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Stomach and Intestine(Tokyo) Volume 27, Issue 10 （October 1992）

胃と腸 27巻10号（1992年10月発行）

Japanese English

今月の主題胃癌の深達度診断mとsmの鑑別―内視鏡的治療のために

主題

内視鏡によるm・sm胃癌の鑑別 Difference between Mucosal and Submucosal Gastric Cancer on Endoscopic Diagnosis 光永篤 ¹ , 村田洋子 ¹ , 長廻紘 ¹ , 鈴木茂 ¹ , 池田郁雄 ² , 中村真一 ² , 春木京子 ² , 千葉素子 ² , 横山聡 ² , 橋本洋 ² , 小幡裕 ² , 鈴木博孝 ³ Atsushi Mitsunaga ¹ ¹東京女子医科大学消化器病センター消化器内視鏡科 ²東京女子医科大学消化器病センター消化器内科 ³東京女子医科大学消化器病センター消化器外科 ¹Department of Endoscopy, Tokyo Women's Medical College キーワード：早期胃癌 , 内視鏡診断 , 深達度診断 Keyword: 早期胃癌 , 内視鏡診断 , 深達度診断 pp.1151-1166

発行日 1992年10月25日 Published Date 1992/10/25

DOI https://doi.org/10.11477/mf.1403110000

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要旨　隆起型早期胃癌では，大きさは深達度診断の重要な要素で，2cm以下のⅡa型ではsm癌を認めず，Ⅰ型，Ⅱa型ともに2cmを越えるとsm癌の頻度が増すが，表層拡大型だけは大きさと深達度との間に関連を認めなかった．そのほか，sm浸潤を示唆する所見として，楔形の鋭い陥凹，著明な発赤，粗大な結節状隆起が見られた．陥凹型早期胃癌では，大きさと深達度との間にある程度の関連はあるものの，1cm以下のものにもsm癌を認め，これが陥凹型での深達度診断を難しくしている一因と考えられた．また，sm癌をm癌と誤診したものの多くは，sm浸潤がごく一部に限局していたもので，このような症例では，見直しによってもsm癌と診断するのは困難と考えられた．一方，m癌をsm癌と誤診したものでは，Ⅲ型の関与を多く認めた．Ⅱa＋Ⅱc型早期胃癌では，隆起部分の粘膜性状を正確に診断することが，深達度診断にとって重要と考えられた．

　Three hundred and seventy four cases (433 lesions) of early gastric cancer which had been operated upon within the last three years were studied to assess accuracy of evaluation of invasivity by endoscopic diagnosis.

　The accuracy of endoscopic diagnosis of invasivity of the elevated type of early gastric cancer was 83.6%. In this type, the size of the tumor was an important factor in diagnosing invasivity; in type Ⅱa, there was no submucosal invasion with tumors less than 2 cm in size. On the other hand, the incidence of submucosal invasion increased when the size of type I or Ⅱa was greater than 4 cm. The other findings suggesting submucosal invasion were a wedge-shaped sharp depression, marked erythema, and large nodular elevation.

　The accuracy of endoscopic diagnosis of the invasivity of the depressed type of early gastric cancer was 77.4%. In this type, the size of the tumor was partially related to the invasivity, but even a small lesion less than 1 cm in size may exhibit submucosal invasion. This may be part of the reason why a precise endoscopic evaluation of invasivity in the depressed type is difficult. In most of cases of the depressed type of submucosal cancer which were misdiagnosed as mucosal cancer, the submucosal invasion was usually found to be patchy, and it was difficult to correct the diagnosis even reviewing endoscopic pictures carefully. On the other hand, most cases of depressed mucosal cancer which were misdiagnosed as submucosal cancer were type Ⅲ gastric cancers.

　The accuracy of endoscopic diagnosis of the invasivity of type Ⅱa ＋ Ⅱc gastric cancer was 75.5%. The mucosal characteristics of elevated parts of the lesion were thought to contribute the accuracy of diagnosis.