宮内 昭 先生のプロフィール

宮内 昭 先生

みやうち あきら

宮内 昭 先生

医療法人神甲会 隈病院 院長

 

専門分野

内分泌外科 甲状腺外科(甲状腺疾患、副甲状腺疾患、甲状腺がん、バセドウ病)

紹介

甲状腺・副甲状腺疾患の診療・研究に40年以上携わってきた第一人者。特に甲状腺がんの診断と治療を専門とし、この手術にともなう反回神経麻痺に対する頸神経ワナ・反回神経吻合による再建を日本で最初に考案・施行した。また急性化膿性甲状腺炎の原因となる一種の発生異常の存在を世界で初めて発見し、下咽頭梨状窩瘻と名付けた。カルシトニンのダブリングタイム(Ct-DT)が髄様がんの予後因子であることを世界で初めて報告し、最近ではサイログロブリンのダブリングタイム(Tg-DT)が乳頭がんの強力な予後因子であることを見出している。最近、小さい甲状腺乳頭癌が世界的に増加し、その取扱いが問題となっている。宮内の提唱により1993年から隈病院では世界で初めて低リスクの甲状腺微小乳頭癌に対して、非手術経過観察を行っており、大多数の微小癌は進行しないこと、少し進行してもその時点で手術を行えば手遅れとはならないこと、隈病院のような専門病院で手術を行っても、手術群の方が経過観察群より声帯麻痺などの不都合事象が多いことを明らかにした。この成果は2015年版アメリカ甲状腺学会の甲状腺腫瘍取扱いガイドラインに大きく取り上げられた。

略歴

1970年 大阪大学医学部卒業
1978年 医学博士取得
1979年 大阪大学医学部第二外科 助手
1979年 Wisconsin 大学 留学
1981年 香川医科大学第二外科 講師
1986年 香川医科大学第二外科 助教授
1998年 隈病院 副院長
1998年 大阪大学医学部 臨床教授(〜2000年)
2001年 隈病院 院長
2006年 日本医科大学 客員教授
2010年 Visiting Professor, University of Belgrade School of Medicine

所属学会・資格・役職など

医学博士
日本外科学会 指導医・専門医
日本外科学会 指導医
日本内分泌外科学会・日本甲状腺外科学会 内分泌外科・甲状腺外科専門医
日本甲状腺学会 甲状腺専門医
アジア内分泌外科学会 理事長(Chairman)
国際内分泌外科学会、アメリカ内分泌外科学会およびアメリカ甲状腺学会の会員

受賞・著書・論文など

【受賞】
日本内分泌学会甲状腺分科会七條賞、1985年
国際内分泌外科学会Best free paper、1987年
日本甲状腺学会三宅賞、2007年
日本内分泌学会Best Endocrine Surgeon of the Year、2008年、
AOTA (Asia Oceania Thyroid Association) Nagataki-FUJIFILM Prize、2015年

【著書】
音声回復のための反回神経再建術、インターメルク社、2001年
よくわかる甲状腺疾患のすべて(分担執筆)、永井書店、2004年
甲状腺・副甲状腺超音波診断アトラス、ベクトルコア社、2007年
甲状腺疾患の疾病管理テキスト、メディカルレビュー社、2009年
Surgery of the Thyroid and Parathyroid Gland, 2nd ed. Sounders, 2013, 分担執筆。
Textbook of Endocrine Surgery, 3rd ed. The Health Sciences Publisher, 2016, 分担執筆。
Thyroid Cancer, A Case-Based Approach, Springer, 2016, 分担執筆

【論文】
I. Managements of Thyroid Ca

【受賞】
日本内分泌学会甲状腺分科会七條賞、1985年
国際内分泌外科学会Best free paper、1987年
日本甲状腺学会三宅賞、2007年
日本内分泌学会Best Endocrine Surgeon of the Year、2008年、
AOTA (Asia Oceania Thyroid Association) Nagataki-FUJIFILM Prize、2015年

