大腸微小腫瘍性病変の内視鏡診断とその取り扱い

Endoscopic Diagnosis and Treatment for Minute Lesions of the Colon

要旨　大腸病変9,760病変(腫瘍性6,759病変，非腫瘍性3,001病変)を対象とし，微小腫瘍性病変の取り扱いについて検討し以下の結果を得た．①表面陥凹型は他形態に比し少数であり腺腫，癌の頻度が高いので，積極的に内視鏡治療を行う．②表面隆起型，隆起型は数も多く腺腫，癌の頻度は低いので，まず生検を行い，癌の疑われる病変にのみ内視鏡治療を行う．③二段隆起・陥凹中の結節の存在する病変は形態に関係なくsm massive癌の可能性が高いので，他の検査を含めた深達度診断を行い，治療法を選択する．数多く存在する微小病変に対しては肉眼的な形態別に取り扱うことが効率の良い方法であると考えられた．

　Nine thousand seven hundred sixty small and minute lesions of the colon (6,759 neoplastic and 3,001 nonneoplastic lesions) were investigated to determine the treatment indication. Results showed : (1) Active endoscopic treatment was indicated for superficiallyexcavated-type lesions, because though the number was small, of the high incidence of adenoma and cancer. (2) Although the number was large, superficiallyelevated-type or elevated-type had low incidence of cancer. Therefore endoscopic biopsy was the first choice and endoscopic treatment was used only when cancer was suspected, and (3) regardless of macroscopic type, the lesions with double elevations and the presence of nodules in the excavated area had high incidence of sm massive cancer, consequently other diagnostic modalities for the depth of cancer invasion were mandatory for selection of treatment.

　In conclusion, it is indicated that, minute lesions which are increasingly found in large number, should be treated according to the macroscopic classification.