早期胃癌の内視鏡的切除法

Endoscopic Resection of Early Gastric Cancer

要旨　早期胃癌100例104病巣を内視鏡的切除した．Ⅰp，2cm以下のⅠs・Ⅱa，1cm以下Ul（－）Ⅱcの分化型腺癌と，胃底腺領域以外の5mm以下のⅡcの未分化型腺癌を適応としている．組織学的に多量の粘膜下浸潤があれば，胃切除をする．病巣を把持鉗子でつまみ上げ，あらかじめ行ったマーキングが残らないようスネアで絞抱する．続いて出血予防に50％グルコースを局注し，高周波で切除する．現在，合併症はない．適応内のものでは断端癌陽性は35病巣（36％），うち9病巣に遺残を認めた．生検癌陰性化後1年未満を除くと遺残率は11％である．遺残は胃角，胃体・前庭小彎のものにあったが，マイクロ波凝固で生検癌陰性となった．手技の工夫，適応の慎重な選択が肝要である．

　We have treated 100 patients with 104 lesions of early gastric cancer by endoscopic resection during the past 6 years.

　The indication for endoscopic resection is limited by the nature of the lesion. That is, (1) macroscopical type and size; type Ⅱa not more than 2 cm in size, or nonulcerative type Ⅱc not more than 1 cm in size, (2) histological type; a differentiated adenocarcinoma, (3) depth; without large amounts of submucosal infiltration.

　Statistically, in these early gastric cancers, the incidence of lymph node metastasis is very rare (less than 1%).

　The resection procedure is as follows: Put pin-point marks around the lesion and pull it up with grasping forceps. After strangling it with a snare wire, apply local injection (about 5 ml of 50% glucose) to prevent bleeding. Then cut it off with high frequency current.

　No complications are experienced when using this method.

　Remnant rate was 11%. Residual cancerous lesions were found on the gastric angle, on the lesser curvature of the body and the antrum. These remnant cancers were treated by microwave coagulation and, upon biopsy, showed negative for cancer. Gastrectomy was performed on 3 patients with massive submucosal invasion in the resected specimens. There were no deaths caused by gastric cancer.