の比較
BACKGROUND: Different aspiration techniques to retrieve bronchoalveolar lavage fluid (BALF) affect sample quality in healthy dogs. Studies evaluating these techniques in dogs with respiratory disease are lacking. OBJECTIVES: To compare sample quality of BALF acquired by manual aspiration (MA) and suction pump aspiration (SPA). ANIMALS: Eighteen client-owned dogs with respiratory disease. METHODS: Randomized, blinded prospective clinical trial. Manual aspiration was performed with a 35-mL syringe attached directly to the bronchoscope biopsy channel and SPA was performed with a maximum of 50 mmHg negative pressure applied to the bronchoscope suction valve using the suction trap connection. Both aspiration techniques were performed in each dog on contralateral lung lobes, utilizing 2 mL/kg lavage volumes per site. Samples of BALF were analyzed by percentage of retrieved infusate, total nucleated cell count (TNCC), differential cell count, semiquantitative assessment of slide quality, and diagnosis score. Data were compared by paired Student’s t-test, Wilcoxon signed-rank test, chi-squared test, and ANOVA. Cohen’s kappa coefficient was used to assess agreement. RESULTS: The percentage of retrieved BALF (P = .001) was significantly higher for SPA than MA. Substantial agreement was found between cytologic classification of BALF obtained with MA and SPA (kappa = 0.615). There was no significant difference in rate of definitive diagnosis achieved with cytologic assessment between techniques (P = .78). CONCLUSIONS AND CLINICAL IMPORTANCE: Suction pump aspiration, compared to MA, improved BALF retrieval, but did not significantly affect the rate of diagnostic success of bronchoalveolar lavage (BAL) in dogs with pulmonary disease.
コメント：犬18例に２つの方法でBALを実施。合併症率33.3％（6/18）、死亡・安楽死3.6％（1/18）（ほさか動物病院 菅沼鉄平-2019.4.8）。
Liu Y, Yan B, Huang Z, et al. Feasibility and safety of fiber optic micro-imaging in canine peripheral airways. PLoS One 2014;9:e84829.
イヌ末梢気道における光ファイバーマイクロイメージングの適用範囲と安全性
PURPOSE: To assess the feasibility and safety of imaging canine peripheral airways (<1 mm) with an experimental micro-imaging fiber optic bronchoscope. METHODS: Twenty healthy dogs were scoped with a micro-imaging fiber optic bronchoscope (0.8 mm outer diameter). Images at various levels of the bronchioles, mucosal color, and tracheal secretions were recorded. The apparatus was stopped once it was difficult to insert. CT imaging was performed simultaneously to monitor progression. The safety of the device was evaluated by monitoring heart rate (HR), respiratory rate (RR), mean artery pressure (MAP), peripheral oxygen saturation (SpO2) and arterial blood gases (partial pressure of arterial carbon-dioxide, PaCO2, partial pressure of arterial oxygen, PaO2, and blood pH). RESULTS: (1) According to the CT scan, the micro-imaging fiber was able to access the peripheral airways (<1 mm) in canines. (2) There was no significant change in the values of HR, MAP, pH and PaCO2 during the procedure (P>0.05). Comparing pre-manipulation and post-manipulation values, SpO2 (F = 13.06, P<0.05) and PaO2 (F = 3.01, P = 0.01) were decreased, whereas RR (F = 3.85, P<0.05) was elevated during the manipulation. (3) Self-limited bleeding was observed in one dog; severe bleeding or other complications did not occur. CONCLUSION: Although the new apparatus had little effect on SpO2, PaO2 and RR, it can probe into small peripheral airways (<1 mm), which may provide a new platform for the early diagnosis of bronchiolar diseases.
コメント：光ファイバーを用いた気管支鏡で犬の1mm以下の末梢気道を描出できるかどうか、またその安全性を評価した。SpO2、PaO2、RRには多少の影響があったが、HR、 MAP、pHには影響がなかった。1mm以下の末梢気管支を調べる事で、気管支疾患の早期診断になりそうである（カンナ動物病院 山中一大-2018.12.21）
Caccamo R, Twedt DC, Buracco P, et al. Endoscopic bronchial anatomy in the cat. J Feline Med Surg 2007;9:140-149.
猫における気管支内視鏡正常所見
The aim of this paper is to define the endoscopic bronchial anatomy of the cat and to adapt these findings to the bronchoscopic nomenclature previously described for the dog by Amis and McKiernan (Amis TC, McKiernan BC (1986) Systematic identification of endobronchial anatomy during bronchoscopy in the dog. American Journal of Veterinary Research 47(12), 2649-2657). In this study, the normal endoscopic bronchial anatomy was identified based on analysis of 10 air-dried feline lungs, two euthanased and eight healthy anesthetized cats using either a rigid or a flexible endoscope. Endoscopic photographs were taken during the examinations in the anesthetized cats for a photographic atlas. Corrosion casts were made from the 10 air-dried lungs to confirm the anatomy identified by bronchoscopy. With the results of our findings a bronchoscopic map of the feline bronchial tree and a photographic bronchoscopic atlas of the healthy cat were made.
