胃sm癌の病理組織学的検討―リンパ節転移を指標として

Risk Factor for Lymph Node Metastasis of Submucosal Invasive Carcinoma

要旨　胃sm癌679例のリンパ節転移と肉眼型，組織型の関連を検討した．肉眼型ではⅠ型を含む隆起型にリンパ節転移が多く（28％），潰瘍を伴わない陥凹型はリンパ節転移が少なかった（12％）．組織型はpapにリンパ節転移が多く（26％），tub 1は少なかった（16％）．更に縮小手術の対象となるsm癌を検索するために4cm以下のsm癌296例の組織型を粘膜内癌成分と粘膜下層癌成分に分類し，深達度別（smを3等分し，sm₁，sm₂，sm₃に分類）に比較検討したが，粘膜内がtub 1で潰瘍を伴わない陥凹型は，深達度や粘膜下層の組織型にかかわらずリンパ節転移を認めず，縮小手術の適応と考えられた．

　To investigate the risk factor for lymph node metastasis of submucosal invasive gastric carcinoma, we examined 679 cases of surgically resected submucosal invasive gastric carcinomas. Macroscopically, 28％ of elevated with Ⅰ type cases were node positive, while in cases of depressed without ulcer, 12％ were positive. Histologically, the rate of lymph node metastasis was high in papillary adenocarcinoma (26％) and mucinous adenocarcinoma (30％), while it was low in well differentiated tubular adenocarcinoma (tub 1) (16％). Histologic type of mucosal and submucosal components were separately. described in 296 cases smaller than 4 cm. When mucosal histologic type was tub 1 and macroscopic type was depressed without ulcer, no cases were node positive even if the tumor had deeply invaded the submucosa. Cases included in this category were thought to be an indication for conservative therapy such as endoscopic mucosal resection or laparoscopic gastrotomy.