胃腫瘍診断におけるX線検査の有用性―外科治療の立場から

Importance of X-ray Examination in the Diagnosis of Gastric Neoplasms―With Special Reference to Surgical Treatment

要旨　胃腫瘍診断におけるX線検査の有用性について，具体例を示しながら外科の立場で述べた．内視鏡とX線検査はそれぞれ利点，欠点があり，両者の質の高い画像を得ることで確実な診断と治療を行いうる．X線検査の有用性を分類すると，(1)広範囲に広がる病変の水平方向への浸潤範囲の把握ができる，(2)胃壁深部の質的変化から壁深達度の判断が可能，(3)胃全体の像からみた腫瘍の部位，性状の把握と切除方法，切除線の判断に有用，(4)内視鏡検査と相補的に併存病変の見逃しを補える，(5)術後胃の病変の把握，などが挙げられる．過去には胃癌の外科治療として，ほとんどの症例で幽門側切除術と全摘術のどちらかが行われてきたが，今日ではEMRから縮小手術，標準手術，拡大手術と多くの選択肢があり，これら術式の決定に，胃全体が眺められ，客観性の高いX線検査の必要性は増している．

　We have described the significance of X-ray examination in the diagnosis of gastric cancer and stromal tumor from the standpoint of surgical treatment. Advantages of X-ray examination over endoscopic examination are;

1)It points out the invasion front of wide-spread type of early cancer

2)It enables diagnosis of the depth of invasion of SM and MP cancer

3)It enables precise comparison of the lesion with the whole stomach

4)In combination with endoscopic examination, it enables detection of a second lesion.

5)It points out the lesions in the postoperative or post EMR stomach

These points are useful in the selection of surgical procedures. Dr. Theodor Billroth first succeeded in carrying out distal gastrectomy with his Billroth I anastomosis for a gastric cancer patient, in 1881. For a long time, two types of gastric cancer surgery, such as distal subtotal gastrectomy and total gastrectomy, have been performed. In recent years, with the increasing number of cases with early gastric cancer, limited surgery such as wedge resection, sleeve resection, and pylorus-preserving distal gastrectomy are becoming more popular for the treatment of patients with early gastric cancer or stromal tumor. Precise diagnosis of the invasion area and depth of invasion are more necessary for these limited surgeries than for conventional surgical procedures.

　We would like to emphasize that both x-ray examination and endoscopic examination are important for preoperative precise diagnosis of gastric neoplasms. The combination of both examinations enables, to a considerable extent, the selection of safe and curative surgical procedures.