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Stomach and Intestine(Tokyo) Volume 32, Issue 13 （December 1997）

胃と腸 32巻13号（1997年12月発行）

Japanese English

今月の主題胃sm癌の臨床―m・sm₁とsm_2・3との鑑別を中心に

主題

胃のm，sm₁癌とsm_2，3癌との鑑別―X線・内視鏡診断の現状 Differential Diagnosis of Gastric m and sm1 Cancer from sm₂ and sm₃ Cancer, Present Conditions of Radiologic and Endoscopic Diagnosis 西俣寛人 ¹ , 西俣嘉人 ¹ , 美園俊明 ² , 田代光太郎 ¹ , 藤田浩 ² , 井出法子 ² , 大重和典 ² , 中島寛隆 ² , 久保園高明 ² , 鳥丸博光 ² , 大石一郎 ² , 仲淳一郎 ¹ , 有馬暉勝 ² , 山田一隆 ³ , 末永豊邦 ³ , 折田守久 ⁴ Hiroto Nishimata ¹ , Yoshito Nishimata ¹ ¹南風病院消化器内科 ²鹿児島大学医学部第2内科 ³南風病院外科 ⁴折田胃腸科外科 ¹Department of Internal Medicine, Nanpu Hospital キーワード：早期胃癌 , 深達度診断 , X線診断 , 内視鏡診断 Keyword: 早期胃癌 , 深達度診断 , X線診断 , 内視鏡診断 pp.1675-1688

発行日 1997年12月25日 Published Date 1997/12/25

DOI https://doi.org/10.11477/mf.1403105260

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要旨　EMR(endoscopic mucosal resection)，縮小手術の対象になりうる20

mm以下の陥凹型分化型胃癌264病変を対象にsm₂以深浸潤の診断能を検討した．sm₂以深癌は，①大きさでは10mm以下では6％，11～15mmで29％，16～20mmでは21％存在した．②占拠部位でsm₂以深への浸潤率に差がみられた．10mm以下では，胃体部後壁，前庭部後壁は，sm₂以深浸潤例はなかった．③形態的所見ではsm₂以深癌の70％が診断可能であった．④X線検査の圧迫法による透亮像，遠景観察の内視鏡像で陥凹辺縁の隆起の存在はsm₂以深の病変の可能性が高かった．⑤sm以深癌の潰瘍合併率は10mm以下で12％，11～15mmで32％，16～20mmで22％であり，潰瘍合併の診断能は50％以下であった．sm₂以深の診断には病変の占拠部位，大きさ，形態的所見，EUSの所見を総合的に判断する必要がある．

　Two hundred sixty four lesions of the depressive type differentiated gastric cancer less than 20 mm in size, which would be an indication for EMR or limited surgery, were evaluated for the detectability of invasion deeper than the sm₂. Characteristics of the gastric cancer with invasion deeper than the sm₂ were summarized as follows: 1) the percentages of the sm₂ cancer were 6% in the lesions less than 10 mm in size, 29% in those larger than 11 mm and smaller than 15 mm, and 21% in those larger than 16 mm and smaller than 20 mm. 2) there was a difference in the rates of invasion deeper than the sm₂ among locations, namely, there was no lesions with invasion deeper than the sm₂ in the posterior wall of the gastric body and the antrum. 3) seventy percent of the cancers with invasion deeper than the sm₂ could be detected by the macroscopic findings. 4) a translucent area by the pressure method in the radiologic examination and a surrounding elevation around depressive lesion by a distant view of endoscopic examnation suggested a lesion with invasion deeper than the sm₂. 5) concomitant rates of gastric ulcer and the sm₂ cancer were 12% in the cancer lesions less than 10 mm in size, 32% in those larger than 11 mm and smaller than 15 mm, and 22% in those larger than 16 mm and smaller than 20 mm. Diagnostic ability in the case of a gastric cancer with ulcers was less than 50%. Diagnosis of the lesions with invasion deeper than the sm₂ should be based on the location, size, morphological findings, and EUS findings of the lesions.