胃癌EMRの一括切除と分割切除の治療効果とレーザーを中心とした遺残再発の治療

Comparison of Single Resection with Piecemeal Resection in EMR and Results of Laser Irradiation as an Additional Treatment for Residual Tumor after EMR

要旨　EMR施行245病変について一括切除，分割切除別の成績，遺残に対する治療法とその成績について検討した．EMRの成績は一括切除で68.1％，分割切除では43.0％で，可能な限り一括切除での治療法が好ましいと言える．このためには一括切除を行う手技的な改良が必要である．肉眼的効果判定の正診率は一括切除で77.7％，分割切除で51.7％であり，現状では組織学的判定を加味することが必須であると思われる．遺残に対する追加治療法としてレーザー照射が72.7％を占め，その成績は初回治療で82.1％であった．追加レーザー治療の再発は肉眼型ではⅠ型，Ⅱc型，病変の大きさでは16mm以上のもの，組織型ではsig，深達度別ではsm例に高かった．

　We studied the outcome of endoscopic mucosal resection (EMR) in patients with early gastric cancer and the outcome of laser irradiation in the management of residual tumor. Between January 1986 and April 1997, we treated 245 lesions with a preoperative diagnosis of early gastric cancer by EMR. The rate of curative resection with EMR was 68.1% by using the single resection technique and 43.0% by the piecemeal resection technique. Accuracy rate of macroscopic efficacy was gauged by comparison with the histopathological results. The accuracy rate was 77.7% using the single resection technique and 51.7% using the piecemeal resection technique. Seventy-two point seven percent of all residual lesions received laser irradiation as an additional treatment. The curative rate of initial laser irradiation was 82.1%. Recurrence rate after additional laser irradiation was high for lesions of type I or type Ⅱc, lesions measuring 16 mm or over in diameter, lesions classified macroscopically as signet-ring cell carcinoma, and lesions that had invaded the submucosal layer of the stomach wall.