潰瘍性大腸炎に伴うdysplasiaとcolitic cancerの内視鏡診断に関する検討―特に拡大観察の有用性に関して

Study on Endoscopic Diagnosis of Dysplasia and Colitic Cancer: Significance of Magnifying Endoscopic Diagnosis

要旨　潰瘍性大腸炎に伴うdysplasiaとcolitic cancerの内視鏡所見について検討した．対象はdysplasiaのみ13例，dysplasiaが検出された後に癌が発生した3例，colitic cancer6例の計22例とした．dysplasiaの内視鏡所見は，顆粒・結節状隆起9例，扁平隆起4例，平坦粘膜3例などである．早期癌はⅡc，Ⅱa，Ⅰsp，Ⅰs，結節集簇様など多彩で，進行癌では3型，5型と浸潤傾向の強いものが多かった．dysplasiaおよび早期癌の見つけだし診断には，色素撤布と拡大観察が有用で，dysplasiaの病変は，Ⅳ型pitやⅢs～Ⅲ_L型pitが粗に観察される．これらの所見に注目して標的生検することが診断には効率的である．

　We focused our study on the diagnosis by endoscopic examination of dysplasia and colitic cancer associated with ulcerative colitis. In all, there were 22 subjects which included 13 patients with dysplasia only ; 3 patients in whom dysplasia was observed previously to the detection of colitic cancer ; and 6 patients with colitic cancer only. Characteristics of findings of dysplasia were nodules with granular lesions (9 cases), flat elevated lesions (4 cases) and flat mucosa (3 cases) . Various early colitic cancers such as Ⅱc, Ⅱa, Ⅰs, Ⅰsp and nodule-aggregating tumor-like lesions were seen. Advanced colitic cancers were often observed to be strongly infiltrating. Magnifying observation with dye spraying was useful for the detection or diagnosis of dysplasia and colitic cancer associated with ulcerative colitis. The main pit patterns of dysplasia or early colitic cancer were type Ⅳ and type Ⅲs with Ⅲ_L.

　It is concluded that magnifying observation with dye spraying is effective for the detection of dysplasia or colitic cancer associated with ulcerative colitis.