胃疾患の内視鏡的超音波断層像と病理所見の対比

Endoscopic Ultrasonography and Pathological Findings in Gastric Disease

要旨　胃疾患において7.5MHzリニア電子走査型超音波内視鏡を用い，バルーン法によって描写した病変の超音波断層像と，切除標本の病理組織学的所見の対比を行った．今回使用した超音波内視鏡による胃病変の超音波断層像は，病理標本の肉眼レベルで確認可能な変化を描出でき，その評価を可能にする．評価は超音波断層像に示される胃壁層構造の形態の乱れとエコーレベルの変化を指標として行われる．一方，病理組織学的検索により初めて明らかとなる病変は，超音波断層像の変化として描出できないことが多い．この内視鏡的超音波断層像の限界は，びまん性・散在性に発育する胃癌の浸潤範囲判定や筋原性粘膜下腫瘍の良・悪性の識別を困難にする．

　The results of endoscopic ultrasonography (EUS) using a 7.5 MHz electronic linear array ultrasonic endoscope were compared with the pathological findings of resected specimens in seventy-four cases of gastric diseases.

　EUS can demonstrate the macroscopic intra-mural changes of gastric disorders. The intra-mural changes were reflected on EUS by the changes of echo-pattern and echo-level brought about by the layer-structure of the gastric wall.

　Consequently, on the macroscopic level, it is possible to diagnose by EUS gastric diseases such as massive infiltrated malignant diseases, peptic ulcer and submucosal tumors.

　On the other hand, EUS is unable to demonstrate the microscopic intra-mural changes of gastric disorders. This limitation of EUS renders it unsuitable for correct assessment of diffuse infiltrated malignant diseases and for a qualitative evaluation of the diseases.