早期胃癌の断端再発症例―特に12年後の残胃再発再切除例について

Stump Recurrence of Early Gastric Carcinoma: especialy about a case which was reresected after 12 years interval

はじめに

　近年，早期胃癌の切除例が著しく増加し，その予後はきわめて良好である．しかしながら，早期胃癌（表在癌）といえども術後再発はありうる．その形式としては2っに大別される．

　Ⅰ．連続性再発←主病巣の取り残し．m，smにおけるow（＋）あるいはaw（＋）

　Ⅱ．非連続性転移からの再発

　　a）壁転移

　　b）リンパ節転移

　　c）血行性転移（肝，肺，骨etc．）

　微小壁転移巣は，組織間隙やリンパ管内に癌細胞が遊離栓塞し，定着増殖することによっておこり，リンパ節転移と同様な機序による．また血行性転移や，早期癌にはまれな腹膜播種などの再発は，リンパ節転移から二次的にも起りうる．

　進行癌では早期癌とことなり，周囲組織からの再発や腹膜播種の形も多いことは周知の通りである．

　今回は，12年後残胃再発再切除例について述べその他の癌研外科における断端再発再切除例にっいてもその概略を報告する．

　A man 57 years of age underwent gastric resection at a certain hospital on June 22, 1955. The diagnosis then was gastritis and gastric ulcer. During 12 years since then he enjoyed good health, but in July, 1967, he had a bout of hematemesis. Under the diagnosis of cancer of the gastric remnant he underwent its resection together with combined excision of the pancreas and spleen. Investigation of the initial resected stomach showed that it was Ⅱa+Ⅱc+Ⅲ, an ow (+) early gastric cancer with remarkable superficial spread. The resected specimen of the second operation shows that it is a shallow Borrmann's Ⅰ type cancer (6.0×6.0×2.5cm), surrounding the stoma on the lessere curvature. Granular Ⅱa is seen in its adjoining areas. Histologically, they both belong to adenocarcinoma tub. med. Of 16 cases of recurrent cancer at the gastric stump re-admitted to the authors' hospital, including this case, reexcision was possible in 10. Four cases were superficial cancers, belonging to Ⅱa+Ⅱc+Ⅲ, Ⅱc, Ⅱa+Ⅰ and Ⅱc+Ⅲ, respectively. They were all of adenocarcinoma tub. with ‘sm’ degree of depth invasion, ow (+) Symptoms at the time of recurrence were hematernesis in 2 cases, dysphagia in 1 and indefinite complaint in 1. The intervals between the initial operation and the re-excision are 12 years and 4 months, 6 years and 2 months, 2 years and 9 months and 1 year and 6 months, respectively. The latter two remained in the state of superficial carcinoma even at time of the second operation. The case recurred after 6 years had only palliative operation because of stomalinfilonly. A case of Ⅱa is included in 6 cases of reexcision due to recurrent cancer at the stoma.

　In cases of operation of early gastric cancer with indistinct borders, it is indispensable to sufficiently explore the stumps.