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Stomach and Intestine(Tokyo) Volume 33, Issue 12 （November 1998）

胃と腸 33巻12号（1998年11月発行）

Japanese English

今月の主題胃癌EMRの完全切除の判定基準を求めて

主題

胃腫瘍性病変EMRの分割切除による完全切除の判定基準 Criteria for Completion in Fractionated Mucosal Resection for Gastric Tumorous Lesion 竹下公矢 ^1,2 , 谷雅夫 ² , 井上晴洋 ² , 佐伯伊知郎 ² , 本田徹 ² , 斎藤直也 ² , 岩井武尚 ² Kimiya Takeshita ^1,2 , Masao Tani ² , Haruhiro Inoue ² , Ichiro Saeki ² , Tooru Honda ² ¹東京医科歯科大学医学部光学医療診療部 ²東京医科歯科大学医学部第1外科 ¹Department of Ertdoscopic Diagnosis and Therapy, Tokyo Medical and Dental University ²The First Department of Surgery, Faculty of Medicine, Tokyo Medical and Dental University キーワード：胃腫瘍性病変 , 内視鏡的粘膜切除 , EMRC法 , endoscopic mucosal resection using a cap-fitted panendoscope , 計画的分割切除 , 組織学的再構築 Keyword: 胃腫瘍性病変 , 内視鏡的粘膜切除 , EMRC法 , endoscopic mucosal resection using a cap-fitted panendoscope , 計画的分割切除 , 組織学的再構築 pp.1599-1608

発行日 1998年11月25日 Published Date 1998/11/25

DOI https://doi.org/10.11477/mf.1403103867

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要旨　教室で過去6年間に，EMRC法(endoscopic mucosal resection using a cap-fitted panendoscope)で内視鏡的粘膜切除を行った早期胃癌88病変，腺腫33病変を対象とした．68病変を一括切除，47病変を計画的分割切除，6病変を追加切除した．本法の治療効果，完全切除の判定，遺残・再発防止策などについて検討した．個々の切除標本の大きさは平均21mmと大型で，部位に関係なくほぼ一定であった．計画的分割切除における再構築は87％で可能であった．特に3分割切除までの30例すべてが再構築可能であった．分割切除例での完全切除の判定評価は，その組織構築性の可否から3分割程度までが妥当と考えられた．予後は5例にのみ遺残再発を認めたが，いずれも3か月以内に追加レーザー照射を行い，局所根治を得た．径15mm近傍以上の隆起性病変や境界不明瞭な平坦陥凹性病変に対するEMRの遺残防止策として，EMRC法による計画的分割切除は極めて有用な方法と考えられる．

　From August 1992 to August 1998, 105 patients with 121 gastric lesions were treated with endoscopic mucosal resection (EMR) using a cap-fitted panendoscope (EMRC). Among the lesions, there were 68 cases of en bloc resection, 47 cases of planned fractionated resection and six cases of additional types of resection. We examined the results of these methods of resection and discussed how to protect the residue following EMR.

　The average size of the resected specimens were 21 × 19 mm in various sites in the stomach. Residues were detected in 5 (4％) of the 121 lesions. These lesions were given an additional single irradiation of Nd-YAG laser within 50 days after the mucosal resection.

　In 41 lesions (87％) of the 47 cases of planned fractionated resection, the specimens were able to be reconstructed easily because they were large in size and contained recognizable marks. All 30 cases in which there was up to three fractionated resections were able to be reconstructed. Criteria for completion in fractionated resection are appropriate in cases of three or less fractions.

　We suggest that planned fractionated resection with EMRC procedure can protect residue or recurrence following EMR of protruded lesions more than 15 mm in diameter and flat or slight depressed lesion, and improve the curability of EMR for gastric tumorous lesion.