病理学的にみた早期胃癌内視鏡的切除の適応条件

Indication of Endoscopic Curative Resection for Early Gastric Carcinoma from a Pathologic Point of View

要旨　外科切除早期胃癌612例について，リンパ節転移の有無を中心に臨床病理学的立場から検討した．転移率は全癌11.4％，m癌2.4％，sm癌22.1％であり，男性8.1％，女性17.4％と女性に高く，癌最大径が増すに従って増加した．肉眼型別ではⅠ型25％とⅡa+Ⅱc型18.8％で高く，分化型腺癌9.7％より未分化型腺癌152％でやや高く，リンパ管侵襲程度に比例して増加した．転移のない癌は，①1cm以下すべての肉眼型・組織型の癌，②2cm以下のⅡa型癌，③2cm以下の隆起型分化型腺癌などが代表的なものであった．以上の結果をもとに早期胃癌内視鏡的根治切除術の適応として，a）1cm以下のすべてのm癌と，b）2cm以下のⅡa型癌と仮に規定し，その妥当性などについて簡単な考察を加えた．

　Clinicopathologic study on 612 early gastric carcinomas surgically resected was carrled out with special reference to regional lymph node metastasis. The incidence of lymph node metastais was 11.4% (70cases) in all 612 early gastric carcinoma cases, and 2.4% (8cases) in 332 mucosal carcinoma cases and 22.1% (62cases) in 280 submucosal carcinoma cases. The incidence was higher in female cases (17.4%) than in male cases (8.1%), and increased according to the increase oftumor sizes.The incidence of lymph node involvement was high in type I carcinomas (25%) and type Ⅱa十Ⅱ ccarcinoma (18.8%), and was higher in undifferentiated carclnomas (15.2%) than in dlfferentiated carcinoma (9.7%).It increased according to the grade of lymphatic permeation.

　On the other hand, early gastric carcinomas without lymph node metastasis were as follows：(1) early gastric carcinomas of all macroscopic and microscopic types less than 1 cm in dlameter, (2) type Ⅱa carcinomas less than 2 cm in diameter, and (3) protruded type carcinomas of differentiated type less than 2 cm in diameter.

　According to the results obtained, it is indicated that endoscopic resection for early gastric carcmomas is curative in all mucosal carcinomas limited to less than 1 cm in diameter without reference to macroscopic types or microscopic types, and type Ⅱa carcinomas less than 2 cm in diameter.