pm胃癌と内視鏡診断

Pm Gastric Cancer and its Endoscopic Diagnosis

　早期胃癌に関する諸問題がほとんど解明されている今日，早期胃癌よりも癌浸潤がさらに一段階深部に進み固有筋層まで到達した胃癌（以下pm胃癌と呼ぶ）が最近注目されている．その理由は早期胃癌よりもさらに詳細な深達度診断の追究，進行胃癌の術後の予後の改善，そして，病理学的に早期胃癌から進行胃癌への進展の解明などの諸問題において，pm胃癌が重要な位置を占めているからである．これらの問題は互に密接な関連があり，その1つの研究は他の問題の解決の手がかりを与えるであろう．われわれは，かかる見地から，第20回日本消化器内視鏡学会関東地方会（1975年6月）において，pm胃癌の臨床とくに内視鏡診断を中心として，シンポジウムに採用し，pm胃癌の諸問題の解明を試みた．以下，国立がんセンターにおけるpm胃癌成績を中心として考察を行なった．

　Hitherto stomach cancer is divided into early and advanced cancers. Pm cancer occupies an intermediate position between early cancer and ss of advanced cancer, not only from infiltrating depth and prognosis but also from diagnostics, macroscopic features and pathological histology.

　So far we have come across 224 cases of pm gastric cancer, corresponding to 11.7 per cent of all resectable gastric cancer in our experience and to 13.0 per cent in a nationwide collection. The incidence of cancer infiltration layer by layer seems to depend on the relative difficulties of diagnosis as well as on the tempo of cancer invasion into the deeper layers. The male outnumbered female in a ratio of 2.56 : 1.0. The peak of incidence was in the age group 60～69. None was seen below the age of 20. Pm cancer was most often seen on the lesser curvature side, especially in the pyloric antrum. Macroscopically, it can be divided into early-cancer-like type and Borrmann types. Borrmann II type was most often seen with a rate of 33.5 per cent, followed in the order of frequency by the type simulating depressed early cancer with an incidence of 28.4 per cent; Borrmann III type, 24.8 per cent; Borrmann I, 9.6 per cent and IIa+IIc-like type, 3.7 per cent. Elevated variety of early cancer is more often than elevated types of advanced cancer. Borrman N type is regarded as since there passing through the muscularis propria, rapidly has been no instance of such a type in pm cancer. The size of pm cancer was most often between 3 and 5 cm in the greatest diameter.

　The results of endoscopic diagnosis showed that in 97.2 per cent cancer was diagnosed, while in 68.6 per cent the diagnosis was narrowed down to advanced carcinoma. Results of recent biopsy showed that cancer was demonstrated in 100 per cent. As some of pm cancer develops very rapidly, accurate diagnosis followed by surgical correction without delay is mandatory.