家族性大腸腺腫症における胃・十二指腸病変の長期経過

Long-term Follow-up Study of Gastroduodenal Lesions in Patients with Familial Adenomatous Polyposis

要旨　家族性大腸腺腫症19家系24症例の胃・十二指腸を，X線・内視鏡検査および生検によって平均14年経過観察した．胃底腺ポリポーシス11例の経過は，増加4例，減少2例，一時的な減少あるいは消失後に増加2例，新生1例，不変2例であった．年齢との関係は，30歳以下では増加傾向が強いが，30歳を超えると減少，消失，増加と多彩な変化を示した．胃腺腫12例の経過は，増加5例，新生4例，消失1例，不変2例であった．一方，十二指腸腺腫20例の経過は，増加7例，不変13例であった．増加例のうち3例では，6個の胃・十二指腸腺腫が急速に増大したため内視鏡的あるいは外科的にポリペクトミーが施行された．胃腺腫は20歳台，十二指腸腺腫は10歳台から発生し，ともに加齢とともに増加するが，30歳台後半からは増大例に高度異型の腺腫が認められた．十二指腸乳頭部腺腫15例の経過は，増大2例，新生3例，不変10例であった．2例（38歳，40歳）では，乳頭部からの生検で高度異型の腺腫が検出されたが，経過中組織像は不変であった．全例，経過中における胃・十二指腸癌の発生はなかった．以上の成績から，本症における胃・十二指腸病変は，予防的手術の適応とならないこと，X線および内視鏡検査による定期的な経過観察が極めて重要であること，径10mmを超える腺腫に対しては内視鏡的切除が必要であることが示唆された．

　The natural history of gastroduodenal lesions was studied in 24 patients with familial adenomatous polyposis. These patients were followed for an average of 14 years and repeatedly examined by radiography, endoscopy, and biopsy. Fundic gland poyposis was found in 11 patients: There was an increase in number or size, or both, of polyps in four, a decrease in two, an initial decrease or disappearance followed by a late-occurring increase in two, a new appearance in one, and no change in two. The number and size of fundic gland polyps increased in the patients aged under 30 years, while the polyps showed various changes such as the decrease, disappearance, or increase in those aged over 30 years. Gastric adenomas were present in 12 patients: There was an increase in number or size, or both, of gastric adenomas in five, a new appearance in four, a disappearance in one, and no change in two. Duodenal adenomas were found in 20 patients: There was an increase in number or size, or both, of duodenal adenomas in seven but no distinct change in 13. In three of the former seven patients, six gastroduodenal adenomas rapidly increased in the size, and were treated with endoscopic or surgical polypectomy. It is suggested that gastric adenomas in patients with this disease may appear as early as 20 years of age while duodenal adenomas as early as 10 years of age, that these lesions proliferates gradually with age, and that in some patients aged over 37 years, there may be a development of adenoma with severe epithelial atypia. Adenoma of the duodenal papilla was detected in 15 patients: There was an enlargement of the duodenal papilla in two, a new appearance of adenoma in three, and no change in ten. During the follow-up period, malignant changes of these lesions were not observed in any patient. These findings indicate that in patients with this disease, gastroduodenal lesions do not require prophylactic surgery, and that careful periodic follow-up examinations using radiography, endoscopy, and endoscopic biopsy should be performed, with endoscopic removal of larger (over 10 mm in size) polyps.