胃粘膜下腫瘍の内視鏡診断の現況

The Present Condition of Endoscopic Diagnosis of Gastric Submucosal Tumor

要旨　通常内視鏡による胃粘膜下腫瘍の診断の現況について検討した．対象は過去14年間の内視鏡診断群347例354病巣，内視鏡的切除群7例7病巣および手術群45例45病巣である．頻度は1.4，2.8，2.1％である．病理組織学的診断は筋原性腫瘍，カルチノイド，異所膵，脂肪腫，inflammatory fibroid polyp，hamartomatous polypなどである．部位別頻度では内視鏡診断群ではC領域小彎，後壁およびA領域大彎に多く，手術群ではC領域に多い．内視鏡診断での上皮性病変との鑑別は，病変をあらゆる方向から観察すること．質的診断のためには，人工潰瘍を含めて潰瘍形成部からの生検が，胃外発育型の場合は体位変換のほかに各種画像診断の必要がある．

　The present condition of endoscopic diagnosis of gastric submucosal tumor was studied. Materials are a group of 347 cases (354 lesions) found by endoscopic diagnosis, a group of 7 cases (7 lesions) found through endoscopic resection, and a group of 45 cases (45 lesions) found through surgical resection. The incidence is 1.4% in the endoscopic diagnosis group, 2.8% in the endoscopic resection group and 2.1% in the surgical resection group.

　Histological diagnosis confirmed inflammatory fibroid polyp and hamartomatous polyp in the endoscopic resection group. It confirmed leiomyosarcoma, leiomyoblastoma, leiomyoma, carcinoid, heterotopic pancreas, lipoma and inflammatory fibroid polyp in the surgical group.

　Regionally, the endoscopic diagnosis group showed many lesions in the lesser curvature of C, posterior wall of C and greater curvature of A and showed many myogenic tumors in the C, and many heterotopic pancreas in the A. The endoscopic resection group showed hamartomatous polyp in the C and inflammatory fibroid polyp in the A.

　The surgical group showed many lesions in the C (42.5%), in the M (40%), and showed many myogenic tumors and carcinoid in the C and M. It is possible to make a diagnosis of carcinod, heterotopic pancreas, and inflammatory fibroid polyp by biopsy and characteristic form.

　Most submucosal tumors associated with ulceration are diagnosable by biopsy. In case of submucosal tumor without ulcer formation, it is necessary to make an artificial ulcer and carry out biopsy. Most submucosal tumors which are more than 2 cm in diameter are to be understood as beeing myogenic tumors.

　The submucosal tumors which are more than 5 cm in diameter, or which are associated with ulcer, need surgery. The submucosal tumors which are less than 5 cm in diameter, and without ulceration, are to be kept under observation.