食道粘膜内癌の臨床診断―内視鏡および超音波内視鏡を中心に

Clinical Diagnosis of Esophageal Mucosal Cancer by Endoscopy and Endoscopic Ultrasonography

要旨　食道粘膜内癌の内視鏡所見，超音波内視鏡による食道癌深達度診断を中心に検討し，以下の結論を得た．（1）食道粘膜内癌の内視鏡所見は，粘膜面の凹凸変化はごくわずかで，表在平坦型あるいはそれに近い所見を呈していた．表在癌症例で混合型を示した11例中1例（9.1％）のみが粘膜内癌であり，他は粘膜下層癌であった．（2）食道粘膜内癌を診断するには，内視鏡検査時に，粘膜面の色調差に注目することが最も重要であり，癌が疑われる場合には，食道ルゴール法を併用することにより，粘膜内癌をより正確に診断することが可能であった．（3）超音波内視鏡で，正常食道壁は基本的に5層構造を示し，粘膜内癌症例でも，癌深達度をこの層構造の変化として客観的に診断することが可能であった．

　Endoscopic findings of esophageal mucosal cancer and the diagnosis of depth of invasion of esophageal cancer through endoscopic ultrasonography were studied and the following results were obtained:

　1) Mucosal changes of esophageal mucosal cancer observed by endoscopy were slight, and endoscopic types of esophageal mucosal cancer showed superficial flat type, erosive type, plateau-like type, and superficial flag+erosive type. In 11 cases of mixed type superficial esophageal cancer, only one case (9.1%) was limited to the mucosa, and the other cases invaded the submucosa.

　2) To find esophageal mucosal cancer, it is important to observe the difference of mucosal coloration carefully, and lugol staining method is zecommended if cancer is suspected.

　3) Normal esophageal wall was visualized in the structure of five layers by means of endoscopic ultrasonography, and the depth of invasion of esophageal cancer could be diagnosed by changes of this five layers even in esophageal mucosal cancer.