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Stomach and Intestine(Tokyo) Volume 29, Issue 7 （June 1994）

胃と腸 29巻7号（1994年6月発行）

Japanese English

今月の主題多発胃癌

主題

多発胃癌―X線診断の立場から―特に微小癌を除く副病変の術前診断の検討 Preoperative X-ray Diagnosis of Multiple Gastric Cancer 美園俊明 ^1,2 , 西俣寛人 ² , 掘雅英 ³ , 西俣嘉人 ² , 尾辻章宣 ⁴ , 中村勇一 ² , 野口昌宏 ² , 尾辻真人 ² , 大井秀久 ² , 新原亨 ² , 徳重浩一 ² , 児島豊史 ² , 徳田雅代 ² , 有馬暉勝 ² , 末永豊邦 ⁵ Toshiaki Misono ^1,2 , Hiroto Nishimata ² ¹鹿児島市医師会病院消化器内科 ²鹿児島大学医学部第2内科 ³今村病院消化器内科 ⁴尾辻外科病院 ⁵南風病院外科 ¹Department of Internal Medicine, Kagoshima Medical Association Hospital ²The Second Department of Internal Medicine, Faculty of Medicine, Kagoshima University キーワード：多発胃癌 , 頻度 , 術前X線診断 , 見直しX線診断 , 存在診断 Keyword: 多発胃癌 , 頻度 , 術前X線診断 , 見直しX線診断 , 存在診断 pp.643-655

発行日 1994年6月25日 Published Date 1994/6/25

DOI https://doi.org/10.11477/mf.1403105821

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要旨　切除胃癌1,603例の全割による組織検査の結果，247例の多発癌を検索しえた．このうち最大径6mm以上の副病変を対象にX線学的検討を行い，更に肉眼診断，肉眼型，組織型，深達度，発生部位や癌の大きさを対比し下記の結果を得た．多発癌の頻度は15.4％で，早期癌で18.0％，進行癌で12.1％であった．術前X線診断で確診できた病変は34.9％で，存在を指摘できなかった病変は49.6％であった．見直し診断では診断率が向上したが，やはり27.2％は存在診断ができなかった．術前に診断できない病変は平坦型や浅い陥凹型の粘膜内癌が多く，特に未分化型に多かった．発生部位では，ほぼ全領域に分布していたが，前壁，大彎，前庭部の診断率が低かった．

　One thousand six hundred and three cases of gastric cancer were evaluated histologically by serial sectioning of the whole specimen for the past 15 years, and 247 cases of multiple gastric cancer were detected. The incidence of multiplicity was 18.0% (153/851) in cases with early cancer, 12.1% (91/752) in cases with advanced cancer and 15.4% (247/1,603) as a total.

　In these lesions of multiple cancer, 149 accessory lesions excluding microcarcinomas less than 5 mm in diameter were analyzed for barium study. Fifty two out of 149 accessory lesions (34.9%) had been preoperatively diagnosed as being definitely malignant, 18 lesions (12.1%) as being possibly malignant, and 5 lesions (3.4%) as being probably malignant, but 74 lesions (49.6%) had not been detected prior to surgery.

　The careful retrospective analysis of the radiophotographs raised this rate of detection to 72.8%, however, the remainder (27.2%) were not demonstrated on radiophotographs.

　The accessory lesions being overlooked by preoperative barium examinations correlated with morphologic feature, histological type, size of intramucosal invasion, depth of invasion and localization. Most of the accessory lesions overlooked by this technique were small in size, flat or slightly depressed, and limited to the mucosa. The undifferentiated type of cancer was more difficult to detect than the differentiated type. The accessory lesions were distributed throughout the stomach as shown in Fig. 14 and Fig. 15. However, there was a tendency that the overlooked accessory lesions were located on the anterior wall, the greater curvature and the antrum of the stomach.