食道sm癌に対する食道温存治療の可能性―X線の立場からの検討：肉眼形態分類からみたリンパ節転移の推定

Possibility of Esophageal Preservation Treatment for Esophageal Cancer Invading the Submucosal Layer-Radiological Prediction of Lymph Node Metastasis of Esophageal Squamous Cell Carcinoma Invading the Submucosal Layer

要旨　リンパ節転移陰性のsm癌をふるい分けることを目的として，sm浸潤食道癌65例について，肉眼病型別に，深達度，脈管侵襲，sm浸潤面積とリンパ節転移の有無との関係を検討した．結果，0-Ⅰと0-Ⅲ型ではリンパ節転移の予測は困難であったが，0-Ⅱ型病変ではsm浸潤面積とリンパ節転移の有無は密接に関係し，臨床的にリンパ節転移の予測が可能と考えられた．リンパ節転移陰性のsm癌は，“sm浸潤の面積が100mm²以下の0-Ⅱ型病変”であり，X線所見は“側面像の壁変形所見の長さが15mm以下の0-Ⅱ型病変”であった．

　The aim of this study was to clarify the radiological findings predictive of lymph node metastasis. Subjects including 65 cases with esophageal squamous cell carcinoma invading the submucosal layer were divided into three groups by their macroscopic type, 0-Ⅰ, 0-Ⅱ, and 0-Ⅲ. The relationship between pathologic findings and lymph node metastasis was examined by χ²-analysis. As a result, the relationship between the size of sm-invasion and lymph node metastasis in the 0-Ⅱ group was shown to be significant, though no significant indicators were found in the 0-Ⅰ and 0-Ⅲ groups. Lymph node metastasis was noticed in only 11.8% of the cases with less than 100 mm² in size of sm-invasion. Because the relationship between the size of sm-invasion and the radiological length of the deformity of the esophageal margin was significant, it is considered that the length of the deformity of the esophageal margin has a relationship with lymph node metastasis. In conclusion, it can be paid that it is possible to predict negative lymph node metastasis on condition that esophagography shows an 0-Ⅱ type lesion and less than 15 mm in the length of deformity of the esophageal margin.