【著書】
音声回復のための反回神経再建術、インターメルク社、2001年
よくわかる甲状腺疾患のすべて(分担執筆)、永井書店、2004年
甲状腺・副甲状腺超音波診断アトラス、ベクトルコア社、2007年
甲状腺疾患の疾病管理テキスト、メディカルレビュー社、2009年
Surgery of the Thyroid and Parathyroid Gland, 2nd ed. Sounders, 2013, 分担執筆。
Textbook of Endocrine Surgery, 3rd ed. The Health Sciences Publisher, 2016, 分担執筆。
Thyroid Cancer, A Case-Based Approach, Springer, 2016, 分担執筆

【論文】
I. Managements of Thyroid Cancer
A. Proposal and initiation of active surveillance clinical trial of low-risk papillary microcarcinoma
1) Ito Y, Uruno R, Nakano K, Takamura Y, Miya A, Kobayashi K, Yokozawa T, Matsuzuuka F, Kuma S, Kuma K, Miyauchi A: An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid 13: 381-388, 2003.

2) Ito Y and Miyauchi A: A therapeutic strategy for incidentally detected papillary microcarcinoma of the thyroid. Nat Clin Pract Endocrinol Metab 3(3): 240-248, 2007.

3) Ito Y, Miyauchi A, Inoue H, Fukushima M, Kihara M, Higashiyama T, Tomoda C, Takamura Y, Kobayashi K, Miya A: An observation trial for papillary thyroid microcarcinoma in Japanese patients. World J Surg 34: 28-35, 2010.

4) Ito Y, Miyauchi A, Kihara M, Higashiyama T, Kobayashi K, Miya A.: Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid 24(1):27-34, 2014.

5) Ito Y and Miyauchi A: Nonoperative management of low-risk differentiated thyroid carcinoma. Current Opinion in Oncology 27(1): 15-20, 2015.

B. Proposal of calcitonin-doubling time as a potent prognostic factor for medullary thyroid carcinoma
1) Miyauchi A, Onishi T, Morimoto S, Takai S, Matsuzuka F, Kuma K, Maeda M, Kumahara Y: Relation of doubling time of plasma calcitonin levels to prognosis and recurrence of medullary thyroid carcinoma. Ann Surg 199: 461-6, 1984.

2) Miyauchi A, Matsuzuka F, Kuma K, Takai S, Nakamoto K, Nakamura K, Nanjo S, Maeda M: Evaluation of surgical results and prediction of prognosis in patients with medullary thyroid carcinoma by analysis of serum calcitonin levels. World J Surg 12: 610-5, 1988.

C. Proposal of thyroglobulin-doubling time as a potent prognostic factor for papillary thyroid carcinoma

1) Miyauchi A, Kudo T, Miya A, Kobayashi K, Ito Y, Takamura Y, Higashiyama T, Fukushima M, Kihara M, Inoue H, Tomoda C, Yabuta T, Masuoka H: Prognostic impact of serum thyroglobulin doubling-time under thyrotropin suppression in patients with papillary thyroid carcinoma who underwent total thyroidectomy. Thyroid 21(7): 707-716, 2011.

2) Miyauchi A, Kudo T, Kihara M, Higashiyama T, Ito Y, Kobayashi K and Miya A: Relationship of biochemically persistent disease and thyroglobulin-doubling time to age at surgery in patients with papillary thyroid carcinoma. Endocr J 60 (4): 415-421, 2013.

3) Miyauchi A, et al. Ki-67 labeling index is a predictor of postoperative persistent disease and cancer growth and a prognostic indicator in papillary thyroid carcinoma. Eur Thyroid J 2:57-64, 2013

D. Proposal of changes in serum thyroglobulin antibody content after total thyroidectomy as a surrogate prognostic indicator in patients with papillary thyroid carcinoma and detectable thyroglobulin antibody.
1) Tsushima Y, Miyauchi A, Ito Y, Kudo T, Masuoka H, Yabuta T, Fukushima M, Kihara M, Higashiyama T, Takamura Y, Kobayashi K, Miya A, Kikumori T, Imai T and Kiuchi T: Prognostic significance of changes in serum thyroglobulin antibody levels of pre- and post-total thyroidectomy in thyroglobulin antibody-positive papillary thyroid carcinoma patients. Endocr J 60: 871-876, 2013.