コメント：猫は犬と同様に主軸状（monopodial)気管支分岐形式を示し、1986年に提唱された犬の気管支鏡的分岐命名法に従って猫でも気管支内視鏡の正常所見が記述された（犬・猫の呼吸器科 城下幸仁-2020.5.25）。
Johnson LR, Drazenovich TL. Flexible bronchoscopy and bronchoalveolar lavage in 68 cats (2001-2006). J Vet Intern Med 2007;21:219-225.
猫68例（2001−2006）への軟性気管支鏡検査および気管支肺胞洗浄実施の後向き研究
BACKGROUND: Bronchoscopy is an important tool for identifying an underlying etiology for respiratory disease in cats. However, the procedure is challenging, because feline airways are small and prone to bronchoconstriction. HYPOTHESIS: Bronchoscopy and bronchoalveolar lavage (BAL) are appropriate and safe diagnostic procedures in the cat. ANIMALS: Sixty-eight cats. METHODS: Flexible bronchoscopy was performed in all cats with the cats under propofol infusion with jet ventilation. The procedures were reviewed for BAL volumes instilled and recovered and for the number and type of complications with the use of 3 flexible endoscopes < 5.0-mm outer diameter. The BAL procedure was compared among scopes by using a one-way analysis of variance. Complication rates were compared by using chi-square analysis. Significance was set at P < .05. RESULTS: Clinical diagnoses included inflammatory airway disease in 46 of 68 cats, pneumonia in 10 of 68, neoplastic disease in 8 of 68, and other conditions in 4 of 68 cats. Mean lavage volumes instilled for the 3 scopes were 2.62-5.05 mL/kg (range, 0.77-9.38 mL/kg). Mean percent fluid recovered for the 3 scopes was 51-73%, (range, 0-140%). BAL cell counts were adequate for cytologic assessment (> 300 cells/microL) in 61 of 64 cats (97%), and in 107 of 120 samples (89%) collected. Complications occurred in 38% of procedures; however, these were mild in 24% of cats; 6% of cats died or were euthanized after the procedure. Complications were not associated with fluid volume instilled or recovered, and could not be related to the underlying disease process. CONCLUSIONS AND CLINICAL IMPORTANCE: Flexible bronchoscopy with BAL was well tolerated in most cats examined.
コメント：合併症率38.2％（24/68）、安楽死5.9％（4/68）であった（ほさか動物病院 菅沼鉄平-2019.4.8）。
Andreasen CB. Bronchoalveolar lavage. Vet Clin North Am Small Anim Pract 2003;33:69-88.
気管支肺胞洗浄
Bronchoalveolar lavage is a valuable diagnostic technique when appropriate patient selection is made, which includes diseases that involve the pulmonary parenchyma and patients that can safely undergo general anesthesia. Bronchoalveolar lavage cytology has the potential to provide a definitive diagnosis or additional diagnostic information with a less invasive procedure than lung aspiration or thoracotomy. Limitations of accuracy in cell counts and negative findings are considerations when interpreting bronchoalveolar lavage fluid results.
コメント：小動物臨床領域での気管支肺胞洗浄についての文献（JASMINEどうぶつ循環器病センター 侭田 和也-2018.11.30）
Johnson L. Small animal bronchoscopy. Vet Clin North Am Small Anim Pract 2001;31:691-705, viii.
小動物における気管支鏡検査
Bronchoscopy is a useful diagnostic and therapeutic tool in veterinary medicine. The increased availability of fiberoptic technology and video-endoscopy has enhanced recognition of the benefits gained from visualization of the lower airways in animals with lower respiratory tract disease. Specimens retrieved from the lower airway during bronchoscopy have greater diagnostic capacity, and a better understanding of the pathophysiology of disease is provided through application of bronchoscopy to animals with respiratory tract disease.
コメント：気管支鏡検査について獣医学の観点から述べた文献（JASMINEどうぶつ循環器病センター 侭田 和也-2018.11.30）
Rha JY, Mahony O. Bronchoscopy in small animal medicine: indications, instrumentation, and techniques. Clin Tech Small Anim Pract 1999;14:207-212.
小動物臨床における気管支鏡検査：適応、装置、手技について
Bronchoscopy is a useful tool in the evaluation and management of canine and feline respiratory diseases. Diagnostic indications include the evaluation of structural diseases (tracheobronchial collapse, stricture, intraluminal mass); inflammatory conditions (chronic bronchitis, pneumonia); and traumatic injuries. Several airway-sampling techniques are available with bronchoscopy; bronchoalveolar lavage has proved to be the most satisfactory specimen-collection technique. Therapeutic indications of bronchoscopy at this time in veterinary medicine are mainly limited to foreign body removal. As advances are made in veterinary bronchopulmonary medicine, other therapeutic applications of the bronchoscope may be realized.
コメント:犬と猫を対象。診断の指標や適応症例について記載（JASMINEどうぶつ循環器病センター 侭田 和也-2018.11.30）。
Wood RE, Pick JR. Model systems for learning pediatric flexible bronchoscopy. Pediatr Pulmonol 1990;8:168-171.
