逆追跡による胃癌の発育経過―2年以上の内視鏡経過観察例について

Endoscopic Observation of Gastric Carcinoma

要旨　われわれは2年以上にわたり内視鏡観察がなされた隆起型癌7例，陥凹型癌24例について，その形の変化，組織像と進行度との関連，観察期間と進行度の相関などを中心に検討を行った．その結果は次のごとくであった．（1）隆起型も陥凹型も高分化型管状腺癌は中分化型管状腺癌に比べ著しい進行度の差がみられた．この傾向は陥凹型でより顕著であった．しかし，低分化型管状腺癌では症例が少ないため，はっきりとした差は認められなかった．（2）観察期間と進行度および大きさとは隆起型では関連性がみられたが，陥凹型では相関はなかった．これは陥凹型では比較的早期に癌の脱落が起こるためで，われわれの症例では21年7か月の経過で粘膜内癌に止まっていた症例があった．（3）早期胃癌の型の変化では隆起型の2例，陥凹型の3例がいずれもBorrmann2型に移行していた．またⅡc+Ⅲ進行型が2例であった．

　Seven cases with elevated-type of early gastric carcinoma and 24 cases with depressed-type early gastric carcinoma which were observed endoscopically for more than 2 years were investigated in this series. Results were as follows: (1) Carcinoma cases of well differentiated adenocarcinoma grew slowly compared with the growth of moderately differentiated adenocarcinoma. This phenomenon was more significant in cases with depressed-type carcinoma. Compared with other histological types, poorly differentiated adenocarcinoma showed no specificity in their growth. (2) In cases with elevated-type carcinoma, relation was observed between time and growth. On the other hand, no relation was observed in cases with depressed-type carcinoma. In cases with depressed-type carcinoma, cancer tissues were frequently dropped off with ulcer formation. Therefore, cancer grew slowly in some cases with depressed-type carcinoma. (3) two cases with elevated-type and three cases with depressed-type changed shape to Borrmann 2 type at the operation.