呼吸器内科

当科では、肺癌を中心とした胸部悪性疾患、細菌性肺炎などの呼吸器感染症、気管支喘息などのアレルギー疾患、間質性肺疾患など、呼吸器疾患全般を幅広くカバーした診療を行っています。また、これらの疾患は全身の臓器にまたがっていることが多く、他の診療科と密に連携して治療を行っています。さらに、当科の最大の特徴として硬性気管支鏡を含めた呼吸器インターベンションに積極的に取り組んでおり、他院では対応できない紹介患者様も広く受け入れています。

スタッフは、呼吸器専門医/指導医(日本呼吸器学会)、気管支鏡専門医/指導医(日本呼吸器内視鏡学会)、がん治療認定医(日本がん治療認定医機構)、がん薬物療法専門医(日本臨床腫瘍学会)である常勤医師と、呼吸器内科レジデント・専攻医が診療にあたっています。

岡山医療センターには、呼吸器科領域全般の多岐にわたる症例が県内外より集まっており、呼吸器系専門病棟(10階B病棟は呼吸器内科と呼吸器外科で構成され、病床数48床)を中心に常時40～50人、年間1000人を超える入院患者に対応しています。呼吸器内科と呼吸器外科とが同じフロアで診療しているため、疾患に応じてシームレスで円滑なチーム医療が達成されています。外来は常勤医師が交替で休みなく毎日行っており、１日に30～50名の患者が来院しています。呼吸器内科は24時間オンコール体制を組んでおり、呼吸器インターベンションを含む高度な医療を提供しています。

● 胸部異常陰影に対する精査： 気管支鏡検査，CTガイド下生検
 肺癌に対する治療： 化学療法，放射線療法，手術，免疫療法，緩和治療
 気道閉塞などに対する呼吸器インターベンション
 感染性肺炎に対する治療： 起炎病原体の推定，適切な抗菌剤の選択
 間質性肺疾患に対する検査，治療： クライオバイオプシー，抗線維化剤，ステロイドパルス療法，免疫抑制剤を用いた治療など
 慢性閉塞性肺疾患(COPD)，肺気腫： 気管支拡張剤吸入療法，気胸に対する気管支充填材EWS留置，経気管支肺容量減量術(BLVR)
 慢性呼吸不全： 在宅酸素療法(HOT)の導入，呼吸リハビリテーション，人工呼吸管理
 気管支喘息に対する治療： ステロイド吸入，気管支拡張剤吸入療法，生物学的製剤
 その他，呼吸器希少疾患など

1) 気管支鏡検査

年間約300～350例前後の症例に気管支鏡検査を行っています。ガイドシース法、超音波気管支鏡ガイド下針生検(EBUS-TBNA、EUS-B-FNA)、超音波気管支鏡ガイド下ミニ鉗子生検(EBUS-MFB)などの最先端のデバイスを用いた検査を行っており、さらに、仮想気管支内視鏡(ナビゲーションシステム)や迅速細胞診(Rose: rapid on-site cytological evaluation)を組み合わせることで診断率の向上を図っています。また、2021年度よりクライオバイオプシーを導入しています。これは、凍結剤(炭酸ガス)で冷却したクライオプローブを用いて、組織を凍結させて採取する技術です。肺癌や間質性肺炎の診断のために十分な組織検体を採取することに加え、気管支内の喀痰、血液の塊、あるいは異物除去、悪性気道狭窄の治療を行うことができます。

2) ガイドラインに準じた肺癌の治療

日本肺癌学会「肺癌診療ガイドライン」に基づいた治療を提供しています。細胞障害性抗癌剤(いわゆる従来の抗癌剤)だけでなく、遺伝子診断や免疫染色結果に基づく分子標的薬、免疫チェックポイント阻害剤を用いた治療を積極的に行っています。近年治療法の進歩が目覚ましく、ガイドラインは毎年のように改訂されておりますが、最新の指針に沿った治療法を提供できるように心がけています。また、科学的根拠に乏しい治療後期の患者さんに対しても、「決して諦めない肺癌治療」をモットーに診療しております(詳しくは「地域がん診療連携拠点病院」のホームページに記載しています。ご参照下さい)。

