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Stomach and Intestine(Tokyo) Volume 33, Issue 13 （December 1998）

胃と腸 33巻13号（1998年12月発行）

Japanese English

今月の主題胃癌EMR後の遺残再発―診断と治療

主題

胃癌EMR後の遺残再発癌に対する内視鏡的追加治療の有用性 A Study of the Efficiency of Additional Endoscopic Treatment for Residual and Recurrent Cancer after Endoscopic Mucosal Resection (EMR) for Early Gastric Cancer 三坂亮一 ¹ , 川口実 ¹ , 工藤拓 ¹ , 坂井康明 ¹ , 梅沢裕信 ¹ , 谷穣 ¹ , 三治哲哉 ¹ , 半田豊 ¹ , 森田重文 ¹ , 大野博之 ¹ , 鶴井光治 ¹ , 斉藤利彦 ¹ Ryoichi Misaka ¹ , Minoru Kawaguchi ¹ , Hironobu Umezawa ¹ , Yuzuru Tani ¹ , Yutaka Handa ¹ ¹東京医科大学第4内科 ¹The Fourth Department of Internal Medicine, Tokyo Medical College キーワード： EMR , 遺残再発癌 , 内視鏡的追加治療 , Nd-YAGレーザー Keyword: EMR , 遺残再発癌 , 内視鏡的追加治療 , Nd-YAGレーザー pp.1719-1725

発行日 1998年12月25日 Published Date 1998/12/25

DOI https://doi.org/10.11477/mf.1403103888

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要旨　早期胃癌に対するEMRおよびEMR後の遺残再発癌に対する内視鏡的追加治療の有効性について検討した．対象は1988年から1997年12月までにEMRが施行された早期胃癌170病巣（152例）である．追加治療としては再EMR，レーザー照射，ヒータープローブ，エタノール局所注入を施行し，各症例の切除材料，術後経過を詳細に検討した．その結果，①初回EMRの完全切除率は62.4％（106/170）で，これらには再発を認めなかった．②遺残再発癌52病巣に施行した内視鏡的追加治療の有効率は98.1％（51/52）であった．③内視鏡的治療法のうちでもレーザー照射が局所根治率87.9％，遺残再発率12.1％と追加治療としての有用性が高かった．このようにEMR後の遺残再発癌に対しては内視鏡的追加治療法の有効性が示されたが，原則的には一括完全切除を目標として慎重に適応決定を行い，更に術後の経過観察を確実に，長期間継続することが重要と思われる．

　To examine the effect of endoscopic mucosal resection (EMR) and additional treatment for early gastric cancer, we studied the endoscopic findings, the histopathological findings, the additional treatments and the process after resection in 152 patients with 170 lesions of early gastric cancer treated by EMR since 1988 to December 1997.

　The rate of complete resection among 170 lesions was 62.4% (106/170) and we performed surgical operations on 12 cases with invasion to the submucosal layer or cut end (+++).

　No recurrent case was recognized among the cases in which complete resection was confirmed by histological examination of the resected specimen. We treated the residual and recurrent cancer by ① re-EMR, ② laser therapy, ③ heater probe or ④ local injection of ethanol. We examined the additional endoscopic treatment for 52 lesions, and 50 of them showed negative for cancer diagnosed through endoscopic biopsy. Two recurrent cases were recognized more than one year after EMR, (1) Ⅱc (tubl) recurred after one year and a half, (2) Ⅱc (tubl) recurred after two years. Both of them had received EMR as the primary treatment and heater probe as the additional treatment. These recurrent cases were completely resected with re-EMR. The rate of efficiency or cure after the additional endoscopic treatment was 98.1% (51/52). Including both the complete resected cases and the additional treatment cases, the rate of efficiency or cure was 92.4% (157/170). We performed re-EMR and added laser therapy in the cases with cut-end positivity for cancer and the rate of cure was as high as 92.4%.