胃カルチノイドの治療

Treatment of Gastric Carcinoid

要旨　当院における胃カルチノイドの治療の実態を報告するとともに文献的に胃カルチノイドの治療法について考察した．当院で経験した胃カルチノイドは27例で，うち14例が外科的切除，13例がEMRを行い経過観察中である．手術を行った高ガストリン血症を伴う多発例の1例にリンパ節転移を認めたが，全例再発・死亡は認めていない．カルチノイド腫瘍の治療方針決定には，大きさ，深達度，組織学的所見（異型度，浸潤増殖様式）が重要である．われわれは術前診断が2cm以下，SM中層までにとどまる場合には，まずEMRを行い，切除材料の病理学的所見にて追加胃切除，リンパ節郭清を行うか，あるいは経過観察とするかを決定する．術前診断が2cm以上，あるいはMP以深の場合には外科的切除を行っている．

　This paper reports the current treatment of gastric carcinoid in our hospital and discusses it based on the literature. Our hospital has treated gastric carcinoid in 27 patients, 14 of whom underwent surgical resection and 13 of whom are still under observetion by EMR. Recurrence or death occurred in none of the patients, although lymph node metastasis occured in 1 patient with multiple carcinoids associated with hyergastrinemia who underwent surgery. In determining therapeutic policy for carcinoid tumors, their size, depth, and histological findings (degree of atypism and infiltration pattern) must be taken into account. If the carcinoid is 2 cm in diameter or smaller and its depth is SM or shallower, we first conduct EMR and then conduct additional gastrectomy with lymph node dissection or just monitor the patients condition depending on the pathological findings of the EMR material. If the carcinoid is greater than 2 cm in diameter or deeper than MP, surgical resection is conducted.