小児気管支鏡検査学習のためのモデルの研究
Considerable practice is necessary to develop the skills essential to successful and safe performance of flexible bronchoscopy, especially in pediatric patients. We review a number of model systems, both mechanical and living, for learning and maturing bronchoscopic skills. For each of the animal models (canine, feline, leporine, and simian), the relevant anatomy and anesthetic techniques as well as the relative advantages and disadvantages of each model are discussed.
コメント：ヒトの小児患者を想定した基礎研究のため、イヌ、ネコ、ウサギ、サルを動物モデルとして解剖、麻酔、各モデルの長所や短所について述べた文献（JASMINEどうぶつ循環器病センター 侭田 和也-2018.11.30）
Amis TC, McKiernan BC. Systematic identification of endobronchial anatomy during bronchoscopy in the dog. Am J Vet Res 1986;47:2649-2657
犬における系統的気管支鏡的分岐命名法の提案
The endobronchial anatomy of 10 inflated, air-dried, canine lungs and 8 healthy anesthetized, sternally recumbent, mixed-breed dogs was evaluated, using a flexible fiberoptic bronchoscope. On the basis of the order of branching of lobar and segmental bronchi observed in these lungs, a nomenclature system was devised to systematically identify individual lobar, segmental, and subsegmental bronchi during bronchoscopy in the dog.
コメント：犬の気管支樹がmonopodial system(主軸状）分岐であることに着目し、犬の気管支鏡的分岐命名法を提唱した（犬・猫の呼吸器科 城下幸仁-2020.5.25）。
Venker-van Haagen AJ. Otoscopy, rhinoscopy, and bronchoscopy in small animal clinics. Vet Q 1985;7:222-224.
小動物臨床における耳鏡検査、鼻鏡検査、気管支鏡検査
Otoscopy, rhinoscopy, and bronchoscopy are indispensable techniwues in ear, nose, and throat clinics and in diseases of the trachea and the bronchial tree. The quality of the instruments used in these techniques is of primary importance. The endoscopic procedures, the instruments used, and the indications for the examinations are discussed.
コメント：耳鏡検査、鼻鏡検査、気管支鏡検査の概要について述べた文献。気管支鏡については喉頭、上気道疾患の診断に不可欠な技術であると述べている。使用機材についての記載が主である。図が4つあるが気管支鏡については正常犬の気管分岐部の白黒写真のみ（JASMINEどうぶつ循環器病センター 侭田 和也-2018.11.30）。
O’Brien JA. Bronchoscopy in the dog and cat. J Am Vet Med Assoc 1970;156:213-217.
犬と猫における気管支鏡検査
コメント：犬と猫における気管支鏡の最初の文献と思われるが情報得られず。アブストラクトもなし（JASMINEどうぶつ循環器病センター 侭田 和也-2018.11.30）。
気管支鏡検査適応疾患
Johnson LR, Johnson EG, Hulsebosch SE, et al. Eosinophilic bronchitis, eosinophilic granuloma, and eosinophilic bronchopneumopathy in 75 dogs (2006-2016). J Vet Intern Med 2019;33:2217-2226.
好酸球性気管支炎、好酸球性肉芽腫、または好酸球性気管支肺症と診断した犬75例（2006-2016）
BACKGROUND: Eosinophilic lung disease is a poorly understood inflammatory airway disease that results in substantial morbidity. OBJECTIVE: To describe clinical findings in dogs with eosinophilic lung disease defined on the basis of radiographic, bronchoscopic, and bronchoalveolar lavage fluid (BAL) analysis. Categories included eosinophilic bronchitis (EB), eosinophilic granuloma (EG), and eosinophilic bronchopneumopathy (EBP). ANIMALS: Seventy-five client owned dogs. METHODS: Medical records were retrospectively reviewed for dogs with idiopathic BAL fluid eosinophilia. Information abstracted included duration and nature of clinical signs, bronchoscopic findings, and laboratory data. Thoracic radiographs were evaluated for the pattern of infiltrate, bronchiectasis, and lymphadenomegaly. RESULTS: Thoracic radiographs were normal or demonstrated a bronchial pattern in 31 dogs assigned a diagnosis of EB. Nine dogs had intraluminal mass lesions and were bronchoscopically diagnosed with EG. The remaining 35 dogs were categorized as having EBP based on radiographic changes, yellow green mucus in the airways, mucosal changes, and airway collapse. Age and duration of cough did not differ among groups. Dogs with EB were less likely to have bronchiectasis or peripheral eosinophilia, had lower total nucleated cell count in BAL fluid, and lower percentage of eosinophils in BAL fluid compared to dogs in the other 2 groups. In contrast to previous reports, prolonged survival (>55 months) was documented in dogs with EG. CONCLUSIONS AND CLINICAL IMPORTANCE: Dogs with eosinophilic lung disease can be categorized based on imaging, bronchoscopic and BAL fluid cytologic findings. Further studies are needed to establish response to treatment in these groups.
