多発胃癌の検討―臨床診断の立場から

Multiple Gastric Cancer: From the Clinical Viewpoint

要旨　当院で外科的もしくは内視鏡的に切除された胃癌1,871例のうち，同時性多発胃癌は156例(8.3％)であった．これらのうち切除標本で指摘可能な130例279病変を対象とし，術前診断，見逃し病変の拾い上げ診断の検討を行った．術前正診率は68.5％であった．初回検査の正診率は，内視鏡検査はX線検査に比し有意に高かった．主病変と副病変問の距離には見逃し率に有意差はなく，見逃し率の高い病変は深達度m，最大径が5mm以下，また占拠部位では体上部と幽門部，小彎で，見逃し病変に多発癌としての特徴はなかった．拾い上げ診断能はX線検査53.5％，内視鏡検査41.9％で両者間に差はなかった．

　In 1,871 cases with surgically or endoscopically resected gastric cancer in our hospital, 156 cases (8.3%) with synchronous multiple gastric cancers were found. We reviewed 279 lesions from 130 cases which were detected by gross sections, and analyzed their preoperative diagnoses and missed lesions. The preoperative diagnostic rate of multiple gastric cancers was 68.5%. The sensitivity of the initial endoscopic examination was significantly higher than that of the initial roentgenographic examination. There was no correlation between the miss rate and the distance between each lesions. The characteristics of missed lesions were as follows: m cancer, less than 5 mm in diameter, located in the upper body, antrum or on the lesser curvature. The detection rates of x-ray and endoscopic examinations were 53.5% and 41.9% respectively, and there was no significant difference between them.