胃EMRの適応拡大：大きさからみて―一括切除を目指した手技の工夫と成績：S-ERHSE法

Endoscopic Resection for Early Gastric Cancer by Direct Incision of the Submucosa, with Local Injection of HSE Solution

要旨　広範な病変に対する一括切除を目指した手技として，1997年10月より粘膜下層直接切離によるERHSE（S-ERHSE）法を考案し臨床応用しているのでその手技，治療成績について概説した．（手技）病変より5mm以上離して全周性にマーキングする．HGE液を局注する．マーキング部位を全周性に粘膜切開する．病変の辺縁を把持鉗子で挙上し，粘膜下層を針状メスで直接切離する．病変を切除回収する．（成績）34例に施行した．病変平均長径30.7mm（20～90），切除粘膜平均長径50.1mm（30～100），一括切除率79％，完全切除率100％，遺残再発率0％，出血0％，穿孔11.8％，平均在院日数8日であった．（結語）S-ERHSE法は広範囲病変に対する一括切除を可能とし，根治的EMRとして適応を拡大できる手技である．

　We have attempted en bloc resection for large lesions of early gastric cancer using the method of S-ERHSE, which the authors devised and have performed, since Oct. 1997. This S-ERHSE (submucosal-endoscopic resection with HSE injection) method is summarized as follows. First step ; circular marking is made 5 mm distant from the lesion. Second step ; local injection of HSE solution into the submucosa to elevate the lesion. Third step ; cutting of the marked mucosa circularly into the submucosa using a scalpel. Forth step ; moving the lesion by forceps and incision of the submucosal layer by scalpel and resection.

　34 patients were treated by this S-ERHSE method. The average size of cancer lesions and resected specimens was 30.7 mm (range 20-90) and 50.1 mm (range 30-100) . The rate of en bloc resection and complete curative resection and residual resection was 79%, 100% and 0%, respectively. The rate of perforation and hemorrhage was 11.8% and 0%. The average length of hospital stay was 8 days. In conclusion, the S-ERHSE method is excellent for en bloc resection of large size cancer lesions. Through this procedure, the number of cases indicated for curative endoscopic mucosal resection can be magnified.