8.胃腫瘍

Gastric Tumor with Massive Bleeding

要旨　上部消化管出血に対する緊急内視鏡検査で診断された疾患中の胃腫瘍の頻度は5％前後で，そのうちの大半は胃癌からの出血である．顕性出血を来した胃癌は進行した症例に多く，占居部位は胃下部に少ない．進行癌肉眼型では2型，3型に多く，4型，類早期癌が続く．早期癌の大半は癌巣内活動性潰瘍を伴った陥凹型である．顕性出血を伴った場合，特に早期癌において初回内視鏡検査での正診率が低い．胃悪性リンパ腫からの顕性出血は少なく，内視鏡止血が困難な場合が多い．間質成分が少なく，組織が脱落しやすいことがその理由として推論されている．このほか，GISTや脂肪腫，血管肉腫，過誤腫，迷入膵など様々な顕性出血を来した胃腫瘍が報告されている．

　Gastric tumors accounted for about five percent of the massive bleeding lesions which were detected by emergency endoscopy. Most of these tumors were gastric cancers which were found predominantly among those of advanced grade and located frequently in the upper or middle region of the stomach. Massive bleeding occurred often in the macroscopic types 2, 3, 4 and IIc-like-advanced cancers. The majority of early cancers with massive bleeding were the depressed type with peptic ulcer in the lesion. The rate of correct diagnosis with the initial endoscopy was low for these bleeding early cancers. The endoscopic management of hemorrhage from gastric lymphoma was difficult because lymphoma tissue with little stroma tended to drop out after hemostasis. In addition, gastrointestinal stromal tumor (GIST), lipoma, angiosarcoma, hamartoma and aberrant pancreas were reported as other types of bleeding gastric tumors.