結節集簇様大腸病変の臨床的取り扱い―内視鏡治療の適応と限界

Management of Colorectal Carpet-like Tumors: lndication and Limitation of Endoscopic Therapy

要旨　大腸の結節集籏様病変の治療の現況，特に内視鏡治療の実態について，多施設で経験した152例に対する治療成績を集計して検討した．内視鏡治療群は61例（40.1％），外科切除群は91例（59.9％）であり，内視鏡治療群の病変の平均最大径は22.48±11.30mmであり，外科治療群よりも小さい傾向がみられた．内視鏡治療群についてその手技の内容をみると，大きい病変に対して各種手技を併用したりpiecemeal polypectomyが用いられることが多く，小さい病変に対してstrip biopsyが用いられることが多かった．経過観察をなしえた42例中6例（14.3％）に再発がみられた．結節集簇様病変に対する内視鏡治療の適応として，癌の浸潤範囲がsm₁までにとどまっていることが確実な症例に限ると考えられ，術前の正確な性状診断と深達度診断が要求された．内視鏡医の技術の巧拙によっても適応は左右されるが，病変が扁平であり，広基性，大きいことが多いため，いずれの内視鏡手技を用いるにせよ，熟練者が慎重に対処しなければならないことを強調した．

　To define the current management of colorectal carpet-like tumors, clinical data of 152 cases were accumulated from 11 centers and analysed.

　Endoscopic therapy was performed in 61 cases (40.1%) and surgical operation in 91 (59.9%). The average (±SD) maximal diameter of lesion in the former group was 22.48±11.30 mm, which was significantly smaller than that of the latter. In the former group, piecemeal polypectomy was generally employed for relatively large lesions, while strip biopsy was often selected for smaller ones. Local recurrence occurred in 6 (14.3%) out of 42 cases in which follow-up examination was made.

　Endoscopic therapy should not be selected for cancer invading beyond sm₁. Therefore, precise diagnosis on the nature and depth of lesion is prerequisite to management decision. Indication of endoscopic treatment also depends on the skill of endoscopists. Whatever method one may choose, the procedure must be cautiously performed, since carpet-like tumors are often flat and large.