胃癌の内視鏡的治療―内科の立場からの適応と問題点

Endoscopic Treatment for Gastric Cancer: Indication and Problems Seen from the Standpoint of Internal Medicine

要旨　胃癌の治療法は外科的手術を原則としているが，内視鏡的ポリペクトミーおよびレーザー内視鏡によって特定のタイプの早期胃癌に対しては内視鏡的根治的治療が期待できるようになった．かかる内視鏡的根治的治療の適応となる早期胃癌にはリンパ節転移がないことが原則であるが，個々の症例においてそれを診断することは不可能に近い．しかし，多数の早期胃癌の手術例において，深達度，大きさと肉眼型の因子から検討すると，リンパ節転移のないタイプが明らかとなった．すなわち，有茎性でのmのⅠ型，focal cancer，3cm以下のⅡa，2cm以下の胃炎類似早期胃癌である．高齢者，手術poor riskで早期胃癌のこれらのタイプの発見された患者は内視鏡的治療のよい対象となる．

　As a rule, surgical operation has been used for treatment of gastric cancer. However, since endoscopic polypectomy and laser endoscopy have been put into practice, endoscopic curative treatment presents a hopeful future for a certain type of early gastric cancer. However, the use of such endoscopic curative treatment depends on the absence of lymph node metastasis, which is impossible to detect in early gastric cancer patients. Factors such as depth of cancer invasion, size and macroscopical type of the lesion were evaluated in many operated cases of early gastric cancer in the National Cancer Center Hospital.The following results concerning the types of early gastric cancer without lymph node metastasis were obtained.

　The types of early gastric cancer were : 1) pedunculated and type I with mucosal involvement, 2) focal cancer, 3) type Ⅱa under 3 cm in size and 4) so-called gastritis-like early gastric cancer under 2 cm in size. Therefore, it was maintained that the use of endoscopic treatment for patients of old age or poor risk for surgery who were found to have these types of early gastric cancer produce effective results.