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要旨 小腸には胃,膵臓,大腸,肺などから腫瘍が転移することがあり,小腸以外に原発を持つ小腸腫瘍を転移性小腸腫瘍と言う.症状としては,狭窄による嘔気,腹部膨満感,腹痛や貧血・体重減少などがあるが,大半が無症状であるために術前診断は難しく,剖検で発見されることが多い.転移の経路としては,(1)脈管性転移,(2)腹膜播種,(3)腸管内転移が知られている.画像診断には,小腸X線造影検査,CT・MRI,超音波検査が用いられる.近年開発されたバルーン内視鏡(DBE,SBE)により病理診断も可能になり,画像所見と病理学的所見を併せて転移性小腸腫瘍と原発性小腸癌の鑑別を行う.本稿では,両者の診断および治療の違いを中心に述べる.
Small intestine tumors are rare disease, and various tumor cells from esophagus, stomach, colon, lung, pancreas, and kidney have the possibility of metastasizing to the small intestine. Symptoms are nausea, bloating, abdominal pain, constipation and so on ; therefore, diagnosis before surgery is difficult to be found, and often pointed out by autopsy. There are 3 main pathways of metastasis :(1)intra-mesenteric metastasis,(2)disseminated metastasis,(3)intra-intestinal metastasis. Radiological enteroclysis, CT scan, MRI, and transabdominal ultrasound have been used. Recently, DBE(double-balloon endoscopy)and SBE(single-balloon endoscopy)has been developed to facilitate pathological diagnosis. Based on the diagnostic imaging and pathological results, a definite diagnosis is made on which are a metastasis or primary tumor of the small intestine.
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