m3・sm1食道癌の内視鏡診断

Endoscopic Diagnosis of m3 and sm1 Cancer of the Esophagus

要旨　m₃の陥凹面の検討では平坦なものから顆粒状のものまで均等にみられたが，平坦なものはすべて深い病変であった．細顆粒状の陥凹を示すものでは3例中2例が浅い陥凹であり，m₂との鑑別が困難であった．顆粒状の凹凸を示すものはm₁・m₂にはほとんどみられず，したがって，sm癌との鑑別が問題となるが，m₃では結節状の凹凸を伴うものは少なく，sm₂やsm₃より浅い陥凹であった．sm₁では陥凹内部に細顆粒状ないし顆粒状の凹凸を伴う．周囲粘膜をより明瞭に押し上げるように発育し，0-Ⅰsepの所見を呈することもあるが，その丈は決して高くなく，ある程度高いものはsm₂であり，sm₃は更に高く結節状となる．隆起性のm₃・sm₁が少なく今回は十分な検討ができなかった．全体に顆粒状の凹凸を示す0-Ⅱaはsm₁であった．高さが2mmを超える0-Ⅰ型は白色の強い亜有茎性の隆起でm₃であった．

　We evaluated 61 cases of mucosal and submucosal cancer of the esophagus using an electronic endoscope (Fujinon EG410HR and Olympus GIFQ230). The classification of depth of cancer invasion is defined by the Japanese Society of Esophageal Diseases as follows, m₁; epithelial cancer and/or mucosal cancer with invasion to the lamina propria mucosae. m₂; mucosal cancer with invasion between m₁ and m₂. m₃; mucosal cancer almost and/or already invading the lamina muscularis mucosae. sm₁; submucosal cancer with invasion to the first third of the submucosal layer. sm₂; submucosal cancer with invasion to the middle third of the submucosal layer. sm₃; massive invasion of the cancer to the submucosal layer.

　m₁ and m₂ cancers showed a shallow depression with flat or fine granular surface, sm₂ and sm₃ showed a deep depression with granular or nodular surface, and also protrusion with 0-Ⅰsep. In this study there were two shallow depressed m₃ cancers with fine granular surface. It was difficult to differentiate them from m₂ cancers. The other depressed m₃ cancers with deep or granular depression were easily differentiated from m₂ and sm₁. It was also difficult to differentiate a deepdepressed sm₁ cancer with fine granular surface from m₃ cancers, but easy to differentiate it from sm₂, because depressed sm₂ cancers were deeper than it. The other depressed sm₁ cancers were deeper than sm₃ lesions, but shallower than sm₂ and sm₃ lesions. In this study we had only a few cases of elevated m₃ and sm₁ cancers, therefore we couldn't estimate sufficiently their endoscopic characteristics.