血管造影による胃癌の壁深達度診断における超選択的拡大撮影の評価

The Evaluation of Superselective Magnification Angiography in Diagnosing the Depth of Cancerous Invasion of Gastric Cancer

要旨　298例の胃癌に対して術前血管造影を行い，どのレベルの動脈に浸潤所見が認められるかによって，①m，②sm，③pm，④ss・se，⑤si・sei，の5段階の壁深達度診断を行い，切除胃の病理診断と対比した．結果：（1）腹腔動脈造影のみを行った97例では正診率は56.7％と不良であったが，漿膜浸潤の有無に関しては83.5％を正しく診断しえた．（2）左胃動脈などの超選択的動脈造影を行った114例では正診率79.5％となり，前者と比べて有意差（p＜0.005）を認めた．（3）超選択的動脈造影を拡大撮影で行った87例では正診率87.4％と更に向上し，mとsmの鑑別も73.9％で可能であった．

　Preoperative angiography was made on 298 patients with gastric cancer. The depth of gastric cancer invasion was histologically classified into the following five groups : (1) mucosa (m), (2) submucosa (sm), (3) proper muscle layer (pm), (4) serosa (ss, se), (5) invasion to other organs (sei), and the accuracy in using angiography to diagnose the depth of invasion was assessed.

　Results :

　1. Diagnostic accuracy for the depth of cancerous invasion was 56.7% (55/97) by celiac angiography. Serosal invasion was correctly diagnosed in 83.5% (81/97) by celiac angiography.

　2. Diagnostic accuracy was 81.6% (93/114) by superselective angiography of the left gastric and common hepatic arteries. This rate was significantly higher than that of celiac angiography.

　3. Diagnostic accuracy was 87.4% (76/87) by superselective magnification angiography. Differentiation of invasion to mucosa and to submucosa was correctly diagnosed in 73.9% (17/23) by superselective magnification angiography.