潰瘍瘢痕併存胃癌

Determination of the Extent of Early Gastric Cancer with Ulcer Scars

要旨●早期胃癌の診断・治療では病変の範囲診断は重要だが，臨床では潰瘍瘢痕（UL）併存病変の範囲診断に難渋することが見受けられる．UL併存病変の形態的特徴を後ろ向きに検討した．2018年8月〜2019年8月までに当院でESDを施行し，UL併存と判断した病変を対象とした．病変の形状が類円形のものを整，辺縁が突起状に拡がるものや，瘢痕上に複数の病変を認めるものを不整・分断に区分した．解析対象となった14例のうち，不整例は7例（50.0%）で5例（35.7%）は病変の境界を全周に追うことが困難だった．不整・分断例のうち，2例は多発病変だった．UL併存病変は高率に不整形で，病変の範囲の評価が困難な症例が多く，範囲診断に十分な注意を払う必要があると考えられた．

　Determination of the extent of the lesion is important in the diagnosis and treatment of early gastric cancer. However, it is sometimes difficult to determine the extent of lesions with ulcer scars（ULs）clinically. We retrospectively investigated the morphological features of UL. Lesions identified as UL by ESD in our hospital from August 2018 to August 2019 were included. Lesions with a round shape were classified as regular, whereas multiple lesions on scars with protruding margins were classified as irregular or divided. Of 14 cases included in this analysis, 7（50%）were found to be irregular and 5（35.7%）showed difficulty following the lesion boundaries circumferentially. Two of the irregularities involved multiple lesions. ULs are often irregularly shaped, and it is difficult to evaluate the extent of lesions in many cases. Therefore, it is necessary to pay sufficient attention to the extent of lesions in the diagnosis.