⑫制癌剤による胃癌の局所療法―その参考例の提示

Local Application of Bleomycin in Cancer of the Stomach, a Case Report

患者　65歳　男

　新潟の某病院で胃ポリープを指摘され，手術をすすめれらたが，なんとか切らずに治してほしいと当科を訪れた．付添ってきた家族の話では，癌だから手術をするようにいわれたという．自覚嚇症状はまったくない．

　当科で精査の結果，X線および内視鏡検査で，前庭部大彎後壁に大きな凹凸不整の隆起性病変を認めた（Fig. 1，2）．生検組織所見（Fig. 3）で高度の異型と診断された．なお故佐野量造博士からも癌とみて手術するようにいわれた．こちらでも手術をすすめたが，頑としてそれを拒否したため，ブレオマイシンによる局所注射療法を行うことにした．

　A 65 year-old male underwent an upper gastrointestinal series and endoscopic examination of the stomach revealing a malignant lesion which manifested as a giant protrusion located in the greater curvature toward the posterior wall of the antepyloric region.

　Histological findings of structural and cellular atypities was documented from lesion specimens obtained during endoscopic examination. The patient refuse to undergo the recommended operative treatment. Consequently. local injection of Bleomycin into the cancer became the chosen treatment.

　Two ml of Bleomycin (3mg/ml) in sterile distilled water was injected directly into the cancer. Three days later, a second injection of the same amount of the solution as repeated. One week after the second injection, massive necrotized tissue was removed by endoscopic forceps with an additional injection of Bleomycin. Thereafter, repeated Bleomycin injection and removal Of necrotized masses were performed weekly. Consequently, no previous lesion was recognized under endoscopy after 18 procedures and biopsy specimens on the last endoscopy no longer manifested malignant histological findings.

　Thereafter he was examined endoscopically at regular intervals and no recurrence was found. Finally he died of mycocardial infarction 19 months after his discharge from the clinic.