吻合部の十二指腸側に著明な狭窄所見を呈して再発した早期胃癌の1例

Recurrent Gastric Cancer with Remarkable Stenosis of the Duodenum, Report of a Case

要旨　幽門下リンパ節⑥に転移を有した早期胃癌が切除後1年3カ月で，吻合部から十二指腸側に著明な狭窄所見を呈して発見された再発例を報告した．1980年3月6日にR₂の胃切除が行われ，Biliroth Ⅰ法で再建された．胃癌は幽門前庭部後壁のⅡc型早期癌で，大きさ10×14mm，深達度smの低分化腺癌であった．ly₀，v₀，aw(－)，ow(－)，進行程度はP₀H₀N(－)S₀であったが，6番のリンパ節に転移を認めた．そのほか，胃角部小彎にUl-Ⅳの胃潰瘍，Ul-Ⅱ，Ⅲの2個の十二指腸潰瘍瘢痕を認めた．術後良好であったが1年後より腹痛が時々あり，この時期での上部消化管X線造影では明らかな異常はなかったが，術後1年3カ月後（1981年6月18日）には胃腸吻合部から十二指腸のVater乳頭部までの著明な狭窄を呈した．生検では粘膜層内および粘膜下層に腫瘍塞栓を認め，手術時と同じ組織型を呈し転移と考えられた．症状は次第に悪化し患者は同年9月13日に死亡した．

　We reported a case of recurrent gastric cancer which showed a remarkable stenosis from the stoma of the stomach to the papilla of Vater in the duodenum one year and three months after the operation.

　Gastrectomy was performed on March 6th, 1980 because of an early gastric cancer, type Ⅱc, on the posterior wall of the antrum. Histologically, the cancer invaded the submucosal layer and was poorly differentiated adenocarcinoma,10×14 mm in diameters (ly₀, v₀, aw (-), ow (-), P₀, H₀, N (-), S₀). But the metastasis of the cancerous tissue was observed in the lymph node (No.6). In addition to gastric cancer, one gastric ulcer and two duodenal ulcer scars existed in the resected specimen. One year later, the patient started to feel intermittent abdominal pain. Roentgenographic examination of the upper gastrointestinal tract did not show obvious abnormal findings. But one year and three months after the operation (June 18th, 1981), the roentgenographic picture showed a remarkable stenosis from the stoma of the stomach to the papilla of Vater in the duodenum. In the biopsy specimen from the stenotic portion of the duodenum and the stoma, adenocarcinoma was observed in the mucosal and submucosal layers and tumor emboli were seen in the blood and lymphatic vessels. The cancerous tissue was similar to that of early gastric cancer which was resected previously. This lesion was thought to be the metastasis from that lesion. The patient died on September 13th, 1981.