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Stomach and Intestine(Tokyo) Volume 32, Issue 11 （October 1997）

胃と腸 32巻11号（1997年10月発行）

Japanese English

今月の主題 Is型大腸sm癌を考える

主題

Is型大腸sm癌の治療―内科の立場から―内視鏡治療の適応を中心に Treatment of Is (Sessile) Type Colorectal Submucosal Carcinomas (from the Standpoint of Physician): Special Reference to Indication for Endoscopic Therapy 斉藤裕輔 ¹ , 渡二郎 ¹ , 藤城貴教 ¹ , 谷口雅人 ¹ , 野村昌史 ¹ , 栄浪克也 ¹ , 垂石正樹 ¹ , 綾部時芳 ¹ , 蘆田知史 ¹ , 太田智之 ² , 折居裕 ² , 横田欽一 ¹ , 小原剛 ¹ , 高後裕 ¹ Yusuke Saitoh ¹ , Jiro Watari ¹ , Takanori Fujiki ¹ ¹旭川医科大学第3内科 ²旭川厚生病院消化器科 ¹The Third Department of Internal Medicine, Asahikawa Medical College キーワード： Is型早期大腸癌 , sm深部浸潤 , 内視鏡治療 Keyword: Is型早期大腸癌 , sm深部浸潤 , 内視鏡治療 pp.1489-1501

発行日 1997年10月25日 Published Date 1997/10/25

DOI https://doi.org/10.11477/mf.1403105226

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要旨　早期大腸癌の中でIs型早期大腸癌の治療上の重要性を明らかにし，併せて深部浸潤したIs型早期大腸癌のX線，内視鏡における特徴を明らかにすることを目的とした．1990年1月から1996年12月までに旭川医科大学第3内科および旭川厚生病院消化器科で診断，治療した早期大腸癌695病変中，Is型早期大腸癌135病変を対象とした．Is型早期大腸癌の深達度別の治療法の内訳について検討した．また，sm深部浸潤例に特徴的に出現する注腸X線，大腸内視鏡所見について病理組織との対比から検討した．その結果，(1)Is型早期大腸癌のsm浸潤率は42.2％（57/135）で，他の隆起型早期癌と比較して有意に高率であり（p＜0.005），深部浸潤例も多かった．(2)sm深部浸潤例に対して内視鏡治療が先行された19病変中，Is型は9病変（47.4％）と多く，その大きさの平均は12.6mmと小さかった．(3)深部浸潤したIs型sm癌の注腸X線検査，内視鏡検査の特徴は，①表面にびらんを有する，②緊満感を有する，③立ち上がりが正常粘膜である，④側面像で弧状変形を認める（注腸X線検査）の4項目であった．結論として，大きさ10mm前後のIs型早期癌のうち，特に，注腸X線，大腸内視鏡検査で隆起表面にびらんを認める病変では深部浸潤例も多く，内視鏡治療の適応決定は慎重に行うべきである．

　During the period between January 1990 and December 1996, there were 135 Is type lesions out of 695 lesions of early colorectal carcinoma. Those Is type early colorectal carcinomas were studied to clarify the indication for endoscopic treatment. Submucosal invasion rate of Is type early cancer was 42.2%, which was significantly higher than those of other protruding types of early cancer 〔Ip (pedunculated) and Isp (subpedunculated) types〕 and was the same as that of Ⅱa (flat elevated) type cancer. There were 19 lesions of moderately and massively extended Submucosal cancers that were initially treated by the endoscopic resection then followed by surgical operation, because there found carcinomatous invasion at the resected margin or lymphatic invasion in the specimens removed by the EMR or endoscopic polypectomy. Almost half of them (nine cases) were Is type by the macroscopic classificasion and their average size was 12.4 mm in diameter. This average size of these nine lesions that were initially treated endoscopically was significantly smaller than that of the Is type early colorectal cancers with sm₂～sm₃ invasion which were initially treated surgically. Useful colonoscopic findings indicating sm₂～sm₃ invasion of Is type cancer were as follows; i) smooth with nodular surface, ii) depression on the surface, iii) expansive appearance, iv) normal mucosa at the border of the tumor. In conclusion, we should be careful to diagnose the depth of invasion of Is type early carcinoma especially around 10 mm in size before endoscopic treatment, because it was generally thought to be less aggressive than the Ip and Isp type early colorectal carcinomas.