3) 呼吸器インターベンション

全身麻酔下に硬性気管支鏡(太く硬い金属の筒を気管内に挿入)下で、気道狭窄に対するシリコンステント挿入などの高度な手技を行っています。中国・四国地方では当院を含め数施設でしか行っていません。また、内視鏡の各種デバイスを用いて軟性気管支鏡下の内視鏡治療にも精通し積極的に治療を行っており、県内外から可及的に処置を要する患者様を受け入れています。

4)　気管支喘息の治療

ステロイド/長時間作動型β2刺激剤吸入療法のみならず、生物学的製剤(オマリズマブ、メポリズマブ、ベンラリズマブ、デュピルマブ、テゼペルマブなど)の有用性が示されており、コントロールが難しい患者さんに導入しています。

5) 経気管支肺容量減量術(BLVR：Bronchoscopic Lung Volume Reduction)

当院では2024年9月よりBLVRを行っております。これは重症肺気腫患者に対して行われ、気管支鏡を用いて気管支内に一方向弁を留置することで、治療対象の肺をしぼませて容量を減らす内視鏡治療です。2023年12月に本邦でも認可された最新の治療法で、肺気腫患者の肺機能や運動能、生存期間を改善させる可能性があります。

日本呼吸器学会　認定施設
日本呼吸器内視鏡学会　認定施設
日本がん治療医認定機構　認定研修施設
日本臨床腫瘍学会　認定研修施設

2023年度主要入院患者数：新入院患者数1,167人

疾患	患者数
肺がん	468
胸部異常陰影・検査	197
感染性肺炎	149
非感染性肺炎	143
胸膜疾患	59
気管支・肺血管疾患	50
COVID-19	25
気管支喘息	25
COPD・呼吸不全	20
悪性腫瘍関連	10
その他	21
合計	1,167

