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要旨 陥凹型未分化型早期胃癌を対象に,NBI(narrow band imaging)拡大観察によって確認できる,通常毛細血管より太さが2倍以上であるCV(caliber variation)のSM癌診断に関する有用性を検討した.検討症例は,NBI観察による画像解析が可能であった手術症例77例(M癌38例,SM癌39例)およびESD症例136例(M癌116例,SM癌20例)である.通常観察でSMと確診できる所見が得られた症例は手術例22/39(56%),ESD例5/20(25%)であった.CVがレトロスペクティブな画像の検討で確認できた症例は,手術例ではM癌5/38(13%),SM癌29/39(74%),ESD例ではM癌13/116(11%),SM癌16/20(80%)であった.NBI観察でCVが確認されたSM癌11例を対象にICG静注後に赤外線拡大内視鏡を用い,CVにpooling像があるかを確認し,腫瘍血管か否かを検討した.6/11(55%)にpoolingが確認できた.正常胃粘膜においては粘膜表層にはSMA(smooth muscle actin)陽性血管は出現しないが,IRIで検討したCV陽性例11例では全例粘膜表層にSMA陽性血管がみられた.CV陽性例の55%にICGでpoolingが確認でき,これらについては腫瘍血管であることが証明できた.CV観察はSM癌の診断に有用な所見の一つであると考えられた.M癌におけるCVの出現率は低く,SM癌診断の決め手となる一つの客観的指標とできる可能性がある.
We investigated submucosal invasive early gastric undifferentiated adenocarcinoma using findings of CV(calibar variation)with NBI. Among operated cases 77 cases and ESD cases 136cases were studied. Operated cases, 38 cases were intramucosal and 39 cases were submucosal cancers. Twenty-tow cases were diagnosed by ordinary endoscopic findings(55%). Among ESD cases, 116cases were intramucosal lesions and 20 were submucosal invasive cases. CV was defined in 29/39(74%)in operated cases and 16/20(80%)in ESD cases of submucosal invasive cancer. Submucosal invasive cancer(11 cases)with CV were detected through IRI with ICG. In 6 cases(6/11 : 55%)pooling was detected with IRI. Concerning immunohistological study, normally, we could not define SMA positive vessels on the surface of the gastric mucosa. But we were able to define SMA positive large vessels in all 11 cases. CV revealed SMA positive vessels on the gastric surface. Using IRI, pooling vessels revealed tumor vessels.
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