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胃癌 378例에 對한 臨床的 觀察

Clinical Stduy of 378 Cases of Stomach Cancer

대한외과학회지 1969년 11권 3호 p.163 ~ 176
이정익,
소속 상세정보
이정익 (  ) - 가톨릭의대 외과학교실

Abstract


The clincal study on 378 cases out of 441 cases of gastric carcinoma admitted to Gospel Hospital during the six years (form 1-1-61 to 12-31-66) revealed the following conclusions:
1) 69.4% of all gastric carcinomas were of the pyloric and antral regions, 20.3% were of the body region and 10.3% were of the cardia regions.
2) Age distribution: Carcinomas of the pylorus, antrum, cardia and fundus. were most frequently found in the fifth decade. Carcinoma of the gastric body was seen most frequently in the 4th decade. The rapid growh and spread of gastric carcinomas occurring below the 3rd decade made radical operations difficult and prognosis poor.
3) Sex Distribution: Male to female ratio in carcinomas of the cardia and fundus was 3.9:1. Male to female ratio in carcinomas of other stomach sites was 3:1.
4) Symptoms and signs of gastric carcinomas:
Epigastric pain and discomfor, and the presence of a palpable mass were elicited in pyloric and antral carcinomas.
Anorexia, weight loss, and indigestion were elicited in carcinomas of the gastric body. General weakness and difficulty in swallowing were noted in carcinomas of the cardia and fundus.
In general, it can be stated that any patient presenting with complaints of indigestion weight loss, and anorexia for periods in excess of 2 mnnths gastric carcinoma should be suspected, in particular carcinoma of the gastric body.
5) 40.4% of patients presenting with pyloric and antral carcinomas were operated on within a 6 month period following the discovery of the lesion.
6) Gastric juice analysis: Achlorhydria was noted in 45.8% of pyloric and antral carcinomas, a higher rate than in carcinomas of other stomach areas.
7) Stool examination:
Occult blood was found in 84.8% of carcinomas of the gastric body. the highest rate of any stomach area.
8) On the radiological examinations filling defect was seen in 73.9% of pyloric and antral carcinomas and obstructive sign was 14.8%, the sum was 88.7% and was the highest rate.
9) Operative resectibility was 75.5% in the pyloric and antral carcinomas and was the greatest frequency. In carcinoma of the gastric body it was 58.5% and was the lowest rate.
Radical operative rate was 51.2% in the pyloric and antral carcinomas and was the greatest frequency. Resectibility of the cardia and fundus carcinomas was 41.5% and was next in rate. That of carcinomas of the gastric body was 32.5% and was the lowest rate.
10) Gastric resection with extensive surgery of neighboring organs was 38.3% in the cardia and fundus carcinomas and was the most high rate.
11) Operative complications were 23.9% in the cardia and fundus carcinomas and was of highest rate.
Wound infection was one of the most commonly seen complications in the surgery of the gastric carcinoma.
12) Operative mortality rate was 7.8% of high rate in the cardia and fundus carcinomas.
Two of three cases who expined were due to anastomotic leakage. So that one must prevent anastomotic leakage with careful anastomosis and mortality rate will be decreased.
13) The more the organs resected in the extensive surgery, the more the complications and mortality rate increased.
In summary the pyloric and antral carcinomas were found rather early due to obstructive sign so that the rate of resectibility was high as well as that of radical resectibility.
Although operactive caseswere not rare due to obstrutive sign in the cardia and fundus carcinomas, in most cases total gastrectomy with splenectomy partical pancreatectomy or hepatectomy was done.
Therefore, leakage anastomosis should be prevented.
Carcinomas of the gastric body were vague in symptoms on the early stages and operations were done after so metastasizing to the neighboring and remote abdominal organs that resectibility rate was low and prognosis was very poor.
Particularly carcinomas below 30 years of age were so rapidly grown and spread shorter period that resectibility rate was low and prognosis was poor.

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