3多発Ⅱc型早期胃癌（2同時・1異時）の内視鏡的切除の1例

Endoscopic Resection of Multiple (Two Simultaneously and One Later) Type Ⅱc Early Gastric Cancers, Report of a Case

要旨　患者は58歳，男性．患者であると同時に医師である筆者（小沢）自身が1986年1月に重複早期胃癌の診断を受けた．2つの病巣は前庭部小彎のⅡc（8×6mm）と，胃体中部後壁のⅡc（10×10mm）であった．内視鏡的切除の対象が主としてIlaを中心とした隆起型早期胃癌であって，Ⅱcに対する内視鏡的切除が危険視されていた時期に，部位を異にした2つのⅡcを同時に内視鏡的に切除した．更に3年後前庭部小彎の切除搬痕部近傍に早期胃癌が再び発見され，再度内視鏡的切除を受けた．その後は現在まで内視鏡所見，生検所見ともに癌陰性である．これらの経過を筆者自身が本症例の担当医になり代わって症例報告し，併せて患者としての不安，苦悩や，更に術中，術後の体験などについても言及する．

　We report here diagnostic process of multiple (three) Ⅱc early gastric cancers and their treatment by endoscopic resection (ER) as well as clinical course in a 58year-old male physician (one of the authors). The patient was pointed out to have two lesions of type Ⅱc early cancer, one on the lesser curvature of the antrum and the other in the posterior wall of the mid-gastric body in January, 1986. ER wassuccessfully performed by one of the authors (KT). Another early cancer developed three years later near the scar on the lesser curvature of the amrum. It was again resected endoscopically in March, 1989. The patient is doing well now 4 years 6 months after the first ER.

　The importance of meticulous follow-up is emphasized since remnant, recurrent or multiple (at different time) cancer after ER is not rare.