局注療法による胃癌の内視鏡的治療の現況

Endoscopic Local Injection Therapy for Gastric Cancer

要旨　今日，内視鏡は診断面だけでなく治療の面でも大いに役立っているが，われわれは1965年以来，手術不能な胃癌，特に早期胃癌に対して各種の制癌剤による局注療法について検討してきた．実験および臨床的な検討から制癌剤の中でもブレオマイシンの局注が最も正常胃粘膜に対する障害作用が少なく，しかも腫瘍組織に対して壊死作用が確実で，かつ適度であることがわかり，今日まで27例の早期胃癌に本剤の局注療法を行ってきた．最長16年の間，再発がみられなかったⅡa型早期胃癌があり，（表面）隆起型早期胃癌が最もよい適応と思われた．そのほか，わが国ではマイトマイシン，OK-432，エタノールなどの局注療法も行われており，リンパ節転移病巣の治療を目的として制癌剤のエマルジョン化など種々工夫されている．今後，更に効果的で安全な薬剤の開発が期待される．しかし，局注療法は胃癌の手術にとって代わるものではなく，その対象は内科側，外科側の意見や本人・家族の意向も含めた総合的判断で手術不能としたものに限るべきと考えている．

　Since 1965, we have been performing endoscopic local injection therapy with bleomycin in gastric cancer. We have treated 27 cases of early gastric cancer with this method. All patients were unable to undertake operations for some reasons. 2 ml of bleomycin (3 mg/ml) in sterile distilled water was injected directly into the tumor. One week after the second injection, massive necrotized tissues were removed by endoscopic forceps. Repeated bleomycin injection and removal of necrotized masses were performed weekly until the tumor could not be recognized. There was no relapse for 16 years at the longest in a patient with early gastric cancer of Ⅱa type.

　There are other endoscopic local injection therapy using mitomycin,OK-432 (picibanil), ethanol, etc. Mechanism of OK-432 suggested that macrophage appeared. With the use of mitomycin and ethanol, it was difficult to control the ulceration to tumor or normal tissue. Protruded-type of early gastric cancer is suitable for endoscopic local injection therapy. It was not effective to metastatic lymph nodes, therefore, fat emulsion of anticancer agents have been deviced. If surgical therapy is not applicable due to high risks, endoscopic local injection therapy is valuable for gastric cancer.