Early Gastric Cancer in National Taiwan University Hospital: An Analysis of 106 Cases

Abstract

臺大醫院自民國53年起至民國69年止，總共有106位病人經由外科手術病理診斷為早 期胃癌。其中男性67例，女性39例。年齡最小為23歲，最大為82歲，平均56.2歲。根 據肉眼觀察，可將早期胃癌分為：突出型（即第I型）5例，平凸型（即Ⅱa型）8例， 平凹型（即Ⅱc型）42例，凹陷型（即第Ⅱ型）5例，其餘為混合型，包括Ⅱc+Ⅲ31例 ，Ⅲ+Ⅱc 7例，Ⅱa+Ⅱc 7例，Ⅱc+Ⅰ 1例。癌症之分佈為：胃賁門2例（佔1.9%）， 胃體部17例（佔16.0%），胃角部28例（佔26.4%），胃鬢部59例（佔55.7%）。胃癌 之最小者為0.3×0.2cm，最大者為10.0×14.0cm，其中有11例之病灶小於1.0cm。癌 細胞侵犯至粘膜下層者共51例（佔48.1%），癌細胞局限於粘模層者共55例（佔51.9% ）。癌症為突出型者（包括I, Ⅱa, Ⅱa+Ⅱc，共18例）與癌症為凹陷型者（包括Ⅱc , Ⅱc+Ⅲ, Ⅲ，共80例），其症狀表現分別為：上腹痛（突出型28%，凹陷型61%）, 腹脹（44%與39%），嘔氣（22%與23%），溢酸（17%與34%），惡心或嘔吐（11%與13% ）,厭食（28%與23%），全身無力感（22%與21%），體重減輕（17%與18%），解瀝青 樣便（11 %與6%）。98例接受胃內視鏡檢查者當中，有11例(11%)診斷為良性病變或 末期胃癌。92例接受內視鏡生檢者當中，僅有2例(2.2%)呈偽陰性結果。吾人初步經 驗顯示手術後存活5年以上者為90.7%。 From 1964 to 1980, 106 cases of early gastric cancer were diagnosed mainly by endoscopy and then operated in the National Taiwan University Hospital. There were 67 males and 39 females in this series, and the age ranged from 23 to 82 years with a mean age of 56.2 years. Regarding the macroscopic findings, five cases showed the figure of protruded type (Type I), 8 of elevated type (Type Ⅱa), 42 of depressed type (Type Ⅱc), 31 of type Ⅱc+Ⅲ, 7 of typeⅢ+Ⅱc, 5 of excavated type (Type Ⅲ), 7 of Ⅱa+Ⅱc and one case of Ⅱc+I. The cancer was found on cardia in 2 cases (1. 9%), body in 17 (16.0%), angle in 28 ( 26.4%) and antrum in 59 (55.7%). The size of cancer measured from 0.3×0.2 to 10. 0×14.0 cm. Eleven cases had a lesion smaller than 1.0 cm. Cancer invasion was limited in the mucosal layer in 55 cases (51.9%) and invaded to the submucosal layer in 51 cases (48. 1%). The symptoms appeared in these patients with early gastric cancer of elevated types (I, Ⅱa, Ⅱa+Ⅱ c, n=18 cases) and those of depressed types (Ⅱc, Ⅱc+Ⅲ, Ⅲ, n=80 cases) were epigastralgia in 28% vs. 61%, abdominal fullness in 44% vs. 39%, belching in 22% vs. 14%, acid regurgitation in 17% vs. 34%, nausea or vomiting in 11% vs. 13%, anorexia in 28% vs. 23%, general malaise in 22% vs. 21%, loss of body weight in 17% vs. 18% and tarry stool in 11% vs. 6%. Eleven (11%) of 98 cases with early gastric cancer failed to be diagnosed by gastric endoscopy. The endoscopic biopsy was falsely negative in only 2 (2.2%) of 92 cases. Five year survival rate after surgery was 90.7% in our earlier experience.