胃ポリープについての若干の考察

Some Observations on Gastric Polyp

はじめに

　昭和41年1月から43年12月までの3年間に，県立ガンセンター新潟病院で手術を受けた胃ポリープの75症例について臨床的観察を行ない，若干の考察を試みた“胃ポリープ”は昔より知られている疾患であるにも拘らず，その定義や分類は末だ確立されていないのが現状である．したがって，筆者ら外科医にとって，手術方針を決定する際に困難を感じることがしばしばある．よって，自験例にもとづいて手術適応と術式を検討した．

　During the 3 years 1966 to 1968, 75 patients underwent gastric operation because of polyp. Of these, malignant lesions were seen in 13 patients (17.5%). In about half of them multiple polyps were observed, but polyposis was found to have no connection with malignant change. Except for one case impossible to classify, 74 cases of gastric polyp with 177 lesions were classified according to Sano. The result was that type I was seen in 129 lesions; type II in 40; and type III in 8. Of 164 benign polyps belonging to types I and II, 160 were under 1.9cm in diameter. Of the remaining 13 malignant polyps, Ⅱ were more than 2cm in diameter. All of them belonged either to type II or III. All polyps of type having the diameter of more than 2cm proved malignant. As for the policy for surgical intervention of gastric polyp, the authors make it a rule to perform conventional gastrectomy when its malignant change is even slightly suspected; when polyp is multiple; or when polyp is associated with advanced gastritis. When malignant change is definitely suspicious, the operative procedure follows that of gastric cancer. In the past, even a solitary benign polyp used to be surgically removed by gastric resection, but this tendency should be discouraged because of postoperative disorders. The authors are now of opinion that a single polyp under 1 cm in diameter with no possible malignant change is adequately managed by polypectomy alone.