小腸上皮性腫瘍（癌・腺腫）

Primary Carcinoma and Adenoma of the Small Intestine

要旨　小腸上皮性腫瘍のうち癌腫と腺腫について頻度，好発部位，肉眼形態，X線像，予後を中心に概説し，早期回腸癌については自験例の4例を含めた12例について詳述した．早期回腸癌症例の平均年齢は67.4歳，男女比は5：1で，腹痛，下痢・血便がそれぞれ4例にみられた．術前X線検査で10例，内視鏡では8例が観察可能であった．11例が回盲弁の口側40cm以内に存在し，全例が隆起型を呈し，最大径は18～50mmで，その平均値は32.5mmであった．ほとんどが高分化腺癌で，m癌が5例，sm癌は6例であった．9例が外科的に切除され，自験2例はEMRで治療された．早期回腸癌の発見にはルーチン検査での回腸終末部の注意深い観察が必要である．

　Twelve cases of primary early carcinoma of the ileum reported in Japan during a fourteen-year period, from 1987 to 2000, were reviewed. As for average ages, the male and female ratio was 5:1 at 67.4 years of age. Abdominal pain, diarrhea and blood stool were noticed as subjective symptoms in four cases. Ten cases were detected by X-ray examination, and 8 cases were detected by colonoscopy. All tumors located in the terminal ileum were within 40 cm proximal to the ileocecal valve. Macroscopic forms of all tumors were protruding types. The size of the tumors varied from a maximum size of 50 mm to a minimum size of 18 mm, with 32.5 mm as the mean size. Nine cases were resected surgically and our 2 cases were treated by endoscopic mucosal resection. Five cases involved mucosal carcinoma and 6 cases involved submucosal invasive carcinoma.

　Observation of the terminal ileum during colonoscopic examination is useful for detecting early ileal cancers.