Journal of Okayama Medical Association
Published by Okayama Medical Association

Full-text articles are available 3 years after publication.


重政 典男 岡山大学医学部産科婦人科学教室
Thumnail 71_4365.pdf 1.98 MB
This investigation was performed on 67 carcinoma of the cervix patients who were subjected to the Okabayashi Operation during the period from June 1957 to Dec. 1958. These patients consisted of 50 unselected cases, the 2 cases who had the postoperative retroperitoneal suppuration, and 15 cases who were subjected to the preoperative x-ray radiation on one side. The bacteriologic examination with Good-pasture's and methylenblue staining was done on the primary sites of cancer, the parametrial tissues and the regional lymph nodes after the serial section. The further investigation was extended to the histological examination concerning the inflammatory reactions. Following results were obtained: 1) The rates of detecting bacteria in the primary sites of carcinoma, parametrial tissues, and lymph nodes were 54.0%, 22.3% and 21.8% respectively. No relationship with the clinical stage was found. 2) The rate of detecting bacteria from the standpoint of C. P. L. classification (IMAI) was same in each type as far as the primary sites concerned, but in both the parametrial tissues and lymph nodes the type L was meaningly higher than type C and P. 3) According to Nagase's classification there were present no significant difference regarding the primary sites and parametria, but in lymph nodes the type II was meaningly higher than the type I in rate. 4) The relationship with growth-type of carcinoma was as follows: Those having the endophytic type in growth were revealed to have the higher incidence of bacteria in both the primary sites and lymph nodes compared with those of exophytic type. 5) Dividing the parametrial tissue into the superior, middle, and inferior parts, the last was meaningly low in rate compared with the superior and middle parts. This was seemingly due to the anatomical relationship of lymph-vessels. 6) As regard to lymph nodes, the hypogastric nodes were 28% and the obturator nodes, superior iliac and inferior iliac nodes were around 15% each in rate. As regard to the relation of the detection rate with the size of lymph nodes, it was revealed that the larger the lymph nodes are, the higher is the incidence. It is, however, noticeable fact that even the bean-sized lymph nodes were not always negative of bacteria. It should be kept in mind, therefore, on the removal of lymph nodes at the time of operation to avoid mashing the lymph nodes as far as possible for protecting the postoperative infection. 7) Those having the metastasized lymph nodes or the parametrial infiltration of cancer were revealed to be higher in rate than those having neither the infiltration nor the metastasis. 8) The lymph nodes and the parametria which were positive of bacteria in the primary sites of cancer were higher in rate than those having no infection in primary sites. 9) The variety of bacteria investigated mostly consisted of cocci and far less of bacilli. 10) No influence to detection rate was arisen from by X-ray preoperative treatment as far as dosage of 1.164 r to 1.392 r concerned. 11) 3 out of 50 cases were complicated with the postoperative retroperitoneal suppuration. 12) It was disclosed that in all three parts, primary sites, parametria, and lymph nodes, those having the servere inflammatory reaction not always showed the high rate of bacteria-detection. It highly seems to us that other factor aside from the bacterial infection, probably anti-carcinoma protecting reaction, could play the important role for the inflammatory reaction of parametrial tissue and stromal tissue of the primary sites of cancer.