胃癌に対する術前照射の内視鏡学的考察

An Endoscopic Study on Preoperative Irradiation of the Gastric Cancer

　最近，胃癌早期診断の発達に伴ない年々その遠隔成績は向上しているとはいうものの，まだわれわれの前に訪れる患者の中には高度の進行胃癌が早期胃癌に比べ圧倒的多数を占めていることは明らかであり，この高度の進行胃癌をどうするかがわれわれ外科医の大きな悩みとなっている．

　現在，手術療法，放射線療法，化学療法の癌3大療法が何れもその独自の立揚だけでは決定的なカを欠き，満足すべき遠隔成績を得ていない現況である．そこでわれわれは，術前放射線療法との併用により，手術適応の拡大を主眼とし，その治療効果を内視鏡学的にとらえ種々なる角度より検討を加え興味ある知見を得ている．

　Preoperative irradiation with 26 MeV betatron produced by Shimadzu Seisakujyo Co., Ltd. was carried out to the highly advanced gastric cancers of Borrmann Ⅱ and Ⅲ types to improve the successful rate of radical resection. We obtained the following conclusions from the endoscopical studies of gastric mucosae, which was performed pre-and post-irradiation.

1. Endoscopical changes shoulcl be evaluated mainly on the basis of the properties of the edge, contour, and bottom of the tumor, softening of the surrounding mucous membrane, and disappearance of hemorrhage.

2. Changes of the tumor were seen when the total doses over 2,000 Rad.

3. The effect of irradiation was noted in the majority of cases when the total closes over 3,000～4,000 Rad.

4. The rate of successful radical resection was improved approximately 13% as compared with that of the non-irradiated group.