早期胃癌に対する縮小手術 : 分節的胃切除術46例の検討 TRANSVERSE GASTRECTOMY FOR EARLY GASTRIC CANCER : CLINICAL STUDY ON 46 PATIENTS

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早期胃癌に対する縮小手術として横断胃切除術(以下横切)を1985年から1993年まで46例(以下横切群)に施行した.適応は胃体中下部に局在する(小彎病変は除く)大きさ約2cmまでの粘膜内癌とした.手術は病変から2~3cmの断端を確保し,大小彎を横断するように分節的に胃を切除し,層々二列の端々吻合にて再建,幽門形成術は付加しなかった.迷走神経は前幹肝枝,後幹腹腔枝を温存した.リンパ節郭清は近傍の大小彎リンパ節およびNo.6, 7, 8a等の生検のみとした.同一期間に幽門側胃切除, D2郭清, B-I再建の標準手術を施行した早期胃癌症例52例(以下対照群)と根治性および術後愁訴,残胃機能などQOLの面から比較してみると,横切群は対照群と同等あるいは有意に良好な成績を示した.以上から横断胃切除術は根治性を損なわず,術後QOLを改善しうる早期胃癌の有用な縮小手術術式の一つになりうると考えられた.

Forty-six patients with early gastric cancer underwent "transverse gastrectomy" between 1985 and 1993. The indication for this procedure was defined as follows: 1) tumors located in middle or lower part of the stomach, 2) size of tumor under 2 cm and 3) intramucosal cancer. We resected the stomach 2_??_3 cm apart from the tumor segmentally, and performed end to end anastomosis of the remnant stomach. Pyloroplasty was not performed to preserve its founction. From 1991, we tried to preserve the vagal nerve (hepatic and celiac branch). Lymphadenectomy was only performed for perigastric lymph nodes of the lesser and grater cavertuer, and for the samplings of the left gastric and common hepatic lymph nodes. These cases were compered, in terms of post-operative QOL and survival, with the early gastric cancer patients who underwent, during the same period, standard operation procedures of distal gastrectomy radical lymph adenectomy (D2 dissection) and Billroth-I reconstruction. This procedure proves to score higher in the area of QOL than standard operations since it keeps postoperative body weight especially. The survival rate of the patients who underwent this procedure is as well as that in standard operations. This results show that the procedure could be a useful method of treatment for early gastric cancer patients to improve their post-operative QOL as well as being a radical operation.

収録刊行物

  • 日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society

    日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society 57(2), 291-297, 1996-02-25

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10008518834
  • NII書誌ID(NCID)
    AN00198696
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    03869776
  • データ提供元
    CJP書誌  J-STAGE 
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