潰瘍合併早期胃癌の画像診断―潰瘍合併早期胃癌の内視鏡診断

Endoscopic Diagnosis for Early Gastric Cancers with Ulceration

要旨　早期胃癌において，内視鏡治療で根治できる症例は多くなったが，潰瘍合併早期癌はいまだ内視鏡治療を困難にしている．筆者らは，陥凹型早期胃癌に対して内視鏡治療，もしくは外科的切除術を行った患者をretrospectiveに検索し，潰瘍合併早期胃癌の特徴について検討を行った．潰瘍合併早期胃癌は，非合併早期胃癌と比べて年齢が低く（p＜0.0001），病変のサイズが大きいものが多く（p＜0.0001），深達度もSM癌の割合が高く（p＜0.0002），未分化型の癌の割合が高かった．また，内視鏡診断と病理組織診断による潰瘍合併の有無の診断一致率は，89％と高い結果であったが，不一致の内容としては，内視鏡診断で潰瘍合併を見落としている症例が多かった（17例vs 9例）．

　Many early gastric cancers were completely treated by endoscopic resection, but early gastric cancers with ulceration were difficult to treat by endoscopic resection. We retrospectively examined patients who received endoscopic resection or surgery for depressed type early gastric cancers, and examined the characteristics of early gastric cancer with ulceration. Patients having early gastric cancer with ulceration were younger（p＜0.0001）, the size of lesions was larger（p＜0.0001）, the rate of invasive cancers to the submucosal layer was greater（p＜0.0002）, and the rate of undifferentiated cancers was greater than early gastric cancers without ulceration. The concordance rate for presence or absence of ulceration by endoscopic diagnosis and pathological diagnosis was 89％, however different diagnoses showed, there were some cases in which the presence of ulceration was overlooked by endoscopy.