十二指腸球部に脱出した超高齢者早期胃癌の1例 A CASE OF EARLY GASTRIC CANCER PROLAPSED INTO THE DUODENAL BULB IN A 90-YEAR-OLD WOMAN

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症例は90歳,女性.肺炎にて当院紹介入院した.入院後食欲低下,嘔吐が出現し,上部消化管内視鏡にて球部内反転法で幽門前部から十二指腸球部に脱出する4cm大の顆粒結節状隆起性病変を認めた.腫瘤の胃内への還納は困難であった.上部消化管造影では球部に脱出する4cm大の分葉状腫瘤陰影を認め,幽門前部から十二指腸球部に胃粘膜が牽引されていた.術前呼吸訓練,完全静脈栄養 (TPN) 管理を施行し,全身状態を改善させた後に幽門側胃切除術+D2リンパ節郭清を行い, Roux-en-Y法で再建した.腫瘍は幽門前部後壁に存在する7.5×4.5×4.Ocm大の亜有茎性隆起性病変で,病理組織検査ではtub1, m, ly0, v0, INFα, n0, stage I Aであった.術後経過良好で術後10日目に退院した.十二指腸球部に脱出した超高齢者(85歳以上)胃癌の本邦報告例は自験例を含め5例のみと非常に稀であった.

A 90-year-old woman was referred and admitted to our hospital for pneumonia. After admission, anorexia and vomiting occurred, and an endoscopy of the upper digestive tract using the bulb inversion method revealed a granular nodular tumor measuring 4cm, which prolapsed from the pyloric antrum into the duodenal bulb. It was impossible to reduce the tumor from the duodenal bulb into the stomach. Contrast-enhanced radiography of the upper digestive tract showed a lobular tumor measuring 4cm and prolapsing into the duodenal bulb. The gastric mucosa was extended from the pyloric antrum to the duodenal bulb. Preoperative respiration training and total parenteral nutrition (TPN) management resulted in a stable general condition. Therefore, distal gastrectomy (D2) and Roux-en-Y anastomosis were performed. Macroscopically, a semipedunculated tumor measuring 7.5×4.5×4.0cm was observed on the posterior wall of the pyloric antrum. The histopathological findings suggested tubl, m, ly0, v0, INFα, n0, and stage I A. The postoperative course was uneventful, and the patient was discharged 10 days after the surgery. In Japan, only 5 elderly patients (over 85 years) with gastric cancer prolapsing into the duodenal bulb, including our patient, have been reported.

収録刊行物

  • 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association  

    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 67(9), 2070-2073, 2006-09-25 

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10018391769
  • NII書誌ID(NCID)
    AA11189709
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13452843
  • データ提供元
    CJP書誌  J-STAGE 
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