早期胃癌に対するHSE局注を併用した内視鏡的胃粘膜切除法

Endoscopic Resection of Early Gastric Cancer Following Locally Injecting Hypertonic Saline-Epinephrine

要旨　食道および胃の腫瘍性病変に対してHSE局注を併用した内視鏡的切除法（ERHSE）を開発し臨床に応用してきた．その特徴の第1はHSE局注を併用したことと，第2はダブルスコープ方式を導入したこと，第3に切除予定線を高周波メスでマーキングし，その部分を切開したうえで切除するので切除範囲が正確であること，第4に組織を回収し病理組織学的に検討を加えることができること，である．早期胃癌113例が切除され，そのうち10例は外科的胃切除が追加された．ERHSEによる治癒切除率は91.2％であった．経過観察の103例では再発はない．累積5年生存率は85.2％である．胃腺腫（異型上皮）は28例で全例再発もなく経過観察中である．以上よりERHSEは早期胃癌などに対する内視鏡的胃粘膜切除法として優れている．

　We have developed a new method of endoscopic resection of early gastric carcinomas and other tumors. Features of this new method are summarized as follows.

　1. In order to prevent bleeding after endoscopic resection of tumors, local injection of hypertonic salineepinephrine (HSE) solution was applied to the lesions. Depressed lesions like IIc type early gastric carcinomas were artificially made protruding by locally injecting HSE solution.

　2. Double-fiberscopic method was employed.

　3. Prior to the resection, high frequency current snare was made, followed by incision of the mucosa along this marking. This procedure made it possible to resect extensive area with precision.

　4. Because of minimal tissue damage, resected materials were better suited for pathological study.

　Endoscopic resection in this way was performed in total of 113 cases of early gastric carcinoma. Curative resection was made in 103 cases (91.2%). The rest of the cases ultimately underwent surgical resection because of non-curative nature of endoscopic resection. Five-year survival rate in the former 103 cases was 85.2%.

　Endoscopic resection by this method we developed seems to be excellent in treating early gastric carcinoma with no lymph node metastasis, especially in patients at high surgical risk.