X線からみた胃癌の粘膜内浸潤範囲診断

The Diagnosis of Intra-mucosal Invasion of Gastric Cancer－From the Standpoint of Roentgenography

要旨　近年，早期胃癌に対してEMR，腹腔鏡補助下の手術，種々の縮小手術が行われるようになり，術前の正確なStage診断の重要性が再認識されている．そこで，胃癌の粘膜内浸潤範囲診断について，組織型によるX線像の差異，Ⅱb様病変のX線診断，噴門部および胃体部癌の口側浸潤範囲と表層拡大型胃癌のX線診断について，症例を呈示し解説した．胃癌の粘膜内浸潤範囲診断を確実なものにするには，病変が忠実に造影されたX線像を描出することが必要で，そのためには病変の存在別の造影法に習熟しておくことが大切である．また，正確な粘膜内浸潤範囲診断は術式の選択，患者のQOLを左右する重要なポイントである．

　In recent years, the importance of the correct stage-diagnosis before an operation has been reconsidered, because endoscopic mucosal resection (EMR), laparoscopy-assisted operations and various reduction operations have come to be performed for early gastric cancer. Here, we show examples and explain the diagnosis of intra-mucosal invasion of gastric cancers, the differences of X-ray features in histological types, the X-ray diagnosis of IIb type lesions and superficial spreading type of early gastric cancer. To verify the diagnosis of intra-mucosal invasion of gastric cancer, it is necessary to accurately show contrasted pathological changes by gastrography. For this purpose, it is important to master the gastrography method, which shows what entity the lesion is. Also, accurate diagnosis of the range of mucosal invasion is the important point, which influences the choice of operation and quality of life of the patient.