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要旨 早期胃癌の肉眼型亜分類のうち0 I型と0 IIa型の違いは隆起の高さである.胃癌取扱い規約にしたがい,組織学的な隆起の高さが正常胃粘膜の2倍以内のものを0 IIa型,それを超えるものを0 I型と判定する.隆起主体の癌の組織型は,そのほとんどが腺管形成能を有する分化型癌である.臨床診断のポイントは,隆起の形・輪郭,辺縁・境界,基部の形状,丈の高さ,表面性状,色調である.臨床病理学的特徴として,0 IIa型はtub1-tub2 ,0 I型はtub1-papが多く,0 I型ではSM浸潤やリンパ節転移の点で注意が必要である.このような点を踏まえ,精度の高い胃X線・内視鏡検査を駆使し,適切な診断・治療を行う.
One difference between type 0 I and 0 IIa in the macroscopic type classification of early gastric cancers is the height of protruded lesions. Type 0 IIa cancers are less than 2 times the height of normal gastric mucosa, and the height of histological protruded lesions separates the above from type 0 I. Most of the histological type of protruded lesions are differentiated type carcinoma. Points for a clinical diagnosis are the form and outline of protruded lesions, the border, the shape of the basal part, height, surface pattern and color.
As clinico-pathological characteristics, type 0 IIa cancers present tubular adenocarcinomas and Type 0 I present papirally adenocarcinomas. In cases of Type 0 I cancers, attention was necessary for submucosal invasion, and, in the case of type 0 IIa cancers, attention was necessary for lymphnode metastasis. We use technically high grade radiographic and endoscopic examination because it is necessary to make an accurate diagnosis and pursuer appropriate treatment.
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