堀江 久永

The aim of this study was to determine the longterm effects of administering preoperative radiochemotherapy to patients with carcinoma of the lower rectum. The outcomes of 29 patients who underwent curative surgery for carcinoma of the lower rectum after receiving radiochemotherapy in the form of 40.5 Gy accelerated hyperfractionation and a total dose of 3400 mg 5-fluorouracil given as suppositories, with or without hyperthermia, and 48 patients who underwent surgery alone, were retrospectively compared. The tumors in all the patients were histologically diagnosed as stage T3. The cumulative 5-year survival rate and 5-year local recurrence-free rate of the patients treated with radiochemotherapy plus surgery were significantly better than those of the patients treated by surgery alone, the respective values being 80.5% vs 59.8% (P = 0.0325) and 95.7% vs 61.4% (P = 0.0041). Dehiscence of the perineal wound, anastomotic leakage, and postoperative ileus occurred at similar frequencies in both groups; however, perineal mound healing after abdominoperineal resection was delayed in the patients treated with radiochemotherapy plus surgery at 42.7 days vs 25.4 days (P = 0.0062). In conclusion, although the wound healing was delayed, preoperative radiochemotherapy is considered to be beneficial for patients with carcinoma of the lower rectum.

大腸癌肺転移症例に対して,doxifluridine(5'-DFUR, Furtulon)とmitomycin C(MMC)の併用療法を施行し,有効であったと考えられた3症例を経験した.いずれの症例もcisplatin(CDDP)と5-fluorouracil(5-FU)の化学療法中或いは化学療法後に増悪した状態にも拘わらず,5'-DFURとMMCの併用療法で,癌の進行を抑えることができた.5'-DFURとMMCの併用療法は外来通院で可能であり,重篤な副作用もなくquality of lifeの面からも有効な治療法となる可能性が示唆された

症例は62歳女で心窩部不快感を主訴とし,上部消化管造影にて幽門狭窄像を認めたため胃癌を疑われた.既往歴では48歳より胆石を指摘されていた.胃内視鏡検査にて,前庭部の前壁に境界明瞭な隆起性病変を認めた.中心部に陥凹を伴い,内視鏡所見では胃粘膜下腫瘍とも胃癌とも言い難い所見を呈していた.しかし10日後の内視鏡像が変化したこと,ならびに追加したCT,超音波内視鏡,経静脈的胆道造影を総合的に検討し,胆石,胆嚢炎が胃前庭部に波及した状態であると判断した.手術所見では,胆嚢は強固に前庭部に癒着し胆嚢内の結石と胃との瘻孔を認めた.根治手術を行い順調に経過した