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41. Tamura T, Ninomiya K, Kubo T, Kuyama S, Tachibana S, Inoue K, Chikamori K, Kudo K, Ochi N, Harada D, Maeda Y, Kiura K. Short-term safety of an anti-severe acute respiratory syndrome coronavirus 2 messenger RNA vaccine for patients with advanced lung cancer treated with anticancer drugs: A multicenter, prospective, observational study. Thoracic Cancer 2021;13(3):453-459.
42. Watanabe H, Ichihara E, Kayatani H, Makimoto G, Ninomiya K, Nishii K, Higo H, Ando C, Okawa S, Nakasuka T, Kano H, Hara N, Hirabae A, Kato Y, Ninomiya T, Kubo T, Rai K, Ohashi K, Hotta K, Tabata M, Maeda Y, Kiura K. VEGFR2 blockade augments the effects of tyrosine kinase inhibitors by inhibiting angiogenesis and oncogenic signaling in oncogene-driven non-small-cell lung cancers. Cancer Science 2021;112(5):1853-1864.
43. Nishii K, Ohashi K, Watanabe H, Makimoto G, Nakasuka T, Higo H, Ninomiya K, Kato Y, Kubo T, Rai K, Ichihara E, Hotta K, Tabata M, Maeda Y, Kiura K. Triple therapy with osimertinib, bevacizumab and cetuximab in EGFR-mutant lung cancer with HIF-1α/TGF-α expression. Oncology Letters 2021;22(3):639.
44. Kano H, Ichihara E, Watanabe H, Nishii K, Ando C, Nakasuka T, Ninomiya K, Kato Y, Kubo T, Rai K, Ohashi K, Hotta K, Tabata M, Maeda Y, Kiura K. SHP2 Inhibition Enhances the Effects of Tyrosine Kinase Inhibitors in Preclinical Models of Treatment-naïve ALK-, ROS1-, or EGFR-altered Non-small Cell Lung Cancer. Molecular Cancer Therapeutics 2021;20(9):1653-1662.
45. Nakasuka T, Ohashi K, Watanabe H, Kubo T, Matsumoto S, Goto K, Hotta K, Maeda Y, Kiura K. A case of dramatic reduction in cancer-associated thrombus following initiation of pembrolizumab in patient with a poor performance status and PD-L1 + lung adenocarcinoma harboring CCDC6-RET fusion gene and NF1/TP53 mutations. Lung Cancer 2021;156:1-4.
46. Hara N, Ichihara E, Harada D, Inoue K, Fujiwara K, Hosokawa S, Kishino D, Kawai H, Ochi N, Oda N, Hotta K, Maeda Y, Kiura K. Significance of PD-L1 expression in the cytological samples of non-small cell lung cancer patients treated with immune checkpoint inhibitors. Journal of Cancer Research and Clinical Oncology 2021;147(12):3749-3755.
47. Nishii K, Inoue M, Obata H, Ueda Y, Kozuki T, Yamasaki M, Moritaka T, Awaya Y, Sugimoto K, Gemba K, Kuyama S, Ichikawa H, Shibayama T, Kubota T, Kodani M, Kishino D, Fujimoto N, Ishikawa N, Tsubata Y, Ishii T, Fujitaka K, Hotta K, Kiura K. Novel prospective umbrella-type lung cancer registry study for clarifying clinical practice patterns: CS-Lung-003 study protocol. Thoracic Cancer 2021;12(5):725-731.
48. Ochi N, Ichihara E, Takigawa N, Harada D, Inoue K, Shibayama T, Hosokawa S, Kishino D, Harita S, Oda N, Hara N, Hotta K, Maeda Y, Kiura K. The effects of antibiotics on the efficacy of immune checkpoint inhibitors in patients with non-small-cell lung cancer differ based on PD-L1 expression. European Journal of Cancer 2021;149:73-81.
