吐血を主訴とした胃癌の6例

Six Cases of Gastric Carcinoma with Chief Complaint of Hematemesis

　胃癌の大部分は腫瘤の崩壊によって潰瘍を形成し，その表面から出血する．しかし，胃潰瘍の揚合にみられるような大量出血をみることは稀で，潜血反応で認められる程度の微量出血であることが多い¹⁾．筆者らは最近，6例の吐血を主訴とする胃癌症例を経験したが，1例を除き，癌性潰瘍の大きさや深達度は必ずしも高度なものではなく，全例とも十分根治手術可能であった．これらの症例を供覧するとともに，顕出血を主訴とする胃癌症例の術前診断，切除胃標本の性状等について若干の文献的考察を加えて検討してみた．

症例

　〔症例1〕26歳　男

　生来，健康で特に自覚症状はなかった．通勤途中，約400mlの吐血をし，当院外科に入院した．入院直後，再度約300mlの吐血をした．

　胃X線所見：2度のX線検査で特記すべき所見を発見できず，胃内視鏡診断後，3度目のX線検査で，胃体上部大彎に不整皺襞集中を認めた．

　胃内視鏡所見：胃体上部大彎に皺襞集中を伴った辺縁不整な潰瘍があり，Ⅱc＋Ⅲ型早期胃癌と診断した．

　胃生検でgroupⅤと診断し，幽門側胃亜全摘出術（リンパ節廓清度R₂）を施行した．

　切除胃肉眼所見：胃体上部大彎に1.5×1.2cm大の皺襞集中を伴った不整潰瘍があり，その潰瘍底部に露出した血管の断端を認めた．組織学的所見はTable6参照．

　Of 100 surgically treated cases for primary gastric cancer for the past 4 years and 10 months, 6 (6 per cent) had chief complaint of hematemesis. The age of these bleeding cancer cases varied from the twenties to sixties. There was not a case of massive bleeding in need of emergency operation. In preoperative diagnosis endoscopy was superior to x-ray. Early endoscopy is recommended to precede radiography. Except for case 1, lesions centered around the posterior wall of the upper and middle parts of the body in resected specimens. Lymphatic invasions of cancer cells around the ulcers were of more than moderate degree except in case 1. Advanced carcinoma simulating early one was seen in more than half the number (4 out of 6). Bleeding gastric cancer did not necessarily have a large crater.

　Histologically, all cases were tubular adenocarcinoma. The degree of atypicality and INF was more than moderate. In only one case was seen more than se in the degree of vertical spead of cancer cells. These data show us that even bleeding gastric cancer would be amenable to curative resection in many cases. Manifest bleeding in the upper digestive tract, especially of hematemesis, demands active endoscopy in the earliest possible period under pertinent supervision of the general condition of the patient. It is most important in establishing the indication for gastrectomy and principles for general management.