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非切除胃癌症例の検討


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Title: 非切除胃癌症例の検討
Other Titles: A study of nonresectable cancer of the stomach
Authors: 三浦, 敏夫 / 平野, 達雄 / 草野, 裕幸 / 中越, 享 / 清水, 輝久 / 下山, 孝俊 / 富田, 正雄 / 浦田, 秀子 / 宮下, 弘子
Authors (alternative): Miura, Toshio / Hirano, Tatsuo / Kusano, Hiroyuki / Nakagoe, Tohru / Shimizu, Teruhisa / shimoyama, Takatoshi / Tomita, Masao / Urata, Hideko / Miyashita, Hiroko
Issue Date: 31-Mar-1992
Citation: 長崎大学医療技術短期大学部紀要 = Bulletin of the School of Allied Medical Sciences, Nagasaki University. 1992, 5, p.113-124
Abstract: 1990年までの22年間に,長崎大学第一外科で手術が施行された胃癌患者1526例のうち非切除となった146例(9.5%)について検討した,男女比は1.2:1,平均年齢は60.0歳で,肉眼型は4型が61.0%で多かった.非切除となった因子は漿膜面浸潤(S因子)が75.3%,腹膜播種性転移(P因子)67.1%,リンパ節転移(N因子)39.0%,肝転移(H因子)25.3%で,複数因子ではS+P因子が21.9%で多かった.術式は試験開腹(L)76例,胃腸吻合(GJS)59例,造瘻(F)11例で,手術死亡は各9.2%,11.9%,18.2%であり,術後40.4%に化学療法が行われた.術式別平均生存期間はGJS156.4日,L142.3日,Fは108.5日で,全体で145.4日であったが,生存率には有意差は認めなかった.予後に差を認めた因子は,性別,占居部位,肉眼型で,男性より女性が,下部より上部が,3型より2型が良好であった.非切除因子よりみた平均生在期間はP>H,P>N,PN>SN,SP>SN,SP>PNであり,化学療法の有無別では施行群の生存期間が長かった.各種の理由で手術が不能であった58例との比較では,生存率に有意差はなく,またstage 4胃癌で絶対非治癒切除がなされた265例との比較では,有意差をもって切除例が良好であった. / During the 22-year period from 1969 to 1990, 1,526 patients underwent laparotomy for gastric cancer. Among them,146 patients had palliative surgery without gastric resection because of the invasion of adjacent structures, peritoneal dissemination, and distant metastases. The sex ratio was 1.2 : 1 and the median age was 60.0 years with a range of 18-86 years. Of these 146 patients, 61.0% had Borrmann type 4 cancer. Seventy-six patients had an exploratory laparotomy only, 59 had bypass surgery, and 11 received a jejunostomy. The postoperative mortality rate was 9.2%, 11.9% and 18.2%, respectively, for these group. The type of operation did not influence survival, but there was a significant association between the survival rate and sex, tumor site and macroscopic tumor type and the number of noncurative carcinomatous factors. The mean survival time was 142.2 days after laparotomy,156.4 days after gastrojejunostomy, and 108.5 days after jejunotomy. None of the patients underwent who underwent laparotomy alone survived for 2.5 years and none of those treated by bypass surgery survived for 2 years. The survival rate for patients without tumor resection was lower than that for patients treated nonoperatively, but the difference was not statistically significant. The survival rate of 265 stage 4 patients who received absolute noncurtive gastrectomy was significantly higher than that of those who underwent nonresective procedures.
Keywords: 非切除胃癌 / 試験開腹 / 造瘻術 / 胃腸吻合術
URI: http://hdl.handle.net/10069/18163
ISSN: 09160841
Type: Departmental Bulletin Paper
Text Version: publisher
Appears in Collections:Volume 5

Citable URI : http://hdl.handle.net/10069/18163

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