クリッピング法による胃癌浸潤範囲の判定―X線，内視鏡所見と切除胃肉眼所見，病理組織構築の対比

Determination of the Extent of Infiltration in Gastric Cancer by Endscopic Clipping Method

　胃癌の浸潤範囲をX線，内視鏡的にどこまで診断できるかを検討するためには，肉眼標本上の癌墳界部の所見を正確にX線，内視鏡所見と対比する必要がある．浸潤範囲の狭いもの，あるいは，境界鮮明なものでは部位の同定も困難ではないが，浸潤範囲が広いものや境界不鮮明なものでは部位の同定が困難となり，したがって臨床材料上の所見の読みも漠然としたものとなる．われわれは最近，陥凹あるいは平坦な胃癌について，術前にクリップによるマーキングを行ない，生検を同時に行なって浸潤範囲を決定している．このクリップによるマーキングを行なった症例について，その浸潤範囲についてのX線学的および内視鏡的検討を行なった結果を報告する．なおクリップ法についての現在までの経験と，切除範囲の決定に対する有効性についても若干述べる．

　Metal clips were marked on gastric mucosa endoscopically in 45 cases of gastric cancer and gastricduodenal ulcer, including 30 cases of depressed or flat gastric cancers, in order to study whether the clip in the X-ray film is found in the gross specimen of the resected stomach.

　In 30 cases of depressed or flat gastric cancers, clips were marked at the cancer border and biopsy specimen was taken from the outer mucosa of the clip in order to determine cancer border before gastrectomy and to compare the findings of X-ray and endoscopy with those of resected specimen exactly. Following results were obtained.

　1) Most clips in the X-ray film were found in the resected specimen, so that the clip proved to be useful for a marker.

　2) When radiological and endoscopic determination of the extent of infiltration of gastric cancer was difficult, clipping and biopsy was useful to determine the extent of mucosal infiltration of gastric cancer before gastrectomy.

　3) Pathological study revealed that radiologic and endoscopic estimation of cancer border depended on the gross picture and histological structures. When stratum of cancer nests in the mucosa was thin, we had a great difficulty in deciding the margin of the cancer by X-ray and endoscopy in most cases.