2) Yamada O1, Miyauchi A, Ito Y, Nakayama A, Yabuta T, Masuoka H, Fukushima M, Higashiyama T, Kihara M, Kobayashi K, Miya A: Changes in serum thyroglobulin antibody levels as a dynamic prognostic factor for early-phase recurrence of thyroglobulin antibody-positive papillary thyroid carcinoma after total thyroidectomy. Endocr J. 61: 961-965, 2014.

E. Preservation and reconstruction of the recurrent laryngeal nerve in thyroid cancer surgery
1) Miyauchi A, Matsusaka K, Kawaguchi H, Nakamoto K, Maeda M: Ansa-recurrent nerve anastomosis for vocal cord paralysis due to mediastinal lesions. Ann Thorac Surg 57: 1020-1, 1994.

2) Miyauchi A, Matsusaka K, Kihara M, Matsuzuka F, Hirai K, Yokozawa T, Kobayashi K, Kobayashi A, Kuma K: The role of ansa-to-recurrent-laryngeal nerve anastomosis in operations for thyroid cancer. Eur J Surg 164: 927-933, 1998.

3) Miyauchi A, Yokozawa T, Kobayashi K, Hirai K, Matsuzuka F, Kuma K.: Opposite ansa cervicalis to recurrent laryngeal nerve anastomosis to restore phonation in patients with advanced thyroid cancer. Eur J Surg 167(7): 540-1, 2001.

4) Miyauchi A, Ito Y, Miya A, Higashiyama T, Tomoda C, Takamura Y, Kobayashi K, Matsuzaka F: Lateral mobilization of the recurrent laryngeal nerve to facilitate tracheal surgery in patients with thyroid cancer invading the trachea near Berry's ligament. World J Surg 31: 2081-2084, 2007.

5) Miyauchi A, Inoue H, Tomoda C, Fukushima M, Kihara M, Higashiyama, Takamura Y, Ito Y, Kobayashi K, Miya A: Improvement in phonation following reconstruction of the recurrent laryngeal nerve in patients with thyroid cancer invading the nerve. Surgery 146: 1056-1062, 2009.

6) Miyauchi A, Masuoka H, Tomoda C, Takamura Y, Ito Y, Kobayashi K, Miya A: Laryngeal approach to the recurrent laryngeal nerve involved by thyroid cancer at the ligament of Berry. Surgery 152(1): 57-60, 2012.

7) Miyauchi A, Masuoka H, Yabuta T, Fukushima M, Kihara M, Higashiyama T, Takamura Y, Ito Y, Kobayashi K, Miya A.:: The ima approach for the quick identification of the right recurrent laryngeal nerve in thyroid cancer surgery. . Surg Today. 43: 225-228, 2012.

8) Maeda T, Saito M, Otsuki N, Morimoto K, Takahashi M, Iwaki S, Inoue H, Tomoda C, Miyauchi A, Nibu KI.: Quality of voice after surgical treatment for thyroid cancer. Thyroid. 23 (7): 847-853, 2013.

9) Kihara M, Miyauchi A, Yabuta T, Higashiyama T, Fukushima M, Ito Y, Kobayashi K, Miya A: Outcome of vocal cord function after partial layer resection of the recurrent laryngeal nerve in patients with invasive papillary thyroid cancer. Surgery 155 (1): 184-189, 2014.

F. Intraoperative neural monitoring for thyroid surgery
1) Randolph GW, Dralle H, the International Intraoperative Monitoring Study Group including Miyauchi A: Electrophysiologic Recurrent Laryngeal Nerve Monitoring During Thyroid and Parathyroid Surgery: International Standards Guideline Statement. The Laryngoscope 121: S1-S16, 2011.

