若年者の上部消化管癌―若年者胃癌

Cancer of the Upper Gastrointestinal Tract in the Young Adult; Gastric Cancer

　若年者の上部消化管癌の中で，最も多いのは胃癌であり，教室では若年者の食道癌や十二指腸癌は経験していないので，教室で最近経験した若年者胃癌を中心に文献的考察を加えて，その実態を述べる．

　因みに，世界最初の若年者胃癌の報告は，1848年Dittrichの報告した19歳女子の剖検例であり，本邦では1894年滝口の25歳男子の例が最初であるとされている¹⁾．また，最年少者の報告は，1859年Widerhoferの生後16日の新生児例で，本邦では1964年三浦²⁾の報告した1歳11月の女児である．この例では，嘔吐，腹部膨満の症状があり，腹部に手拳大の腫瘤が触知され，単開腹術が行なわれており，全経過は約5月で死亡している．

　Thirty one cases of gastric cancer in the young adult seen at the 2nd Department of Surgery, Kyushu University School of Medicine, during a 12-year period from 1960 to 1971 were reviewed. The incidence of gastric cancer in the young adult was 2.4% of 1,303 patients in whom laparotomy was performed. As the initial symptoms, epigastric pain and poor appetite were present in 54.8% and 22.6% respectively. As chief complaint, epigastric pain, and nausea and vomiting were present in 54.8% and 38.7% respectively. The duration of the symptoms was less than three months in 16.1% and longer than one year in 45.2%. A tumor mass was palpable in 45.2%, preoperatively. Early gastric cancer was detected in 4 instances (12.9%) and cancer at the stage Ⅳ was in 64.5% of 31 young patients with gastric cancer. Gastric resection was performed in 24 (77.4%) of the 31 patients treated by laparotomy. Curative oparation was performed in 11 (35.5%) of the cases, that is, 45.8% of 24 patients treated by gastric resection, and in 8 (66.7%) of 12 males and in 3 (25%) of 12 females with gastric resection. The major factor against the radical resection was peritoneal dissemination, present in 35.5% of the cases with laparotomy. AMC (the entire stomach), MC or CM was predominantly involved region in the young, compared with other age groups. The size of the lesions larger than 8.1 cm, in greatest diameter, was noted in 41.7%. Histological investigation revealed carcinoma simplex in 69.6%. A five year survival was noted in 23.2% of the 31 cases with a 74% of 11 cases treated by curative gastric resection.