早期の残胃癌の特徴―診断のポイント―X線検査

Roentogen Diagnosis of Early Carcinoma of the Postoperative Stomach Previous Gastrectomy for Carcinoma

要旨　胃癌術後の残胃癌40例を手術不能進行癌，手術可能進行癌，早期癌に分けて，部位別頻度と経過年数を調べた．その結果，術後5年以内の症例では進行癌は吻合部縫合部に多く，早期癌は残胃部に多くみられた．次に，早期発見のためのX線検査法を述べた．残胃部，縫合部，吻合部を意識して撮影することが基本である．検査は二重造影を中心として行い，それぞれの部の正面像と側面像の2方向撮影を目安とし，空気とバリウムをその都度追加する必要を認めた．さらに，症例のX線像を呈示することにより，縫合部では小彎のペッツを目印として所見を読影し，吻合部では小腸との境界部に注意することを強調した．特に陥凹型の早期癌では所見が軽微なため詳細な描出が必要であった．

　40 cases of carcinoma (17 unresectable advanced cancers, 13 resectable advanced cancers, 10 early cancers) of the gastric remnant previous to gastrectomy for cancer were investigated. Most advanced carcinomas detected within 5 years after operation are situated in the anastomosis and suture, which suggests that they have been missed at the initial operation. On the other hand early cancers were discovered in the remnant so it was considered that cancer might easily occur in the remnant. It is necessary for radiologists to recognize that the upper third of the normal stomach is considered to correspond very closely to the postoperative stomach and to take pictures of the gastric remnant, the area if suture and the area of anastomosis.

　We investigated many figures of the cases and confirmed that the double contrast method is best suited for detecting early carcinoma of the gastric remnant. However, the frontal and lateral double contrast view of the region of the suture and anastomosis is also of great help for making a diagnosis of carcinomas in this region.

　1) Department of Gastroenterology, Social Health Insurance Medical Center, Tokyo

　2) Department of Pathology, Social Health Insurance Medical Center, Tokyo

　3) Department of Radiology, Social Health Insurance Medical Center, Tokyo