早期胃癌に対する内視鏡的レーザー治療

Endoscopic Laser Therapy for Early Gastric Cancers

要旨　内視鏡的レーザー照射により治療され，6か月以上経過観察が可能であった早期胃癌84病変の治療成績を組織型，大きさ，肉眼型および深達度別に検討した．いわゆる絶対的適応（高分化型腺癌のm癌で20mm以下の隆起型と潰瘍を伴わない10mm以下の陥凹型）40病変のうち38病変（95.0％）において6か月以上の癌陰性が得られており，絶対的適応病変にレーザー治療は有効な治療法と考えられた．相対的適応（絶対的適応以外の早期胃癌）44病変では28病変（63.6％）で6か月以上の癌陰性が得られ，絶対的適応病変に比べ癌陰性率は不良ではあるが，対象が手術不能例であり合目的的な治療法と考えられる．しかし，相対的適応のうち陥凹型のsm癌12病変中6か月以上癌陰性が得られたものは3病変（25.0％）と極めて不良であった．

　Eighty four early gastric cancers were treated with endoscopic Nd-YAG laser irradiation therapy. Macroscopic type Ⅰ and Ⅱa less than 2.0 cm in size and type Ⅱc with Ul (-) less than 1.0 cm in size mucosal cancers are considered to be absolute indications for endoscopic therapy because of the minuscule possibility of lymph node metastasis.

　Absolutely indicated 40 lesions were treated with endoscopic laser irradiation and 38 of them showed no relapse of cancer over 6 months' period. Ralatively indicated 12 superficial elevated type lesions were also treated with laser therapy and 11 of them had no recurrence of cancer after more than 6 months'duration. However, laser treatment had poor efficacy in dealing with superficial depressed type lesions with submucosal invasion.

　Therefore it is suggested that endoscopic laser therapy could be highly effective, if it would be applied on absolutely indicated and protruding type lesions.