2) Barczyński M, Randolph GW, Cernea CR, Dralle H, Dionigi G, Alesina PF, Mihai R, Finck C, Lombardi D, Hartl DM, Miyauchi A, Serpell J, Snyder S, Volpi E, Woodson G, Kraimps JL, Hisham AN; with the International Neural Monitoring Study Group.: External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International neural monitoring study group standards guideline statement. Laryngoscope 123: S1-S14, 2013.

3) Masuoka H, Miyauchi A, Higashiyama T, Yabuta T, Fukushima M, Ito Y, Kihara M, Kobayashi K, Yamada O, Nakayama A, Miya A: A prospective randomized study on injury of the external branch of the superior laryngeal nerve during thyroidectomy comparing intraoperative nerve monitoring and a conventional technique. Head Neck. 2014 May 21. doi: 10.1002/hed.23778. [Epub ahead of print]

4) Masuoka H, Miyauchi A, Yabuta T, Fukushima M, Miya A.: Innervation of the cricothyroid muscle by the recurrent laryngeal nerve. Head Neck. 2015 Jan 12. doi: 10.1002/hed.24015. [Epub ahead of print] , 2015.

G. Thyroid function in patients on L-thyroxine following total thyroidectomy for papillary thyroid carcinoma
1) Ito M, Miyauchi A, Morita S, Kudo T, Nishihara E, Kihara M, Takamura Y, Ito Y, Kobayashi K, Miya A, Kubota S, Amino N: TSH-suppressive doses of levothyroxine are required to achieve preoperative native serum triiodothyronine levels in patients who have undergone total thyroidectomy. Eur J Endocrinol 167: 373-378, 2012.
H. T3 thyrotoxicosis due to excess conversion of L-thyroxine in patients with massive metastases of follicular thyroid carcinoma
1) Miyauchi A, Takamura Y, Ito Y, Miya A, Kobayashi K, Matsuzuka F, Amino N, Toyoda N, Nomura E, Nishikawa M.: 3,5,3'-Triiodothyronine Thyrotoxicosis due to Increased Conversion of Administered Levothyroxine in Patients with Massive Metastatic Follicular Thyroid Carcinoma. J Clin Endocrinol Metab 93 (6): 2239-2242, 2008.

I. Postoperative care of patients undergoing thyroid surgery
1. Stretching exercise to reduce postoperative neck complaints in patients undergoing thyroid surgery
1) Takamura Y, Miyauchi A, Tomoda C, Uruno T, Ito Y, Miya A, Kobayashi K, Matsusuka F, Amino N, Kuma K: Stretching Exercises to Reduce Symptoms of Postoperative Neck Discomfort after Thyroid Surgery: Prospective Randomized Study. World J Surg 29: 775-779, 2005.

2. Prevention of tetany
1) Uruno T, Miyauchi A, Shimizu K, Tomoda C, Takamura Y, Ito Y, Miya A, Kobayashi K, Matsuzuka F, Amino N, Kuma K: A prophylactic infusion of calcium solution reduces the risk of symptomatic hypocalcemia in patients after total thyroidectomy. World J Surg 30(3): 304-308, 2006.

J. Diagnosis of metastatic lesions with measurements of thyroglobulin and calcitonin in FNA needle washout in papillary and medullary thyroid carcinoma
1) Uruno T, Miyauchi A, Shimizu K, Tomoda C, Takamura Y, Ito Y, Miya A, Kobayashi K, Matsuzuka F, Amino N, Kuma K: Usefulness of thyroglobulin measurement in fine-needle aspiration biopsy specimens for diagnosing cervical lymph node metastasis in patients with papillary thyroid cancer. World J Surg 29: 483-485, 2005.
2) Kudo T, Miyauchi A, Ito Y, Takamura Y, Amino N, Hirokawa M: Diagnosis of medullary thyroid carcinoma by calcitonin measurement in fine-needle aspiration biopsy specimens. Thyroid 17(7): 635-638, 2007.

