多発食道癌の診断―内視鏡を中心に

Multiple Primary Esophageal Cancers

要旨　1994年から1998年まで教室で手術により切除された食道癌274例の検討では，食道多発癌症例は59例（21.53％）で171病巣を認めた．病巣の長径は12～0.1cm（平均1.7cm）であった．一方，粘膜切除症例での多発癌は同時性，異時性合わせて18.7％と手術切除症例に比べて低率であり診断精度の相違と考えられる．副病巣の発生部位は，主病巣の近傍が多く深達度はほとんどがmであった．また，食道多発癌例では単発食道癌例に比べ頭頸部癌の合併頻度が有意に高かった．食道癌症例では，ヨード染色を含めた食道全長の詳細な観察が必要である．

　A retrospective evaluation was made concerning 274 patients with esophageal cancer who underwent esophagectomy between 1994 and 1998. Among them, multiple primary esophageal cancers were detected in 59 patients (21.5％), but, in patients with superficial esophageal cancer who underwent endoscopic mucosal resection, the incidence of multiple primary esophageal cancer was 18.7％. This percentage was considerably less than that of surgically resected cases. The accessory lesions tended to occur near the main lesions, and almost all accessory lesions were mucosal cancer. The incidence of head and neck cancers among the multiple esophageal cancer cases was significantly higher than that of single esophageal cancer cases. In the diagnosis of esophageal cancer, it is necessary to observe the entire esophagus with iodine staining.