49. Ochi N, Ichihara E, Takigawa N, Harada D, Inoue K, Shibayama T, Hosokawa S, Kishino D, Harita S, Oda N, Hara N, Hotta K, Maeda Y, Kiura K. Response to letter re: The effects of antibiotics on the efficacy of immune-checkpoint inhibitors in non-small cell lung cancer patients differ according to PD-L1 expression. European Journal of Cancer 2021;157:523-524.
50. Hosokawa S, Ichihara E, Bessho A, Harada D, Inoue K, Shibayama T, Kishino D, Harita S, Ochi N, Oda N, Hara N, Hotta K, Maeda Y, Kiura K. Erratum to: Impact of previous thoracic radiation therapy on the efficacy of immune checkpoint inhibitors in advanced non-small-cell lung cancer. Japanese Journal of Clinical Oncology 2021;51(8):1348.
51. Ichihara E, Harada D, Inoue K, Shibayama T, Hosokawa S, Kishino D, Harita S, Ochi N, Oda N, Hara N, Hotta K, Maeda Y, Kiura K. Characteristics of patients with EGFR-mutant non-small-cell lung cancer who benefited from immune checkpoint inhibitors. Cancer Immunol Immunother 2021;70(1):101-106.
52. Hosokawa S, Ichihara E, Bessho A, Harada D, Inoue K, Shibayama T, Kishino D, Harita S, Ochi N, Oda N, Hara N, Hotta K, Maeda Y, Kiura K. Impact of previous thoracsic radiation therapy on the efficacy of immune checkpoint inhibitors in advanced non-smasll-cell lung cancer. Jpn J Clin Oncol 2021;51(2):279-286.
53. Tanzawa S, Ushijima S, Shibata K, Shibayama T, Bessho A, Kaira K, Misumi T, Shiraishi K, Matsutani N, Tanaka H, Inaba M, Haruyama T, Nakamura J, Kishikawa T, Nakashima M, Iwasa K, Fujiwara K, Kohyama T, Kuyama S, Miyazawa N, Nakamura T, Miyawaki H, Ishida H, Oda N, Ishikawa N, Morinaga R, Kusaka K, Fujimoto N, Yokoyama T, Gemba K, Tsuda T, Nakagawa H, Ono H, Shimizu T, Nakamura M, Kusumoto S, Hayashi R, Shirasaki H, Ochi N, Aoe K, Kanaji N, Kashiwabara K, Inoue H, Seki N. A phase II study of S-1 and cisplatin with concurrent thoracic radiotherapy followed by durvalumab for unresectable, locally advanced non-small-cell lung cancer in Japan (SAMURAI study). Ther Adv Med Oncol 2021;13:1758835921998588.
54. Kudo K, Kawakado K, Kawajiri T, Nishi T, Makimoto G, Tamura T, Kuyama S, Tanimoto M. Dramatic response of brain metastasis from EGFR-mutation-positive NSCLC to dacomotinib. Intern Med 2020;59(14):1739-1740.
55. Okawa S, Fujiwara K, Shimonishi A, Matsuura H, Ozeki T, Nishimura J, Kayatani H, Minami D, Shinno Y, Sato K, Ota K, Shibayama T. Rapidly Progressive Acute Kidney Injury Associated with Nivolumab Treatment. Case Rep Oncol 2020;13(1):85-90.
56. Higo H, Miyahara N, Taniguchi A, Senoo S, Itano J, Watanabe H, Oda N, Kayatani H, Ichikawa H, Shibayama T, Kajimoto K, Tanimoto Y, Kanehiro A, Maeda Y, Kiura K; OKAYAMA respiratory disease study group (ORDSG). Deterioration of high-resolution computed tomography findings predicts disease progression after initial decline in forced vital capacity in idiopathic pulmonary fibrosis patients treated with pirfenidone. Respir Investig 2020;58(3):185-189.
