家族性大腸腺腫症における胃・十二指腸病変の経過

Follow-up Study of Gastroduodenal Lesions in Familial Adenomatosis Coli

要旨　家族性大腸腺腫症14家系21症例の胃・十二指腸が，X線・内視鏡検査および生検によって平均5年以上経過観察された．胃底腺ポリポーシス10例の経時的変化は，増加4例，減少2例，減少→増加1例，消失→増加1例，新生1例，不変1例であった．これらの変化と大腸切除との間に明らかな関係は認められなかった．胃腺腫7例のうち5例は不変であったが，他の1例では2個の腺腫のうち1個が消失，残りの1例では腺腫の癌化が示唆された．十二指腸に単発ないし多発性の腺腫が認められた12例（対象13例中）のうち，9例は不変であったが，他の2例では部分的に軽度増加あるいは減少が観察された．更に，残りの1例では初回検査で見落とされた径17mmの球部隆起が，1年10カ月後50×30mmの進行癌に増大した．10例中4例の乳頭部に腺腫が発見されたが，その内視鏡像および生検組織像に経時的変化は認められなかった．以上の成績より，本症における胃・十二指腸病変は，大腸に比べると発育は緩徐で，癌化の頻度も低いが，今後長期生存例が増えるにつれ，上部消化管癌の発生頻度も増すことが予想され，長期間の定期的follow-upが必要であることが示唆された．

　Gastroduodenal lesions of 21 cases of familial adenomatosis coli in 14 families were followed by x-ray and endoscopic examination with biopsy for average more than five years and the following results were obtained.

　1) In ten out of the 21 cases, fundic gland polyposis was noted. Among the ten cases, progressive changes in number and size of the fundic gland polyp were evaluated and the results were as follows: four cases had an increase in its number and size, two cases had a decrease in its number and size, two cases had its temporal regression or disappearance but eventually had an increase in its number and size, one case had a new development and no change was observed in the remaining one case. There was no apparent correlation between these changes and operation of the colon.

　2) Gastric adenoma was noted in seven out of 21 cases. Among the seven cases, changes in number and size of the gastric adenoma were evaluated and it disclosed the following findings: five cases had no change but other one had disappearance of one of two adenomas and the last one had malignant change of the adenoma.

　3) Twelve out of 13 cases, which were followed by hypotonic duodenography and duodenofiberscopy, were found to have duodenal adenoma. In nine out of the 12 cases, the adenoma remained unchanged, but in other two cases, a slight increase or decrease in number and size of the adenoma was partly noted. In the remaining one case, protruded lesion of the bulb (17 mm in diameter), which was overlooked by initial examination. became advanced cancer measuring 50×30 mm for one year and 10 months.

　4) Duodenal papilla was followed by endoscopic biopsy in ten cases and four of them were found to have adenoma. No endoscopic and histologic changes were noted among them for average more than five years.

　5) These results suggest that gastroduodenal lesions in familial adenomatosis coli grow less rapidly than its colonic lesions and have less malignant potentials.

　However, increased incidence of malignant changecan be expected if we have more cases of long-term survivors from now on. Therefore, periodic follow-up for such patient should be considered for a long period.