早期胃癌切除範囲決定のための術前点墨法―特に漿膜面染色の有用性について

Preoperative Endoscopic Injection of Carbon Ink as a Method to Demarcate Area for Gastrectomy Applied to Early Gastric Cancers

要旨　早期胃癌において断端部癌遺残や不必要な胃全摘を防止するために，漿膜面染色を目的とする術前点墨法を考案した．本法は内視鏡検査により癌浸潤範囲を決定し，次に手術直前に，再度内視鏡下にその癌口側浸潤端から口側1cmの部位に点墨する．そして術中漿膜側から透見される墨汁による染色マークを切除線決定の指標とするものである．胃壁内の深さは筋層あるいは粘膜下層に，時期は手術前3日以内に，量は0.1ml注入すると良好な染色マークを得ることができた．

　For the recognition of the appropriate area of gastrectomy, the present study was undertaken to clarify whether staining with carbon ink was useful or not, when properly injected under endoscopy into its wall.

　The involved area of cancer is decided endoscopically and histologically, then carbon ink is injected endoscopically into that portion approximately 1 cm from the border of the gastric cancer. Carbon ink should be made to penetrate at least as deep as the submucosa or muscularis. And also the injection should be done within three days before the operation. At the time of the operation, a black spot was observed through the serosa of the stomach, and thus furnished a guide for deciding a resection line.

　In the specimen removed from the stained area, cancer was not detected histologically. This simple method was performed with neither accident nor side effect.