コメント：犬の好酸球性肺疾患の分類と臨床所見と気管支鏡検査所見。大型犬が中心。小型犬では気管挿管せず、血管カテーテルを介してジェット換気で酸素供給しその脇から3.8㎜のビデオ内視鏡を挿管して検査を行っている。SPO2が85％以下で手技の中断との報告であった（ほさか動物病院 菅沼鉄平-2019.10.11）
Johnson LR, Johnson EG, Vernau W, et al. Bronchoscopy, Imaging, and Concurrent Diseases in Dogs with Bronchiectasis: (2003-2014). J Vet Intern Med 2016;30:247-254. doi: 10.1111/jvim.13809
気管支拡張症の犬における気管支鏡検査、画像検査および併発疾患(2003–2014)
BACKGROUND: Bronchiectasis is a permanent and debilitating sequel to chronic or severe airway injury, however, diseases associated with this condition are poorly defined. OBJECTIVE: To evaluate results of diagnostic tests used to document bronchiectasis and to characterize underlying or concurrent disease processes. ANIMALS: Eighty-six dogs that had bronchoscopy performed and a diagnosis of bronchiectasis. METHODS: Retrospective case series. Radiographs, computed tomography, and bronchoscopic findings were evaluated for features of bronchiectasis. Clinical diagnoses of pneumonia (aspiration, interstitial, foreign body, other), eosinophilic bronchopneumopathy (EBP), and inflammatory airway disease (IAD) were made based on results of history, physical examination, and diagnostic testing, including bronchoalveolar lavage fluid analysis and microbiology. RESULTS: Bronchiectasis was diagnosed in 14% of dogs (86/621) that had bronchoscopy performed. Dogs ranged in age from 0.5 to 14 years with duration of signs from 3 days to 10 years. Bronchiectasis was documented during bronchoscopy in 79/86 dogs (92%), thoracic radiology in 50/83 dogs (60%), and CT in 34/34 dogs (100%). Concurrent airway collapse was detected during bronchoscopy in 50/86 dogs (58%), and focal or multifocal mucus plugging of segmental or subsegmental bronchi was found in 41/86 dogs (48%). Final diagnoses included pneumonia (45/86 dogs, 52%), EBP (10/86 dogs, 12%) and IAD (31/86 dogs, 36%). Bacteria were isolated in 24/86 cases (28%), with Streptococcus spp, Pasteurella spp, enteric organisms, and Stenotrophomonas isolated most frequently. CONCLUSIONS AND CLINICAL IMPORTANCE: Bronchiectasis can be anticipated in dogs with infectious or inflammatory respiratory disease. Advanced imaging and bronchoscopy are useful in making the diagnosis and identifying concurrent respiratory disease.
コメント：気管支拡張症の診断には胸部X線写真検査よりもCT、気管支鏡検査の方が有用であった。
気管支拡張症と診断された86頭の犬の併発疾患として気管虚脱（48％ 41/86）、肺炎（誤嚥、間質性、異物性、その他）（52％ 45/86）、炎症性気道疾患（36％ 31/86）、好酸球性気管支肺症（12％ 10/86）が認められた。また培養検査にて細菌が（28％ 24/86）で検出されStreptococcus spp、Pasteurella spp、腸内細菌、およびStenotrophomonasが分離された(ほさか動物病院 菅沼鉄平-2019.01.25）。
人におけるInterventional bronchoscopyのこれまでと現在
掲載準備中
人におけるラリンゲルマスクを介した気管支鏡検査
Alon D, Pertzov B, Gershman E, et al. The Safety of Laryngeal Mask Airway-Assisted Bronchoscopy versus Standard Nasal Bronchoscopy. Respiration 2017;93:279-284.
従来法の経鼻挿入気管支鏡検査に対するラリンゲルマスクを介した気管支鏡検査の安全性
BACKGROUND: The use of laryngeal mask airway (LMA) for fiberoptic bronchoscopy was first described in 1982. The LMA was found to be beneficial in operator view, flexibility, and also in maintaining stable oxygen saturation. Despite its advantages, the use of LMA has not become widespread. OBJECTIVE: The aim of this paper was to evaluate the safety of LMA-assisted bronchoscopy compared to standard nasal bronchoscopy. METHODS: We conducted a prospective randomized trial. The study group included 105 patients prospectively randomized to undergo either LMA-assisted (53 patients) or standard nasal bronchoscopy (52 patients). The data collected included continuous monitoring of respiratory and hemodynamic parameters and medication doses. RESULTS: The LMA group had a significantly lower percentage of desaturation (pulse oximetry saturation [SpO2] <88%) events compared to the non-LMA (NLMA) group (37 vs. 63.4%; p = 0.008). The median percentage of time with SpO2 >88%, from the total procedure time, was 100% (IQR 98-100) in the LMA group and 98% (IQR 96-98) in the NLMA group (p = 0.003). Sedation in the LMA group required significantly higher doses of propofol (p < 0.001). The mean systolic blood pressure values were significantly lower in the LMA group, but this difference did not result in a higher percentage of clinically significant hypotension. CONCLUSION: The use of LMA allows for better airway support, stable oxygen saturation, and a more convenient port of entry during flexible fiberoptic bronchoscopy. These results, together with the known advantages of the laryngeal mask, should lead to more widespread use in the evolving field of interventional pulmonology, in particular in high-risk patients and complicated procedures.