57. Senoo S, Miyahara N, Taniguchi A, Oda N, Itano J, Higo H, Hara N, Watanabe H, Kano H, Suwaki T, Fuchimoto Y, Kajimoto K, Ichikawa H, Kudo K, Shibayama T, Tanimoto Y, Kuyama S, Kanehiro A, Maeda Y, Kiura K; Okayama Respiratory Disease Study Group (ORDSG). Nintedanib can be used safely and effectively for idiopathic pulmonary fibrosis with predicted forced vital capacity ≤ 50%: A multi-center retrospective analysis. PLoS One 2020;15(8):e0236935.
58. Ohashi K, Ninomiya K, Yoshioka H, Bessho A, Shibayama T, Aoe K, Ishikawa N, Kozuki T, Kawai H, Kuyama S, Miyoshi S, Fujitaka K, Obata H, Tsubata Y, Awaya Y, Inoue M, Inoue K, Horita N, Yanai H, Hotta K, Kiura K. Impact of HER2 expression on EGFR-TKI treatment outcomes in lung tumors harboring EGFR mutations: A HER2-CS study subset analysis. Lung Cancer 2020;150:83-89.
59. Ichihara E, Harada D, Inoue K, Sato K, Hosokawa S, Kishino D, Watanabe K, Ochi N, Oda N, Hara N, Hotta K, Maeda Y, Kiura K. The impact of body mass index on the efficacy of anti-PD-1/PD-L1 antibodies in patients with non-small cell lung cancer. Lung Cancer 2020;139:140-145.
60. Makimoto G, Hotta K, Oze I, Ninomiya K, Nakanishi M, Hara N, Kano H, Watanabe H, Hata Y, Nishii K, Nakasuka T, Itano J, Ninomiya T, Kubo T, Ohashi K, Ichihara E, Minami D, Sato A, Tabata M, Maeda Y, Kiura K. Patients' preferences and perceptions of lung cancer treatment decision making: results from Okayama lung cancer study group trial 1406. Acta Oncol 2020;59(3):324-328.
61. Ozeki T, Fujiwara K, Shimonishi A, Nishimura J, Okawa S, Takada K, Kayatani H, Minami D, Sato K, Shibayama T. Bilateral Testicular Metastases from Lung Adenocarcinoma Showing an Objective Response to Nivolumab: A Case Report and Review of the Literature. Intern Med 2019;58(22):3277-3282.
62. Okawa S, Kayatani H, Fujiwara K, Ozeki T, Takada K, Iwamoto Y, Minami D, Sato K, Shibayama T. Pembrolizumab-induced Autoimmune Hemolytic Anemia and Hemophagocytic Lymphohistiocytosis in Non-small Cell Lung Cancer. Intern Med 2019;58(5):699-702.
63. Takigawa Y, Fujiwara K, Saito T, Nakasuka T, Ozeki T, Okawa S, Takada K, Iwamoto Y, Kayatani H, Minami D, Sato K, Nagao M, Shibayama T. Rapidly Progressive Multiple Cavity Formation in Necrotizing Pneumonia Caused by Community-Acquired Methicillin-resistant Staphylococcus aureus Positive for the Panton-Valentine Leucocidin Gene. Intern Med 2019;58(5):685-691.
64. Minami D, Ozeki T, Okawa S, Takada K, Iwamoto Y, Kayatani H, Sato K, Fujiwara K, Shibayama T. Comparing the Clinical Performance of the New 19-G ViziShot FLEX and 21- or 22-G ViziShot 2 Endobronchial Ultrasound-guided Transbronchial Needle Aspiration Needles.　Intern Med 2018;57(24):3515-3520.
65. Minami D, Kayatani H, Sato K, Fujiwara K, Shibayama T, Yonei T, Sato T. Clinical Characteristics of Severe Refractory Asthma Associated with the Effectiveness of Bronchial Thermoplasty. Acta Med Okayama 2019;73(2):155-160.
