残胃の悪性病変―切除例を中心に

Malignant Lesions in the Remnant Stomach: Mainly on resected cases

　胃診断学のめざましい進歩により，近年早期胃癌が数多く発見されてきており，胃癌の治療成績も，早期癌のふくまれる率が高くなるにつれて，向上を示してきている．胃癌の治療成績の向上と共に，長期にわたるfollow upに際して，残胃の診断も重要な問題を含んできている．残胃の癌が再発と共に異時性に別個の癌の発生も考慮される必要があろう．従来は，残胃の悪性病変，すなわち残胃に新しく癌が発生してくる場合，初回手術が良性病変（胃潰瘍，ポリープ，胃炎）によるものであり，良性疾患に対する胃手術後の残胃悪性病変についての報告が山形ら¹⁾の集計では，1961年までに欧米で196例であって，わが国では1963年までわずか14例であったが，近年増加している²⁾．

　初回が胃癌である場合には，残胃の癌が再発によるものか，新しく別個の癌かの判定が困難な場合もあって，とくに残胃にみられる癌が進行癌であるものでは，両者の鑑別が困難な場合もあって，かかる問題に関しての報告は少ない．

　A report is made of malignant lesions in the remnant stomach with special attention paid to re-resected cases. They consist of four cases of cancer in the remnant stomach which had been surgically managed because of benign lesions, 12 cases of metachronous and multiple cancers in the remnant stomach in persons who had undergone primary resection of cancer in the lower portion of the stomach and two of cancer in the reconstructed stomach after excision of esophageal carcinoma.

　The results of operation for cancer in the gastric remnant used to be unfavorable in persons who had undergone partial gastrectomy because of benign lesions, because cancer was usually detected only in advanced stages. However, early cancer in the remnant stomach has been reported recently. In cases hitherto reported, protruded types were seen most frequently.

　Recurrence of cancer in the stump or metastasis mostly accounted for cancer in the remaining part of the stomach which was had been resected partially on account of cancer. Furthermore, cancer developing independently in the remnant stomach is detectable. We have found two cases of early cancer among 12 of metachronous multiple cancers.

　During the follow-up period of gastrectomized patients early cancer in the remnant stomach can be detected by their periodic check-up with endoscopy.