コメント：ラリンゲルマスク使用時の気管支鏡検査と経鼻気管支鏡検査での各パラメーターの比較。ラリンゲルマスク使用時の方が長い時間より安定した酸素飽和が得られる。それ以外のパラメーターに有意差はなし。またこの研究には併発疾患のある患者も含んで行ったため、併発疾患のある患者でより安全性が高い検査を行うことができると考える。(Sho Animal Clinic 草場翔央-2019.9.3 )
犬・猫のBALF細胞診 診断基準
Johnson LR, Vernau W. Bronchoalveolar lavage fluid lymphocytosis in 104 dogs (2006-2016). J Vet Intern Med 2019.
気管支肺胞洗浄液にてリンパ球増加を認めた犬の104症例（2006-2016）
BACKGROUND: Bronchoalveolar lavage (BAL) fluid cytology and culture are used to characterize respiratory diseases in dogs. Little is known about disorders associated with increased numbers of lymphocytes in BAL fluid. OBJECTIVE: To evaluate duration of clinical signs and detection of specific respiratory diagnoses in dogs with BAL lymphocytosis. ANIMALS: One-hundred four client-owned dogs evaluated for respiratory signs. METHODS: Medical records of dogs that had >300 cells/muL and >20% lymphocytes on a differential cell count of BAL fluid between January 1, 2006, and January 1, 2016, were reviewed retrospectively. Cases were evaluated for the duration of clinical signs and respiratory diagnoses, including aspiration injury, infectious or inflammatory respiratory disease, and airway collapse. RESULTS: Dogs ranged in age from 0.5 to 16 years (median, 7.9 years) and had a median body weight of 11.4 kg (range, 2.0-42.7 kg). Eosinophilic lung disease was documented in 13 of 104 dogs (Group 1) and airway neutrophilia associated with infectious or inflammatory disease was found in 59 of 104 dogs (Group 2). Lymphocytosis alone in BAL fluid was described in 32 dogs (Group 3). Duration of cough did not differ among groups, but airway collapse was significantly more common in dogs with solitary lymphocytosis than in those with other types of inflammation. CONCLUSIONS AND CLINICAL IMPORTANCE: Lymphocytosis in BAL fluid is common in dogs and, in many cases, likely represents a common response to airway injury, independent of the type or duration of insult. It is unknown whether airway collapse leads to lymphocytosis or if the inflammatory process causes airway collapse.
コメント：
背景及び目的：犬の気管支肺胞洗浄液（Bronchoalveolar lavage fluid：BALF）解析においてリンパ球増加が関与する呼吸器疾患に関する知見は少ない。本研究では犬におけるBALF中リンパ球増加と臨床症状の持続期間、及び特異的な呼吸器疾患との関係を検討した。
材料および方法：2006年から2016年にBALを実施した犬のうち、20%以上のリンパ球比率増加が認められた犬について臨床症状とその持続期間、基礎となる呼吸器疾患（気管支鏡所見や画像検査、微生物学的検査などより）を評価した。
結果：対象期間において約20%（104/569）でBALF中リンパ球増加を認めた。そのうち59例で好中球増加（>8%）、13例で好酸球増加（>14%）が合わせて認められた。これらの群と単独のリンパ球増加群では臨床症状（咳嗽）及びその持続期間に有意差は認められなかったが、気道の虚脱（airway collapse*）は単独のリンパ球増加群で多く認められた。
考察：BALF中リンパ球増加は気道の炎症反応に関与していることが示唆された。しかし、airway collapseがリンパ球増加を引き起こすのか、リンパ球増加によりairway collapseが生じるのかは不明である。
*airway collapse：気管虚脱や気管支軟化症、気管気管支軟化症などを含む
(犬・猫の呼吸器科 稲葉健一-2019.4.30）
Zhu BY, Johnson LR, Vernau W. Tracheobronchial brush cytology and bronchoalveolar lavage in dogs and cats with chronic cough: 45 cases (2012-2014). J Vet Intern Med 2015;29:526-532.
慢性咳を呈する犬猫45例における気管支気管支ブラシ細胞診と気管支肺胞洗浄
BACKGROUND: Animals with chronic cough can have normal bronchoalveolar lavage fluid cytology when small airway disease is absent. Cytology of a tracheobronchial brushing can detect inflammation in larger airways; however, evaluation of this technique has been limited in veterinary medicine. OBJECTIVE: To compare airway brush cytology to bronchoalveolar lavage fluid analysis in dogs and cats with chronic cough. ANIMALS: Forty dogs and five cats undergoing bronchoscopic investigation of chronic cough. METHODS: Prospective study. Bronchoscopy and bronchoalveolar lavage were performed followed by tracheobronchial brushing of central airways. Results of cytologic assessment of BAL fluid and brush cytology were compared for the presence or absence of inflammation and concordance of inflammatory cell type. RESULTS: Brush cytology detected central airway inflammation in 34 of 40 (85%) dogs with inflammatory BAL fluid. However, the type of inflammation reported differed in 23 of 34 dogs. In five cats with inflammation in BAL fluid, brush cytology detected inflammation in four; the type of inflammation was discordant in all cats. CONCLUSIONS AND CLINICAL RELEVANCE: Brush cytology has good agreement with BAL regarding the presence of inflammation, although the type of inflammation detected with the different sampling techniques commonly varies. Brush cytology can provide supplementary information to BAL, and additional studies will provide further information on the role of tracheobronchial brush cytology in the diagnosis and management of respiratory conditions.
