Satoshi Murakami

A STUDY ON PERTINENCE OF NON-CURATIVE GASTRIC RESECTION FOR STAGE IV GASTRIC CANCER

治癒切除不能のStage IV胃癌に対して,胃切除術を行った70症例を対象に,予後,術後在院期間からみた手術の妥当性について検討した.試験開腹,あるいはバイパス手術に終わった12症例と生存率を比較したところ,そのMSTは252日と119日で,胃切除例で有意に延長していた(p<0.01).非治癒切除因子が1因子の症例(n=51)のMSTは367日であり,2因子の症例 (n=19) の141日と比較して有意に長かった(P<0.01).1因子のみで予後を比較すると, P因子のMSTがN因子, H因子に比較して短かったが,いずれも非切除より生存期間の延長を認めた.非治癒切除因子が2因子ある場合は,胃切除による生存期間の延長を認めなかった(p=0.53).非治癒切除因子が2因子ある場合,在院死亡率は47.4%, 在院率は73.6%と高く,殊にP因子を含む症例で高かった.従って,非治癒切除因子が2因子ある場合は原則的に胃切除の適応はないものと考えられた.

CLINICAL STUDIES ON 35 CASES OF PERFORATION OF THE SMALL BOWEL

During the last 10 years, 35 cases of perforation of the small bowel were treated. 16 cases (45.7%) were due to post operative adhesive ileus, 10 (28.6%) to abdominal trauma and 4 (11.4%) to inguinal or femoral hernia. Operative mortality was 17.1%. Thirty-six hours after operation, mortality was 4.3%, but over 36 hours mortality was elevated to 41.7%. In cases of small bowel perforation due to abdominal trauma and hernia, operations were undertaken sooner than in cases of perforation, due to adhesive ileus. In these cases, prognosis was good. On the other hand, all cases of small bowel perforation due to malignant tumor and mesentery arterial thrombosis died within 30 days of operation; thus the prognosis of these cases was extremely poor. Abdominal free air, leucocytosis (over 10, 000) and muscular defense were decisive factors in undertaking operation. Leucocytosis was found in 51.4% of all cases, and abdominal free air in only 34.3%. On the other hand, muscular defense was found in 85.7%, so that it was necessary to observe the patients condition, espcially abdominal signs, carefully.