長崎大学第一外科における切除胃癌の臨床病理学的検討

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長崎大学第一外科で，1969年1月より1995年12月までの27年間に，胃癌の診断で入院した1933例のうち，切除例1697例について臨床病理学的に検討した。切除胃癌例の男女比は2.0：1で，年齢は19歳より87歳で平均年齢は60.3歳であった。深達度はt1　614例，t2　446例，t3　486例，t4　151例で，表在癌が36.2％を占めた。占居部位は下部，中部，上部の順で，中部小弯が265例（15.6％）でもっとも多かった。肉眼型は進行癌では1型109例，2型348例，3型307例，4型211例であり，早期胃癌ではⅡc，Ⅱa＋Ⅱc，Ⅱa，Ⅱ＋Ⅲ，Ⅰ型の順で，Ⅱcが55.7％を占めた。総合的胃癌の進行程度は，stage Ⅰが45.8％を占めた。切除術式は全摘485例，噴切59例，幽切1124例で，全摘と噴切が31.5％を占めた。再建法は幽門側胃切除ではB-Ⅰ法が72.3％で多く，全摘術ではRoux-Y法が368例で多く，空腸間置法が12.6％に行われた。リンパ節郭清は86％はD2以上の郭清がされ，手術根治度は根治度Aが51.9％を占めた。腹膜播種は13.0％，肝転移は4.4％に認めた。リンパ節転移は組織学的には50.1％に認めた。組織型はtub2　513例，por 611例が多かったが，分化型は50.8％であった。リンパ管侵襲ly（＋）は67.6％，静脈侵襲v（＋）は48.7％であった。早期胃癌とくに深達度m癌のリンパ節転移の危険因子について検討し，腹腔鏡下胃局所切除の適応についても述べた。From January 1969 to December 1995, 1933 patients with carcinoma of the stomach were admitted to our surgical department. Of these patients,1861 (96.2 percent) underwent surgical exploration,1697 of whom (87.8 percent of the total) were found to have surgically respectable disease. In 164 patients (8.8 percent), the neoplasm could not be resected. We report here results of a clinico-pathological examination of the resected 1697 stomach and changes and results of a surgical approach to the treatment of carcinoma of the stomach. There was a male preponderance with a male to female ratio of 2.0:1. Ages of the patients ranged from 19 to 87 with a mean of 60.3 years. Forty percent of the lesions were located in the antrum, 38.2 percent in the body, and 21.8 percent in the upper third of the stomach. Macroscopically, resected cases involved type 1 in 109; type 2 in 348, type 3 in 307 and type 4 in 211. Distal gastrectomy was performed in 1,124 of the patients, total gastrectomy in 485, proximal gastric resection in 59, and partial resection in 17 in the series. Continuity of the alimentary tract in total gastrectomy was restored using a Roux-Y procedure in 368 patients, a jejunal interposition in 61 patients, and a double tract procedure in 50 patients. All the resected patients were pathologically staged and scrutinized according to the general rules for the gastric cancer study in surgery and pathology: 541 (31.9 percent) were in stage Ia, 236 (13.9 percent) in stage Ib, 223 (13.1 percent) in stage II, 179 (10.6 percent) in stage IIIa, 144 (8.5 percent) in stage IIIb, 137 (8.1 percent) in stage IVa and 237 (14.0 percent) in stage IVb. The depth of cancerous infiltration in 302 cases was limited to the mucosal layer, the submucosal layer in 312, proper muscle layer in 161, subserosal layer in 285, and definite serossal invasion in 486, and invasion to contiguous structures in 151. The results of pathologic examination showed differentiated carcinoma in 828 (50.8%). Regional lymph node involvement in the removed specimen was found in 850 cases (50.1 percent) .Lymph node involvement in the m-early cancers in which the depth of cancerous invasions was limited to the proper mucosal layer was 3.1 percent. Besides, no metastasis was found in cases no scar was present and the histologic type was differentiated. On the results of pathologic examination of resected stomach and dissected lymph nodes of these cases in our institute, we have performed laparoscopic partial gastrectomy as minimally invasive procedure for treatment of the early gastric cancers.
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長崎大学第一外科における切除胃癌の臨床病理学的検討

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