コメント：慢性咳を呈する犬と猫のBALおよびブラシ細胞診の細胞学的評価。両者を合わせて行うことでBALの結果に加えて、必要な情報を補足的に得ることができさらなる診断治療が期待できる(Sho Animal Clinic 草場翔央-2019.10.8）
Woods KS, Defarges AM, Abrams-Ogg AC, et al. Comparison of manual and suction pump aspiration techniques for performing bronchoalveolar lavage in 18 dogs with respiratory tract disease. J Vet Intern Med 2014;28:1398-1404.
呼吸器疾患犬18頭における、BALFの手動吸引（MA）とサクション吸引（SPA）の比較
BACKGROUND: Different aspiration techniques to retrieve bronchoalveolar lavage fluid (BALF) affect sample quality in healthy dogs. Studies evaluating these techniques in dogs with respiratory disease are lacking.
OBJECTIVES: To compare sample quality of BALF acquired by manual aspiration (MA) and suction pump aspiration (SPA).
ANIMALS: Eighteen client-owned dogs with respiratory disease.
METHODS: Randomized, blinded prospective clinical trial. Manual aspiration was performed with a 35-mL syringe attached directly to the bronchoscope biopsy channel and SPA was performed with a maximum of 50 mmHg negative pressure applied to the bronchoscopesuction valve using the suction trap connection. Both aspiration techniques were performed in each dog on contralateral lung lobes, utilizing 2 mL/kg lavage volumes per site. Samples of BALF were analyzed by percentage of retrieved infusate, total nucleated cell count (TNCC), differential cell count, semiquantitative assessment of slide quality, and diagnosis score. Data were compared by paired Student’s t-test, Wilcoxon signed-rank test, chi-squared test, and ANOVA. Cohen’s kappa coefficient was used to assess agreement.
RESULTS: The percentage of retrieved BALF (P = .001) was significantly higher for SPA than MA. Substantial agreement was found between cytologic classification of BALF obtained with MA and SPA (kappa = 0.615). There was no significant difference in rate of definitive diagnosis achieved with cytologic assessment between techniques (P = .78).
CONCLUSIONS AND CLINICAL IMPORTANCE: Suction pump aspiration, compared to MA, improved BALF retrieval, but did not significantly affect the rate of diagnostic success of bronchoalveolar lavage (BAL) in dogs with pulmonary disease.
コメント: SPAの方がBALFの回収率は有意に高かったが、BALによる犬の呼吸器疾患診断率にMAとSPAの有意差はなかった（カンナ動物病院 山中一大-2018.12.11）。
Woods KS, Fefarges AMN, Abraham-Ogg ACG, et al. Comparison of bronchoalveolar lavage aspiration techniques in healthy dogs: manual aspiration and suction pump aspiration:2012 ACVIM Forum Abstructs. J Vet Intern Med 2012;26:820.
健常犬におけるBAL回収法の比較：用手法とサクションバルブ法
The purpose of the study was to compare the diagnostic qual¬ity of bronchoalveolar lavage fluid (BALF) cellular component acquired by manual aspiration via polyethylene tubing (MAPT) and suction pump aspiration (SPA) via suction trap connection techniques in healthy dogs.
Bronchoalveolar lavage was performed under general anesthesia using bronchoscopic guidance in twelve healthy beagles. Following passage of the endoscope, sterile polyethylene tubing was inserted through the biopsy channel and MAPT performed with a 35mL syringe attached to the tubing wedged in the bronchus. Similarly, SPA was performed using 5kPa negative pressure applied directly to the bronchoscope’s suction valve via disposable aspiration tube. MAPT and SPA techniques were performed in randomized order in opposite caudal lung lobes of each dog. Two lavages boluses were infused at each site using a weight- adjusted aliquot volume (1 mL/kg). The BALF samples were submitted and prepared for total nucleated cell count and differ¬ential cell count. A subjective scale for quality and percent of retrieved fluid were evaluated. Results were compared using a paired Wilcoxon sign rank test.
The proportion of BALF retrieved was significantly higher (mean difference 19.02%, p = 0.001) for SPA than MAPT. From the BAL cell differential analysis, a higher percentage of epithelial cells was present when compared to SPA (mean differ¬ence =0.81, p = 0.05).
The results suggest that SPA provided BALF samples of higher diagnostic quality than MAPT in healthy dogs. The SPA technique may improve the diagnostic accuracy and significance of BAL in dogs.
Statement on prior publication: Abstract presented at the Ontario Veterinary College Graduate Research Symposium, Uni¬versity of Guelph, Guelph, Ontario, Canada; November 16th, 2011.
