内視鏡的大腸ポリペクトミー

Endoscopic Polypectomy of the Colon

　Colonofiberscopeが開発され¹⁾²⁾，深部大腸の内視鏡的観察が非観血的に容易に行ないうるようになるにしたがって，本邦でも大腸ポリープの診断頻度が飛躍的に増加してきている³⁾．しかし，Colonofiberscopeの開発された初期には，診断されたポリープは外科的に開腹して切除するしか治療法はなかった．しかし，直腸およびS状結腸下部のポリープの切除ないし焼灼は，直腸S状結腸直達鏡を用いて古くから行なわれており，Jackman⁴⁾らは，直腸癌でさえも適応をえらんで行なえば焼灼という姑息的な治療でも良好な成績が得られると述べている．

　著者らは，この直達鏡を用いた切除ないし焼灼法，常岡⁵⁾らの開発した胃ファイバースコープを用いた胃ポリープの内視鏡的切除法等を参考として，Colonofiberscopeを用いて深部大腸ポリープの内視鏡的切除を検討してきた．最近では，高周波電流を用いることにより，容易に深部大腸ポリープの内視鏡的切除が可能となってきている．

　Endoscopic polypectomy of the deeper part of the colon has been tried in many ways since colonofiberscope was first put in practical use. In 1970 we came out well with polypectomy in the colon by using an ordinary biopsy forceps, but it remained rather unpopular because the maneuver was not simple and high techniques were required. In the following year we began to study polypectomy over again with the use of high frequency current. This method is now more easily done hand in hand with newer instruments available.

　Endoscopic polypectomy is done by using a snare which tightens up a given polyp followed by turning on high frequency current. This method is best indicated for polyps either pedunculated or subpedunculated. Preliminaries including complete emptying of bowel contents must be attended to. High frequency current is used by turns for coagulation and taking out the polyp. Bleeding does not usually follow, and the excised polyp is easily recovered by aspiration. Injured mucosa usually heals in a week or two, and in another two months even a trace of a scar is often unnoticed.

　All our patients were hospitalized for polypectomy, and so far we have polypectomized 44 cases without any untoward accident such as massive bleeding or perforation. Histologic study of the resected polyps revealed in 4 cases carcinoma in situ that had not been found out by previous biopsy. Endoscopic polypectomy is thus worthy of note in the sense of complete biopsy.

　It is stressed here that endoscopic polypectomy, although now simplified, should be done only by those skilled in handling the scope and with utmost caution.