内視鏡経過例における胃癌発育の遡及的検討―肉眼型からみて

Retrospective Study of the Growth of Gastric Cancer which was Observed by Endoscopy from the View Point of the Macroscopic Features

要旨　内視鏡写真の遡及的な検討が可能であった53症例54病変について，内視鏡で発見可能な初期像を隆起型，陥凹型，潰瘍型に分類し形態変化を検討した．隆起型では深部浸潤を来すことはまれで側方への進展速度も遅かった．陥凹型の深部浸潤の速度は様々であり，初期像からの浸潤速度の予測は困難であった．潰瘍型も様々な深部浸潤速度をとり一定の傾向を認めなかった．今後，胃癌の発育の多様性と患者側の要因も考慮した治療方針の決定と，見逃しを減らすために初期像を念頭に置いた内視鏡検査が必要と思われた．

　The initial macroscopic features that should be detected as early cancer were investigated in 54 lesions in 53 cases in a retrospective study. These 54 lesions were categorized as protruded, excavated, and ulcer type to study their time-dependent changes. In the protruded type, deep invasion was rare and side invasion had slow progression. The rate of deep invasion varied in the excavated type, and therefore initial estimation of the rate was difficult. In ulcer type, the rate of deep invasion also varied and did not show a constant trend.

　The various growths of early gastric cancer and patient factors should be considered when planning a treatment schedule, and endoscopic examination on initial macroscopic features is essential to reduce the likelihood of missing lesions.