胃悪性リンパ腫の手術的治療と成績

Malignant Lymphoma of the Stomach: Surgical Treatment and Its Results

　胃に発生する悪性腫瘍の中で，肉腫はまれであるが，その発生母地より，悪性リンパ腫と平滑筋肉腫に大別され，その頻度は悪性リンパ腫が平滑筋肉腫より多いと言われている．特に悪性リンパ腫は，発生母地となるリンパ組織の分布の上から，胃に原発したものか，全身性のリンパ節より発生し胃に転移したものか，の鑑別が困難な場合がある．今回は，胃に認められた悪性リンパ腫について，単発性および多発性のものから，胃と共に消化管（小腸）に悪性リンパ腫が合併したもの，ならびに頸部リンパ節に悪性リンパ腫が認められたものに対する外科治療およびその成績について検討を加えてみたい．悪性リンパ腫の肉眼形態，組織学的分類，深達度ならびにリンパ節転移などは，外科治療成績の検討の上から詳細な分析が必要であって，胃癌について既に用いられている取扱い規約¹⁾（以下規約と略）に準じて，悪性リンパ腫の病変を取り扱った．なお，胃診断学の進歩により早期胃癌が数多く見出されているが，早期胃癌様の病変を示した，悪性リンパ腫で病巣が粘膜下層までに止まるものは早期悪性リンパ腫として報告がなされている^2)～4)．悪性リンパ腫の中で，早期悪性リンパ腫も経験しているので，併せて検討する．

　A study has been made of surgical treatment for malignant lymphoma of the stomach and its results. The question whether the treatment should be surgical, radiation or chemotherapy should be discussed on the basis of sufficient study of histological findings, the degree of extention and soon.

　From 1946 to 1978 67 patients with malignant lymphoma of the stomach were surgically treated in the Department of Surgery, Cancer Institute Hospital. In 51 patients it was single, in seven multiple, in five it was accompanied with malignant lymphoma of the intestine, and in four it was associated with that of the neck. The five-year survival rate of solitary malignant lymphoma of the stomach surgically treated was 41 per cent, and that of radical operation including relative non-curative resection was 55 per cent. The five-year survival rate of early malignant lymphoma limited within sm was 90 per cent. Even when it was associated with positive metastasis to lymph nodes, the five-year survival rate was 75 per cent. That of advanced malignant lymphoma spreading beyond pm dropped to 39 per cent. This fact shows that as in gastric carcinoma the prognosis depends on the absence or presence of lymph node metastasis and the degree of depth invasion. In solitary malignant lymphoma surgical treatment with positive resection of lymph nodes is essential.

　In patients with multiple occurrence the lesions were often too far advanced and the prognosis was poor. Some patients survived five years when no lymph node metastasis was seen. When accompanied with malignant lymphoma of the intestine or neck, the prognosis of patients surgically treated was poor. We would like to place our hope on radiation therapy and chemotherapy in such patients.