1 0 0 0 OA 若年者胃癌

著者
福富 久之 吉田 茂昭 河村 譲 平嶋 登志夫 吉森 正喜 小黒 八七郎 広田 映伍 崎田 隆夫
出版者
一般社団法人 日本消化器内視鏡学会
雑誌
日本消化器内視鏡学会雑誌 (ISSN:03871207)
巻号頁・発行日
vol.19, no.4, pp.408-417, 1977 (Released:2011-05-09)
参考文献数
26

Clinical and histological studies on gastric carcinoma has been reported by many authors, but we have as yet limited information of gastric carcinoma in the young with special reference to early stage. In this paper 50 cases of gastric carcinoma patients less than 30 years of age in our hospital during 15 years period from 1962 to 1976 will be reported with comparative statistics. The cases were divided into two groups. One is the early carcinoma group in which cancerous invasion limited within submucosal layer. Another is the advanced carcinoma group in which deeper cancerous invasion than submucosal layer was detected. The incidence of gastric early carcinoma in the young was in 10 (1.4%) of 737 patients detected by gastric resection, and in 6 (1.2%) of 481 male and 4 (1.6%) of 256 female with early gastric carcinoma. As the initial symptoms in early gastric carcinoma group, gastric pain were present in 800. The duration of the symptoms were less than 6 months in 20% and longer than 1 year in 400. Macroscopically, all cases were of depressed type (IIc or IIc+III). Protruded type (I, IIa) early carcinoma could not be found in the young. Histologically, 9 out of 10 cases showed mucocellular adenocarcinoma, mostly having ulcer and ulcerscar in the center of depressed cancerous invasion. The degree of cancerous invasion was 6 in the mucosal layer and 4 in submucosal layer and no lymphatic metastasis was found except 1 case. Young early carcinoma was most often seen on the lesser curvature side, especially in the middle portion. Distribution pattern of intestinal metaplasia in the surrounding mucosa of gastric carcinoma was examined histologically, and metaplasia were shown in 6 cases of 10 specimens. In advanced carcinoma group, 40 cases of advanced carcinoma were studied, and this corresponds to 1.8 percent of all surgical cases in our experience. The female outnumbered male in ratio of 23 to 17. Gastric resection was performed in 31 of the 40 patients treated by laparotomy, and in 16 of 17 male, 15 of 23 female with laparotomy. Macroscopically, Borrmann f, Borrmann iV type carcinoma were predominantly found compared with other age groups. Especially Borrmann IV diffused type was seen in 320. We have no case of Borrmann I type which were found frequently in old patients. Lymphatic metastasis is positive in 34 cases of 40 cases. Histological investigation revealed mucocellar adenocarcinoma in 740. The entire stomach or middle portion of the stomach was predominantly involved region in advanced carcinoma group similar to that of early carcinoma group. Five year survival rate was noted in 200 of the 31 resectable cases of advanced carcinoma. Further studies of a greater number of gastric carcinoma in the young might be necessary.
著者
笹子 三津留 木下 平 丸山 圭一 岡林 謙蔵 田尻 久雄 吉田 茂昭 山口 肇 斉藤 大三 小黒 八七郎 石川 勉 松江 寛人 山田 達哉
出版者
一般社団法人日本消化器外科学会
雑誌
日本消化器外科学会雑誌 (ISSN:03869768)
巻号頁・発行日
vol.23, no.9, pp.2191-2195, 1990-09-01
被引用文献数
8 or 0

リンパ節転移の無い早期胃癌を特定化し局所切除をすればリンパ節郭清をともなった手術と同等の治療成績を挙げることが期待される.1962年から1985年までに国立がんセンター病院で切除された単発早期胃癌1,440例のリンパ節転移についての検討より,リンパ節転移を否定しうる病変は,IIb,2.0cm以下の潰瘍性変化の無いIIc,2.0cm以下のIIa,腺腫内癌であった.そこで安全誤差をいれて,(1)1.5cm以下のIIa,(2)1.5cm以下の胃炎類似型IIcまたはIIb,(3)腺腫内癌の3つを局所治療の適応とした.切除標本の組織学的検索結果により完全切除は厳重な経過観察,粘膜内断端陽性は外科的局所切除,粘膜下層浸潤もしくは脈管浸潤例はR1以上の胃切除を行うという治療体系を作った.現在までの11例中8例は局所切除のみで,3例では外科的切除が追加された.この治療体系は癌が根治する可能性を下げることなく局所切除を行える優れた治療体系である.