大腸腫瘍（腺腫，m癌）の内視鏡的切除後のサーベイランスおよび局所再発病変の診断と治療

Study of Surveillance Colonoscopy and Local Recurrence after Endoscopic Treatment for the Colorectal Tumors

要旨　大腸腫瘍の内視鏡的治療後経過観察例2,287例を対象として，サーベイランスにより発見された腺腫と癌の特徴と局所再発例について検討し，以下の結果を得た．腺腫，癌とも初回治療時腫瘍の個数が多い群，70歳以上，大腸癌の既往を有する症例で発見率が高い．癌はサーベイランス例の91例（4.0％）98病変に発見された．その内訳は早期癌88病変（m癌72病変，sm癌16病変），進行癌10病変である．発見時期は初回治療後5年以内が90％を占めた．腺腫，m癌とも局所再発が各々13例，12例みられ，いずれの手技においても局所再発があった．特に，EMRの分割摘除例に9.0％と多かった．局所再発は平均約1年で発見され，内視鏡的治療で治癒可能なものが多かった．

　We investigated surveillance colonoscopy and local recurrence after endoscopic treatment for colo-rectal tumors. Two thousand two hundred and eighty seven patients were followed-up by colonoscopy after removal of initial tumors by endoscopic treatment. They were observed over periods of at least one year(mean follow-up period: 61 months). Results were as follows.

　1) High risk patients were those in whom, at the time of the initial treatment nemerous cancers had been detected, and those over 70 years of age with a history of colorectal cancer.

　2) Newly detected cancers were present in 91 patients (4.0%) of the patients surveyed.

　3) The characteristics of newly detected cancers were mainly early cancer (87%) and superficial-type cancers (55%).

　4) 90% of newly detected cancers were detected within five years after the initial tumors.

　5) Local recurrence of adenoma and m cancers was discovered in 13 patients and 12 patients, respectively.

　6) Local recurrence was observed in cases where cancers had been removed by the procedures of hotbiopsy, polypectomy, endoscopic mucosal resection and, most frequently, where the procedure of endoscopic piecemeal mucosal resection had been employed.

　7) Mean detected time of local recurrence was 13.3±10.3 months and most of them were removed by endoscopic procedures.

　It is concluded that surveillance colonoscopy is important and usefull for the detection of local recurrence and for newly developed cancers.