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術前にⅡc類似進行胃癌と診断され,術後3年目に再発死亡したⅡc型早期胃癌(深達度sm)の1例を報告する.
症例
患 者:46歳,男,自営業.
主 訴:空腹時心窩部痛.
家族歴:特記すべきことはない.
既往歴:30歳のときに虫垂切除術を受けた.
現病歴:1971年4月ごろより,空腹時の心窩部痛が間歇的に出現するようになった.同年9月近医を受診し,胃X線検査を受けた結果,十二指腸潰瘍と診断され投薬を受けた.症状は一時期消失したが,翌年の6月ごろより上記症状が再発したため,再び同医を受診して胃X線検査を受けたところ胃の変形を指摘され,精密検査を勧められた.同月某大学病院にて精密検査を受け,手術したほうがよいと言われた.同年7月5日に癌研外科を受診し,8月17日に入院した.空腹時の心窩部痛は断続的に入院時まで続いた.
A 46-year-old man suffering from epigastralgy when hungry came to our hospital to undergo an operation.
In the x-ray findings a defined and deeper depressed lesion surrounded by mucosal elevation was observed accompanied with converging mucosal folds in a shallow depression. Diagnosis as advanced cancer simulating type Ⅱc was made.
Endoscopically, this lesion was finally diagnosed as advanced cancer similar to type Ⅱc+Ⅲ (pm), and the surrounding mucosa was edematous.
An operation (R3) performed on October 25, 1972 resulted in only relative curative resection because cancerous metastasis to lymph node (N3) was found.
The lesion measuring 6.0×5.5 cm was proved to be type Ⅱc (sm) accompanied with Ul-Ⅲs and cancerous invasion to intramural lymph duct and vessel. The part of sm infiltration measured 2.5×1.0 cm.
Postoperative prognosis depends upon the dimension of sm infiltration, the degree of invasion to submucosal lymph vessels and histological type of cancer.
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