胃粘膜内癌EMRの適応拡大における分割切除の工夫と問題点

Contrivance and Problem of Fractionated EMR in Spreading Indication for Mucosal Gastric Cancer

要旨　1992年8月から2002年1月までに，絶対適応の早期胃癌108例121病変に対し，内視鏡的吸引粘膜切除法（EAM）を施行した．分割切除例の標本再構築率は100％であり，完全切除率は一括切除例で84.2％，分割切除例で76.9％と有意差なく，完全切除例では，一括切除例で平均23.6か月，分割切除例で平均28.6か月の観察期間中遺残再発はなかった．以上より，EAM法における分割切除法は臨床的に妥当と考えられた．また，大口径のスネアガイドチューブー体型先端フードでは，平均径30mmの標本が得られ，分割切除を念頭に置いた場合，現状では，長径30mmまでの粘膜内癌に対し，適応拡大が可能と考えられた．

　Endoscopic aspiration mucosectomy (EAM) was applied in 108 cases including 121 lesions of early gastric cancer from August 1992 to January 2002. All of the specimens obtained by fractionated resection using EAM were able to be reconstructed. There was no significant difference in the rate at which complete resection was attained by single procedure resection and by fractionated resection. There has been no recurrence from completely resected cases whether the resection was made by single procedure or fractionated resection. We concluded that fractionated resection using EAM was clinically effective and appropriate. The average size of the specimens obtained by the large-caliber hood attached to the snare-guide tube was 30 mm. Our conclusion is that we can radically resect mucosal cancer up to 30 mm in size by fractionated resection using EAM.