コメント：サクションバルブ法は、用手法より質の高いBALFサンプルを得られた（犬・猫の呼吸器科 城下-2018.12.5）
Allerton FJ, Leemans J, Tual C, et al. Correlation of bronchoalveolar eosinophilic percentage with airway responsiveness in cats with chronic bronchial disease. J Small Anim Pract 2013;54:258-264.
慢性気管支疾患の猫のおけるBALF中好酸球と気道過敏性との関連性
OBJECTIVES: To retrospectively assess the relationship between bronchoalveolar lavage fluid analysis and lung function parameters as assessed by means of barometric whole body plethysmography and airway responsiveness testing in cats with chronic bronchial disease and to evaluate the potential application of barometric whole body plethysmography and airway responsiveness testing to distinguish between eosinophilic and non-eosinophilic bronchitis. METHODS: Twelve cats presented for chronic bronchial disease with complete bronchoalveolar lavage fluid and barometric whole body plethysmography data were identified. Cats were retrospectively assigned to eosinophilic bronchitis or non-eosinophilic bronchitis groups on the basis of bronchoalveolar lavage fluid eosinophil percentage (threshold 17%). Airway responsiveness was quantified by calculating the concentration of carbachol-inducing bronchoconstriction (C-Penh-300), defined as a 300% increase of basal enhanced pause (Penh). RESULTS: Log Penh was significantly higher and C-Penh-300 significantly lower in eosinophilic bronchitis cats compared to non-eosinophilic bronchitis cats (P=0.031 and P=0.032, respectively). Bronchoalveolar lavage fluid eosinophil percentage was moderately correlated with log Penh (P=0.012, r=0.70) and showed a weak inverse correlation with C-Penh-300 (P=0.047, r=-0.58). CLINICAL SIGNIFICANCE: This study provides supportive evidence of a correlation between airway eosinophilic inflammation and plethysmographic measures of bronchoconstriction and airway responsiveness. Further investigation of the use of barometric whole body plethysmography to differentiate between forms of chronic bronchial disease in cats is indicated.
コメント：
De Lorenzi D, Masserdotti C, Bertoncello D, et al. Differential cell counts in canine cytocentrifuged bronchoalveolar lavage fluid: a study on reliable enumeration of each cell type. Vet Clin Pathol 2009;38:532-536.
犬のBALF細胞診において各細胞タイプ算定の良好な再現性を得るための細胞カウント数について
BACKGROUND: Bronchoalveolar lavage (BAL) allows cell recovery from the lower respiratory tract; differential cell counts of BAL fluid gives important information in the assessment of various bronchial and pulmonary diseases. To the best of our knowledge no study has investigated the relation between the number of cells counted and the reproducibility of BAL fluid differential cell counts. OBJECTIVE: The purpose of this study was to investigate using statistical methods how many cells should be counted in cytocentrifuged BAL fluid preparations in order to obtain a reliable enumeration of each cell type. METHODS: BAL fluid samples from dogs with suspected bronchopulmonary disease were obtained during fiberoptic bronchoscopy with a standardized protocol. Differential cell counts were performed on May-Grunwald-Giemsa-stained cytocentrifuged preparations by 2 independent observers. Reproducibility for the enumeration of each cell type was expressed as the intraclass correlation coefficient. We considered a threshold level of >or=0.90 to be high and a threshold level of >or=0.85 to be adequate. RESULTS: Forty BAL fluid samples were included in the study. For neutrophils, alveolar macrophages, and eosinophils high reproducibility was reached by counting 200 cells; adequate reproducibility was reached for lymphocytes and bronchial epithelial cells by counting 500 cells. CONCLUSIONS: A 500-cell differential count is required for all types of cells to be quantified with adequate reproducibility in canine cytocentrifuged BAL fluid samples.
コメント：遠心分離によるBALF細胞診評価で十分な再現性を得るには最低500 cell countsが必要である（犬・猫の呼吸器科 城下幸仁−2019.4.30）.
Foster SF, Martin P, Braddock JA, et al. A retrospective analysis of feline bronchoalveolar lavage cytology and microbiology (1995-2000). J Feline Med Surg 2004;6:189-198.
猫のBALF解析の細胞診と微生物学に関する調査
A retrospective study of 88 bronchoalveolar lavage specimens from 80 cats presenting to the University of Sydney Veterinary Centre between 1995 and 2000 was performed. Bronchoalveolar lavage cytology and microbiology in conjunction with other diagnostic aids and patient records were used to classify cases as lower respiratory tract infections (LTRIs), LRTI revisits, feline bronchial disease, cardiac disease, neoplastic disease and multisystemic disease. Cases for which a definitive diagnosis could not be made were classified as inconclusive. Infectious agents identified were Mycoplasma spp., Pasteurella spp., Bordetella bronchiseptica, Salmonella typhimurium, Pseudomonas sp., Cryptococcus neoformans, Aelurostrongylus abstrusus and Eucoleus aerophilus. The study highlights the importance of bronchoalveolar lavage cytology and microbiology in the evaluation of feline lower respiratory tract disease.
