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Stomach and Intestine(Tokyo) Volume 28, Issue 2 （February 1993）

胃と腸 28巻2号（1993年2月発行）

Japanese English

今月の主題内視鏡的食道粘膜切除術

主題

早期食道癌に対する内視鏡的粘膜切除の実際―2チャンネル法 Endoscopic Mucosectomy of Early Esophageal Cancer 門馬久美子 ¹ , 吉田操 ² , 山田義也 ¹ , 田所康正 ¹ , 榊信廣 ¹ , 田島強 ³ , 室井正彦 ² , 岩崎善毅 ⁴ , 滝沢登一郎 ⁴ Kumiko Momma ¹ , Misao Yoshida ² , Yoshiya Yamada ¹ , Tsuyoshi Tajima ³ , Yoshiaki Iwasaki ⁴ ¹東京都立駒込病院内科 ²東京都立駒込病院外科 ³東京都立駒込病院内視鏡科 ⁴東京都立駒込病院内病理科 ¹Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital ²Department of Surgery, Tokyo Metropolitan Komagome Hospital ⁴Department of Pathology, Tokyo metropolitan Komagome Hospital キーワード：内視鏡的粘膜切除 , 早期食道癌 , 2チャンネル法 Keyword: 内視鏡的粘膜切除 , 早期食道癌 , 2チャンネル法 pp.141-151

発行日 1993年2月25日 Published Date 1993/2/25

DOI https://doi.org/10.11477/mf.1403106045

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要旨　早期食道癌に対する内視鏡的粘膜切除法は，食道温存のまま小さな侵襲で癌が根治できる局所治療法であり，切除組織の病理組織学的検索から，局所根治の判定や追加切除の必要性が判定できる唯一の方法である．リンパ節転移や脈管侵襲のない深達度ep～mm₂までの癌が適応であり，癌の根治目的にep癌28例，mm癌9例，手術拒否sm癌1例と，病変の全生検および確定診断目的に異型病変2例の計40例に粘膜切除を行った．診断に相違のあった症例は6例15％であり，扁平上皮癌の診断にて切除した38例中，3例は高度異型上皮，2例は癌が検出されず再生上皮のみであった．また，高度異型上皮の診断にて切除した2例中，1例にep癌が診断された．深達度診断に相違のあった症例は4例12％であり，粘膜切除前に深く診断した症例は1例，浅く診断した症例は3例であった．分割切除を併用しているため，病変の大きさに制限はないが，分割切除施行25例中，不完全切除1例と切除断端がぎりぎりであった2例で局所再燃がみられた．最長経過観察期間は5年であり，他臓器癌にて死亡した1例を除き，リンパ節転移や他臓器転移はなかったが，3例8％で異時性多発食道癌が診断された．

　We evaluated the clinical and pathological characteristics of 40 patients who underwent endoscopic mucosectomy for esophageal mucosal lesions (28 intraepithelial cancers, 9 mucosal cancers, 1 submucosal cancer, and 2 atypical epithehim lesions).

　Pathological diagnosis of biopsy specimens before endoscopic treatment was as follows: 33 squamous cell carcinomas, 3 atypical epitheliums, and 2 regenerative epitheliums. One out of 2 cases of atypical epitheliums was found to have a small focal squamous cell carcinoma in the mucosectomy specimen. Accuracy rate of pre-procedural diagnosis of invasivity was 88%.

　The completeness of endoscopic resection could be confirmed by identification of normal mucosa around a lesion in the resected specimen and no iodine unstained area surrounding an iatrogenic ulcer. Two out of 22 cases of intraepithelial carcinoma had local recurrences after endoscopic piecemeal resections. They were completely removed by endoscopic mucosectomies.

　Five cases had a small amount of bleeding from the iatrogenic ulcers, which were successfully controlled by conservative treatments. Two cases developed esophageal stenosis after circular resection of the esophagus. Minimal mediastinal emphysema was noted in one case, but there was no sign of perforation in the esophagogram and it disappeared in ten days.

　Forty patients with endoscopic mucosectomy had been followed for 19.9 months on the average (range from 1 to 60 months). One patient was expired by an advanced cancer arising from other organ, which had no evidence of recurrence of esophageal cancer. There was a case of incomplete resection, which developed a local recurrence and underwent surgical resection. There were 3 cases of metachronous multifocal cancers which could be resected endoscopically.