噴門部早期癌―とくにその診断についての考察

Early Carcinoma of the Cardiac Region: A clinical study on its diagnosis

　早期癌手術例の報告は年々増加し，1969年林田¹⁾による全国集計では，22施設において昭和37年1月より昭和43年10月までの7年間に発見された早期胃癌は2，364例を数え，年毎にその発見例数は急増している．しかしながら噴門部を中心とする胃上部の早期癌は，ほぼ6.0％未満であり，松江（1970）²⁾による国立がんセンターの報告でも，早期胃癌300例中噴門部のものは10例（3.3％），春日井（1970）³⁾によると128例中9例（7.0％）に認めているにすぎない．われわれの教室において，昭和35年1月より昭和47年6月までの11年半の間に切除された早期胃癌は169例で，そのうち噴門部のものは7例（4.1％）と，諸家の報告に近似した頻度を示しているが（表1），今回はこれら7例の噴門部早期癌症例を中心に，X線並びに胃内視鏡による噴門部附近の術前診断について，切除胃所見と対比しながら，2，3の検討を加えてみた．

　Of 169 cases of early carcinoma of the stomach encountered in our Department from Jan. 1961 to June 1972, cardiac lesions were seen in 7 (4.1 per cent), corresponding to 3.6 per cent of cardiac carcinomas of all stages experienced during the same period. Macroscopically,2 cases were of eleveted types (Ⅰ and Ⅱa), and the others, of depressed type (Ⅱc). Except for 2 anaplastic cases, all showed histologically well differentiated, either tubular or papillary, adenocarcinoma. The rate of accuracy in radiographic and endoscopic diagnoses of these early carcinomas was as low as 28.6 per cent. A wide depressed lesion was apt to be mistaken for an advanced one, and a small Ⅱc on the anterior wall of the cardiac region was overlooked by both examinations.

　Radiologic techniques for detecting minute lesions in this segment should be more attended to. For this purpose, we have studied both in the right and left recumbent projections (Matsuura) a few slender, smooth and regular lines of the cardiac mucosa that are always observed around the cardiac orifice and are subject to change even by slight cancerous infiltration.

　Faulty techniques in the use of gastric endoscope (GTF, Va type) together with remote observation by “U-turn” method can also result in overlooking a rather widely spreading early carcinoma in this region.