大腸villous tumorの治療と予後

Treatment and Prognosis of Villous Tumor of the Large Intestine

要旨　大腸villous tumorの治療法は，その部位，大きさ，腫瘍内の癌巣の有無により選択される．特に癌巣についてはその大きさ，深達度という拡がりを正確に判断しなければ，誤った治療により予後を不良にすることもある．1955年から1984年までに癌研病院で扱った大腸villous tumor35例の治療内容を検討した．内視鏡的ポリペクトミーのみによって完全摘除しえたものは3例にすぎず，他の32例には何らかの外科的処置が加えられた．初回治療後再発したものは2例で，1例は内視鏡的ポリペクトミー後に，他の1例は経肛門的摘除後であったが，いずれも再発後の治療で完治している．癌巣の有無の診断には通常の生検では誤った判断に陥りやすい．sm以下の癌巣の有無については病変の形状の把握が大切である．

　The method of treatment of villous tumor of the large bowel varies according to its location and size, and, most importantly, to the presence or absence of cancer nest in it.

　If the correct diagnosis of cancer is not made in the stage of villous tumor, an inadequate treatment will lead to poor prognosis.

　We reviewed 35 cases of villous tumor of the large intestine experienced in Cancer Institute Hospital from 1955 to 1984. There were only three cases in which tumors were completely removed by an endoscopic polypectomy, and 32 cases received one of several kinds of surgical procedures. In two cases, the recurrence of tumor was observed after the first treatment, the one being after the endoscopic polypectomy and the other after the peranal local excision.

　The conventional biopsy was not reliable in finding a cancer in villous tumor. In order to determine whether a villous tumor contains an invasive cancer or not, it is important to observe either the change of the surface of the tumor by endoscopy or any changes of the bowel wall on barium enema.