66. Minami D, Takigawa Y, Kayatani H, Sato K, Fujiwara K, Shibayama T. Transoesophageal ultrasound-guided bronchoscopic aspiration of a superior mediastinal tumour using the BF-UC290F instrument. Respirol Case Rep 2019;7(5):e00427.
67. Minami D, Kayatani H, Sato K, Fujiwara K, Shibayama T. Effectiveness of benralizumab for allergic and eosinophilic predominant asthma following negative initial results with omalizumab. Respirol Case Rep 2018;7(1).
68. Okawa S, Shibayama T, Shimonishi A, Nishimura J, Ozeki T, Takada K, Kayatani H, Minami D, Sato K, Fujiwara K, Yonei T, Sato T, Suno M. Success of Crizotinib Combined with Whole-Brain Radiotherapy for Brain Metastases in a Patient with Anaplastic Lymphoma Kinase Rearrangement-Positive Non-Small-Cell Lung Cancer. Case Rep Oncol 2018;11(3):777-783.
69. Ninomiya T, Ishikawa N, Inoue K, Kubo T, Yasugi M, Shibayama T, Maeda T, Fujitaka K, Kodani M, Yokoyama T, Kuyama S, Ochi N, Ueda Y, Miyoshi S, Kozuki T, Amano Y, Kubota T, Sugimoto K, Bessho A, Ishii T, Watanabe K, Oze I, Hotta K, Kiura K. Phase 2 Study of Afatinib Alone or Combined With Bevacizumab in Chemonaive Patients With Advanced Non-Small-Cell Lung Cancer Harboring EGFR Mutations: AfaBev-CS Study Protocol. Clin Lung Cancer 2019;20(2):134-138.
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1. 藤原慶一．緩和医療：終末期医療．日本臨床腫瘍学会（編） 新臨床腫瘍学, 南江堂 2024年, pp.715-718． 2. 松岡涼果，藤原慶一，市川健，大森洋樹，中村愛理，藤原美穂．慢性気道感染症と鑑別を要し，クライオ肺生検で診断したIgG4関連呼吸器疾患の1例．日本呼吸器学会雑誌2023;12(3):114-118.
3. 白羽慶祐, 瀧川雄貴, 佐藤賢, 山下真弘, 井上智敬, 中村愛理, 藤原美穂, 藤原慶一, 神農陽子, 柴山卓夫．多形腺腫摘出10年後に認められた肺転移に対してEUS-B-FNAで診断した1例．気管支学2023;45(6): 425-430.
4. 白羽慶祐，工藤健一郎，藤原慶一，光宗翔，吉田秀行，柴山卓夫．脳室腹腔短絡術によりオシメルチニブ内服が可能となった肺癌髄膜癌腫症の1例．日呼吸誌2023;12(2):93-97.
5. 瀧川雄貴，佐藤賢，工藤健一郎，松本奨一朗，栗林忠弘，大西桐子，光宗翔，渡邉洋美，佐藤晃子，藤原慶一．軟性気管支鏡下に高周波スネアにて切除しえた術後気管支内転移した胸腺腫の1例．気管支学2022;44(2):171-176.
6. 瀧川雄貴，渡邉洋美，佐藤賢，永喜多敬奈，神農陽子，藤原慶一．超音波気管支鏡ガイド下針生検にて診断した胸腺上皮性腫瘍の2例．日呼吸誌2022;11(4):178-182.
7. 瀧川雄貴，工藤健一郎，佐藤賢，井上智敬，大西桐子，光宗翔，渡邉洋美，佐藤晃子，藤原慶一，柴山卓夫．繰り返すEWS気管支充填術にて外科治療を回避し，有瘻性膿胸の治療に成功した1例．気管支学2022;44(4):300-304.
8. 津野夏美，瀧川雄貴，佐藤賢，光宗翔，渡邉洋美，工藤健一郎，佐藤晃子，藤原慶一，岩本康男，柴山卓夫．大腸癌縦隔リンパ節転移気管浸潤による気道狭窄に対し気道インターベンションを施行し，呼吸機能が改善した1例．気管支学2022;44(6):432-436.
9. 山原美穂，藤原慶一，栗林忠弘，松岡涼果，牧田雅典，柴山卓夫．珪肺に合併し，閉塞性肺炎と前縦隔腫瘤を契機に診断された形質芽球性リンパ腫の1例．日呼吸誌2022;11(2):103-108.
10. 瀧川雄貴，佐藤賢，光宗翔，岩本佳隆，工藤健一郎，藤原慶一．高周波スネアを用いて気管支鏡下に切除した気管支過誤腫の8例．日呼吸誌2022;11(2):113-116.
11. 瀧川雄貴，佐藤賢，栗林忠弘，大西桐子，光宗翔，松浦宏昌，渡邉洋美，工藤健一郎，藤原慶一．硬性気管支鏡下に切除した縫合糸による気管支異物肉芽腫の1例．気管支学2021;43(5):468-472.
12. 藤原慶一．緩和医療：終末期医療．日本臨床腫瘍学会（編）南江堂 2021年．新臨床腫瘍学　pp.361-364.
13. 山原美穂，藤原慶一，下西惇，松浦宏昌，西村淳，尾関太一，萱谷紘枝，南大輔，佐藤賢，柴山卓夫．EGFR遺伝子変異陽性肺腺癌に対してニボルマブが奏効した1例．呼吸臨床 2020;4(6):No.e00102.
14. 工藤健一郎, 市原英基．COVID-19における肺炎.癌と化学療法2020;47(12):1657-1661.
15. 瀧川雄貴，南大輔，佐藤賢，西村淳，尾関太一，大川祥，髙田健二，萱谷紘枝，藤原慶一，柴山卓夫．食道に接する肺腺癌の診断にEUS-B-FNAが有用であった1例．気管支学2019;41(3):298-302.
16. 瀧川雄貴，佐藤賢，南大輔，西村淳，尾関太一，大川祥，高田健二，萱谷紘枝，藤原慶一，柴山卓夫．大腸癌気管分岐部転移に対し気管支動脈塞栓術後にDumon YⓇステントを留置した1例．気管支学2019;41(4):401-406.