K. Medullary thyroid carcinoma
1) Miyauchi A, Matsuzuka F, Hirai K, Yokozawa T, Kobayashi K, Kuma S, Kuma K, Futami H, Yamaguchi K: Unilateral surgery supported by germline RET oncogene mutation analysis in patients with sporadic medullary thyriod carcinoma. World J Surg 24 (11): 1367-1372, 2000.

2) Miyauchi A, Matsuzuka F, Hirai K, Yokozawa T, Kobayashi K, Ito Y, Nakano K, Kuma K, Futami H, Yamaguchi K: Prospective trial of unilateral surgery for nonhereditary medullary thyroid carcinoma in patients without germline RET mutations. World J Surg 26: 1023-1028, 2002.

3) Miyauchi A, Futami H, Hai N, Yokozawa T, Kuma K, Aoki N, Kosugi S, Sugano K, Yamaguchi K: Two germline missense mutations at codons 804 and 806 of the RET proto-oncogene in the same allele in a patient with multiple endocrine neoplasia type 2B without codon 918 mutation. Jpn J Cancer Res 90 (1): 1-5, 1999.

4) Kihara M, Miyauchi A, Yoshida H, Yamada O, Masuoka H, Yabuta T, Higashiyama T, Fukushima M, Ito Y, Kobayashi K, Miya A: Tandem germline RET mutations in a family pathogenetic for multiple endocrine neoplasia 2B, confirmed by a natural experiment. Eur Thyroid J 3:272-277, 2014.

L. Proposal of a new entity of thyroid cancer: Intrathyroidal epithelial thymoma (ITET) / CASTLE
1) Miyauchi A, Kuma K, Matsuzuka F, Matsubayashi S, Kobayashi A, Tamai H, Katayama S: Intrathyroidal epithelial thymoma: An entity distinct from squamous cell carcinoma of the thyroid. World J Surg 9: 128-35, 1985.

2) Dorfman DM, Shahsafaei A, and Miyauchi A: Intrathyroidal epithelial thymoma (ITET)/carcinoma showing thymus-like differentiation (CASTLE) exhibits CD5 immunoreactivity: new evidence for thymic differentiation. Histopathol 32: 104-109, 1998.

3) Ito Y, Miyauchi A, Nakamura Y, Miya A, Kobayashi K, Kakudo K: Clinicopathologic significance of intrathyroidal epithelial thymoma/carcinoma showing thymus-like differentiation. Am J Clin Pathol 127(2): 230-236, 2007.

II. Benign thyroid diseases
A. Acute suppurative thyroiditis / Pyriform sinus fistula
1) Takai S, Miyauchi A, Matsuzuka M, Kuma K, Kosaki G: Internal fistula as a route of infection in acute suppurative thyroiditis. Lancet 1: 751-2, 1979.

2) Miyauchi A, Matsuzuka F, Takai S, Kuma K, Kosaki G: Piriform sinus fistula. A route of infection in acute suppurative thyroiditis. Arch Surg 116: 66-9, 1981.

3) Miyauchi A, Matsuzuka F, Kuma K, Takai S: Piriform sinus fistula. An underlying abnormality common in patients with acute suppurative thyroiditis. World J Surg 14: 400-5, 1990.

4) Miyauchi A, Matsuzuka F, Kuma K, Katayama S: Piriform sinus fistula and the ultimobranchial body. Histopathology 20: 221-27, 1992.

5) Miyauchi A, Tomoda C, Uruno T, Takamura Y, Ito Y, Miya A, Kobayashi K, Matsuzuka F, Fukata S, Amino N, Kuma K: Computed tomography scan under a trumpet maneuver to demonstrate piriform sinus fistulae in patients with acute suppurative thyroiditis. Thyroid 15(12): 1409-1413, 2005.

