大腸大型無茎性腫瘍の内視鏡的切除における局所再発の検討―20mm以上の腺腫・m癌について

Local Recurrence after Endoscopic Mucosal Resection (EMR) in Cases with Colorectal Large Sessile Mucosal Tumors

要旨　内視鏡的に切除した20mm以上の無茎性大腸腺腫あるいはm癌で，6か月以上の間隔をおいて経過観察を行った34病変34例を対象として，切除の実際と経過を検討した．一括切除は14病変に施行され，切除腫瘍径は平均24.9mmであった。切除断端部のhot biopsyによる追加焼灼は14病変中3病変（21％）に用いられた．一方，分割切除は20病変に施行され，切除腫瘍径は平均36.1mmであった．hot biopsyによる追加焼灼は20病変中12病変（60％）に用いられた．局所再発例は2例でいずれも分割切除例であり，2チャンネル操作を併用していた．再発率は34病変全体では5.9％（2/34）であり，分割切除例20病変では10％（2/20）であった．再発例のうち，1例は追加焼灼で治癒し以後再発なく経過した．他の1例では内視鏡的切除の際に穿通が生じ10か月後に進行癌が再発した．大腸大型無茎性腫瘍に対する内視鏡的切除例では，切除断面の直後観察と短期間隔での追跡観察が再発の防止および対策，更に治癒への導入に重要である．

　From September 1990 to July 1998, 34 patients with colorectal sessile mucosal tumors larger than 20 mm underwent colonoscopic management and surveillance.

　In 14 patients with single resection, the average of maximum diameter of the resected tumor was 24.9 mm. The hot biopsy procedure was added to remove the remainder after EMR in three of the 14 patients (21%). In all of the 14 patients, complete endoscopic treatment was obtained. In 20 patients with piecemeal resection, the average of maximum diameter of the resected tumor was 36.1 mm. The procedure using hot biopsy after EMR was carried out in 12 of these 20 patients (60%). Local recurrence occurred in two cases in which piecemeal resection using 2 channel scope was performed. In one case, endoscopic treatment was carried out after the added procedure using hot biopsy. In another case, penetration occurred after EMR. Local recurrence was diagnosed at the stage of advanced cancer.

　On the basis of this data concerning endoscopic treatment, it can be said that EMR is a safe therapeutic procedure for large sessile colorectal mucosal tumors. Close follow-up with colonoscopy result in curative endoscopic management.