早期胃癌に対する内視鏡的治療における多発癌の問題点

The Problems of Multiple Early Gastric Cancer for Endoscopic Treatment

要旨　早期胃癌の内視鏡的治療における多発癌の問題について検討した．内視鏡的治療における多発癌と対比するため，切除胃における多発性早期胃癌の検討も行った．切除胃における同時性多発性早期胃癌の頻度は9.4％であった．しかし，高齢者ではその頻度が高く，70歳台は13.7％，80歳台では17.6％であった．切除胃における多発性早期胃癌の組織型は分化型癌と分化型癌の組み合わせが79.3％であった．内視鏡的治療のうちレーザー照射治療を行った57症例71病巣(平均年齢74.9歳)では，“同時期発見癌”が10.5％，“経過中発見癌”が8.8％であった．内視鏡的粘膜切除術を行った58症例65病巣(平均年齢68.9歳)では，“同時期発見癌”が6.9％，“経過中発見癌”が5.2％であった．経過中に胃内他部位に発見された癌(＝経過中発見癌)はすべて内視鏡的治療の適応であったことから，現行の経過観察法で十分であると考えられた．また，多発癌症例は新たに癌が発見される可能性が高く，特に慎重な内視鏡観察が必要である．

　We investigated the problems of multiple early gastric cancers for endoscopic treatment. The incidence of simultaneous multiple early gastric cancers in the resected stomach was 9.4%. In elderly patients, however, the incidence was higher than that of all ages: aged 70-79 years; 13.7% and aged over 80 years; 17.6%. Histological examination of the resected specimen revealed that 79.3% of multiple early gastric cancers was a combination of differentiated adenocarcinomas.

　Endoscopic treatment includes laser irradiation treatment and endoscopic mucosal resection.“simultaneously discovered carcinoma”was found in 10.5% of the cases with laser treatment, whereas“carcinoma discovered during the follow-up period”was 8.8%. Endoscopic mucosal resection was performed in 65 lesions of 58 cases (mean age; 68.9 years).“simultaneously discovered carcinoma”was found in 6.9% of these cases and“carcinoma discovered during the follow-up period”was found in 5.2%.

　Since all carcinomatous lesions that were discovered in other areas of the stomach during the follow-up period could be treated endoscopically, current observation method seems to be adequate.

　Furthermore, there is a high probability of discovering new lesions in multiple cancer cases, therefore it is important to perform endoscopic observation with great care.