6) Miyauchi A, Inoue H, Tomoda C,and Amino N: Evaluation of Chemocauterization Treatment for Obliteration of Pyriform Sinus Fistula as a Route of Infection Causing Acute Suppurative Thyroiditis. Thyroid 19(7): 789-793, 2009.

7) Miyauchi A: A new management algorithm for acute suppurative thyroiditis? Nature Reviews Endocrinology 6 (August): 424-426, 2010.

8) Masuoka H, Miyauchi A, Tomoda C, Inoue H, Takamura Y, Ito Y, Kobayashi K, Miya A: Imaging studies in sixty patients with acute suppurative thyroiditis. Thyroid 10(21): 1075-1080, 2011.

B. Graves’ disease
1) Miyauchi A, Amino N, Tamaki H, Kuma K: Coexistence of thyroid-stimulating and thyroid-blocking antibodies in a patient with Graves' disease who had transient hypothyroidism. Am J Med 85: 418-20, 1988.

2) Takamura Y,Nakano K, UrunoT, Ito Y, Miya A, Kobayashi K, Yokozawa T, Matsuzuka F, Kuma K and Miyauchi A: Changes in Serum TSH Receptor Antibody (TRAb) Values in Patients with Graves' Disease after Total or Subtotal Thyroidectomy. Endocrine Journal 50(5): 595-601, 2003.

I. Autotransplantation of the adrenal gland
1) Miyauchi A, Kihara M, Matsusaka K, Nishitani A, Nishiyama Y: Successful autotransplantation of an adrenal gland using a new method of omental wrapping: Report of a case. Surg Today (Jpn J Surg) 29: 960-962, 1999.

III. International group studies
1) Randolph GW, Dralle H, the International Intraoperative Nerve Monitoring Study Group including Miyauchi A : Electrophysiologic Recurrent Laryngeal Nerve Monitoring During Thyroid and Parathyroid Surgery: International Standards Guideline Statement. The Laryngoscope 121: S1-S16, 2011.

2) Schulte KM, Gill AJ, Barczynski M, Karakas E, Miyauchi A, Knoefel WT, Lombardi CP, Talat N, Diaz-Cano S, Grant CS: Classification of parathyroid cancer. Ann Surg Oncol 19 (8): 2620-8, 2012.

3) Barczyński M, Randolph GW, Cernea CR, Dralle H, Dionigi G, Alesina PF, Mihai R, Finck C, Lombardi D, Hartl DM, Miyauchi A, Serpell J, Snyder S, Volpi E, Woodson G, Kraimps JL, Hisham AN; with the International Neural Monitoring Study Group: External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International neural monitoring study group standards guideline statement. Laryngoscope 23 Suppl 4: S1-14, 2013.

IV. Domestic group studies
1) Sakurai A, Suzuki S, Kosugi S, Okamoto T, Uchino S, Miya A, Imai T, Kaji H, Komoto I, Miura D, Yamada M, Uruno T, Horiuchi K, Miyauchi A, Imamura M, and MEN Consortium of Japan: Multiple endocrine neoplasia type 1 in Japan: establishment and analysis of a multicentre database. Clinical Endocrinology 76: 533-539, 2012.

2) Sugitani I, Miyauchi A, Sugino K, Okamoto T, Yoshida A, Suzuki S: Prognostic factors and treatment outcomes for anaplastic thyroid carcinoma: ATC research consortium of Japan cohort study of 677 patients. World J Surg 36(6): 1247-1254, 2012.
3) Yamazaki M, Suzuki SI, Kosugi S, Okamoto T, Uchino S, Miya A, Imai T, Kaji H, Komoto I, Miura D, Yamada M, Uruno T, Horiuchi K, Sato A, Miyauchi A, Imamura M, Sakurai A: MEN Consortium of Japan. Delay in the diagnosis of multiple endocrine neoplasia type 1: typical symptoms are frequently overlooked. . Endocr J 59: 797-807, 2012.

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