内視鏡的粘膜切除術（EMR）後遺残再発した早期胃癌の1例

Recurrence of Early Gastric Cancer after Endoscopic Mucosal Resection, Report of a Case

要旨　患者は82歳，男性．便潜血反応陽性と本人の希望もあったため，当院で上部，下部消化管内視鏡検査を施行．胃体下部後壁に約1．5cmのO-Ⅰ型胃癌を指摘された．1995年6月EMR（endoscopic mucosal resection）を施行．深達度はm，断端陽性であった．このため上部消化管内視鏡検査による経過観察を1か月後，2か月後，6か月後，1年後に行った．1年後にはEMR前とほぼ同じ大きさで同じ形態を呈した．再度EMRを施行し深達度m，断端陰性であった．その後再発は認めていない．遺残再発した早期胃癌の形態が興味深く，更に断端陽性であったが，1年後に治癒切除された症例を経験したので報告する．

　An 82-year-old man who had diabetes melitus and hypertension was admitted to our hospital because of cerebral infarction and positive fecal occult blood. Upper gastrointestinal endoscopy and total colonoscopy were carried out. These examinations with biopsies re-vealed early gastric cancer type 0-I at the posterior of the lower corpus. We performed endoscopic mucosal resection (EMR) for it. Histological findings showed Group V, papillary adenocarcinoma limited to the mucosal layer, ly(-), v(-), cut end (+). Using upper endoscopy, we followed up this patient after EMR (one month, three months, six months, and one year later). One year later a tumor had recurred at the same location and was the same size. We performed EMR again. Histological findings showed Group V, papillary adenocarcinoma limited to the mucosal layer, ly(-), v(-), cut end(-). Since that time, there has been no recurrence of the tumor in this patient.