コメント：15年間で80頭の猫に88回行われたBAL検体の解析に対する調査。猫の下気道疾患の評価にBALの細胞診と細菌学検査の重要性について述べられている（犬・猫の呼吸器科 城下幸仁-2019.3.7）
Hawkins EC, DeNicola DB, Kuehn NF. Bronchoalveolar lavage in the evaluation of pulmonary disease in the dog and cat. State of the art. J Vet Intern Med 1990;4:267-274. PDFあり
技術講座：犬と猫の肺疾患評価における気管支肺胞洗浄
Bronchoalveolar lavage is a diagnostic procedure used to obtain specimens representative of disease processes involving the deep lung. Saline is instilled into an airway in sufficient volumes to bathe the alveoli dependent on that airway. The saline is retrieved by suction along with cellular and acellular material lining the epithelial surfaces of the lung. Cytologic and microbiologic evaluation of the fluid can be used to characterize pulmonary diseases in the dog and cat.
コメント：犬と猫の気管支肺胞洗浄の方法や解釈や症例を示した初めての論文。細胞診所見を、急性好中球性炎症、慢性活動性炎症、慢性炎症、好酸球性炎症、出血、腫瘍の6つのパターンに分類している（犬・猫の呼吸器科 城下幸仁-2020-8.30）。
犬・猫におけるInterventional bronchoscopy-症例報告
Musani AI, Veir JK, Huang Z, et al. Photodynamic therapy via navigational bronchoscopy for peripheral lung cancer in dogs. Lasers Surg Med 2018;50:483-490.
気管支鏡を用いた犬の末梢肺腫瘍のレーザー治療
OBJECTIVE:In the setting of lung cancer, photodynamic therapy (PDT) is typically used to treat centrally located endobronchial tumors. The development of navigational bronchoscopy has opened the potential for using PDT to treat peripheral lung tumors. However, there is limited information about the feasibility of this approach for treating peripheral lungcancers, and about its effects on surrounding healthy lung tissue. We studied the use of PDT delivered by electromagnetic navigational bronchoscopy to treat peripheral lung cancer in dogs.
MATERIALS AND METHODS: Three dogs with peripheral lung adenocarcinomas were given intravenous porfimer sodium (Photofrin® [Pinnacle Biologics, Inc., Chicago, IL]) to photosensitize the tumors, then navigational bronchoscopy was used to deliver photoradiation. One week after PDT, the tumors and involved lung lobe were surgically excised and evaluated histologically.
RESULTS: PDT was successful in all three dogs and was associated with tolerable and manageable adverse effects. Tissue sections from within PDT-treated tumors showed regions of coagulative central necrosis admixed with small numbers of inflammatory cells, and arterial thrombosis. Viable adenocarcinoma was seen in the surrounding areas.
CONCLUSION: These results suggest that PDT can be successfully deployed to treat peripheral lung cancers using navigational bronchoscopy. Furthermore, damage to surrounding noncancerous tissues can be minimized with accurate placement of the optical fiber. Studies of this modality to treat peripheral lung cancers in humans may be warranted.
コメント：末梢の肺腫瘍にレーザー治療(PDT)を試みた。PDTにより、腫瘍を分散させることが出来る可能性が示された。さらに、光ファイバーを正確に配置させることで、正常組織へのダメージも最小限にでき得る（カンナ動物病院 山中一大-2018.12.11）。
Martin-Flores M, Cortright CC, Koba SJ. Removal of an Airway Foreign Body via Flexible Endoscopy Through a Laryngeal Mask Airway. J Am Anim Hosp Assoc 2015;51:325-328.
ラリンゲルマスクを介した軟性鏡による気道異物除去の１例
A Silky terrier weighing 4.7 kg was presented with an airway foreign body after having aspirated a fragment of an orotracheal tube that was identified on radiological examination. Due to the small size of the patient, flexible endoscopy could not be performed through the lumen of a tracheal tube. Following IV induction of general anesthesia, the airway was instrumented with a laryngeal mask airway that was attached via a three-way connector to an anesthesia breathing circuit. A flexible endoscope was passed through the free port of the connector. That arrangement allowed for the passage of an endoscope through the lumen of the laryngeal mask airway and into the trachea without interrupting the continuous supply of O2 and sevoflurane.
コメント：4.7kgのシルキーテリアで、ラリンゲルマスクを通し、軟性気管支鏡を気道内に揷入することで気道異物を除去した。ラリンゲルマスクを用いることで、酸素や吸入麻酔薬の供給を妨げずに内視鏡を揷入する事が出来た（カンナ動物病院 山中一大-2018.12.11）。
Queen EV, Vaughan MA, Johnson LR. Bronchoscopic debulking of tracheal carcinoma in 3 cats using a wire snare. J Vet Intern Med 2010;24:990-993.
ワイヤースネアを用いた３匹の猫における気管内腫瘍の気管支鏡的減容積術
コメント：３例の猫で気道内腫瘤において、気管支鏡およびワイヤースネアを用いた減容積手術を行った症例報告。当手技において、臨床症状の改善および生存期間の延長が認められた。またこの３症例において、手技上の合併症や麻酔の副反応は認められなかった(Sho Animal Clinic-草場翔央-2019.5.2）
