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良性疾患で胃切除を受け,術後数年を経て発生した胃癌は一般に残胃癌といわれている.残胃癌の報告例は欧米では多いが,本邦では少なく,山下ら1)によると中村ら2)(1953年)の報告以来1971年までに106例の報告例があるのみである.これら残胃癌の報告例のほとんどは進行癌で,山下らは残胃早期癌の報告はわずか5例に過ぎないと述べている.山岸ら3)も残胃早期癌の報告はわずかに7例のみであると述べている.しかしながら,山下ら1),山岸ら3)の報告例の中には,学会報告のみで詳細が不明なもの,あるいは胃切除後5年以内に発見された例も含まれている.したがって,胃切除5年以上経過した残胃早期癌の文献的報告例はさらに少ないものと思われる.
著者らが文献的に調査したところ,残胃に発生した早期癌の報告は6例のみであり,きわめて稀であると思われる.このたび著者らは,胃潰瘍術後27年目に発見された残胃早期癌を経験したので,文献的考察を加えて報告する.
Cancer developing in the gastric remnant several years after partial gastric resection due to benign lesions is called cancer of remnant stomach.
In our country reports of such cases have been few; according to Yamashita 106 cases were reported up to 1971. Most of them belonged to advanced cancer. Early cancer of the gastric remnant is thus very limited. We report here such a case, a tiny cancer of the stomach developing in the gastric stump, with reference to the literature.
A 70-year-old farmer came to our hospital complaing of abdominal distention he noticed 27 years after gastric resection performed on account of ulcer. X-ray revealed no abnormality in the stomach, while. endpscopy showed a hemispheric small protrusion subsequently diagnosed by biopsy as tubular adenocarcinoma. Histologic study of the resected specimen revealed IIa type early cancer, well differentiated tubular adenocarcinoma with slight atypicality, extending over the superficial layer of the tip of a polypoid lesion, which measured 5×5 mm.
Up to the present, cases of early cancer seen in the gastric remnant amount to only 5 in number. Roentogenology is often inefficient in its diagnosis because of unusual configuration of the gastric stump. Small lesions are apt to be overlooked. Early cancer of the stomach is now detected with ease owing to the development of both X-ray techniques and endoscopic diagnosis. However, once the stomach is resected for one reason or another, detection of early cancer faces great difficulty. One should be very careful in the examinations of the gastric remnant in daily practice.
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