早期胃癌の内視鏡的治療と縮小手術―適応と方法および功罪

Endoscopic Treatment and Limited Surgery against Early Gastric Cancer: Indication, Procedure, Advantages and Disadvantages

要旨　早期胃癌に対する内視鏡的治療・縮小手術の適応を左右する因子であるリンパ節転移に関し，当科で経験した早期胃癌切除症例559例をもとに，臨床病理学的特徴について検討を加えるとともに，種々の縮小手術の術式における適応と問題点について考察した．これまでに適応とされていた症例に加え，高分化型の隆起型癌については腫瘍径が2cmを超える症例についても，またsm癌においても高分化型微量浸潤例ではリンパ節転移がみられず，適応拡大の可能性が示唆された．早期胃癌の縮小手術は今後適応を拡大して，より積極的に行われることが予想され，明確な適応の設定と効果的な術式が確立されることが望まれる．

　A clinicopathological evaluation involving 559 cases of early gastric cancer which were resected in our hospital was made concerning especially the probability of lymph node metastasis, on which probability the possibility of endoscopic treatment or limited surgery depends. We also considered the indications for surgery, and various methods of limited surgery. No lymph node metastasis was found in cases of well differentiated elevated type cancer over 2 cm in diameter. It was considered that some type of limited surgery was available in such cases. Furthermore, well differentiated submucosal invasive cancer with minimal invasion had no node metastasis. These results suggested that the indication for surgery might be able to be expanded. It is expected that limited surgery against early gastric can-cer will be performed more actively in the future if the indication for surgery is suitably expanded. It is desirable to establish a definite indication and an effective procedure for limited surgery.