胃癌の切除範囲をどう決めるのか―X線診断の立場から

How to Determine the Range of Resection in Gastric Cancer

要旨　X線診断で胃癌の切除範囲を決めるのに必要な事項を，胃上部，胃体部の早期癌68例，早期類似進行癌32例を対象に検討した．①食道浸潤のX線診断に必要な撮影体位は半立位腹臥位第1斜位である．EGJより食道側に限局したバリウム斑，顆粒状陰影が存在すれば，食道側浸潤の可能性が高い．②EGJと口側浸潤境界の距離の診断には半立位仰臥位第2斜位の撮影が有効である．③肉眼所見，内視鏡所見の軽微な症例のX線所見はバリウム付着の差として描写されているものが多い．

　Data necessary for determining the range of resection by x-ray diagnosis in gastric cancer were studied using as subjects 68 cases of early cancer, and 32 cases of advanced cancer simulating early gastric cancer in the upper part of the stomach and also in the body of the stomach.

(1) The posture to be taken by patients in x-ray diagnosis of esophageal infiltration is the semi-upright position, and the prone right anterior oblique position. The possibility of infiltration on the esophageal side was high if there were barium flecks or granular shadows localized on the esophageal side of EGJ.

(2) In diagnosing the distance between EGJ and infiltrative boundary on the oral side, radiography with the patient in the semi-upright position, supine, and left anterior oblique position was effective.

(3) X-ray findings in cases in which macroscopic findings and endoscopic findings were mild were often visualized as differences in the adherence of barium.