胃癌の切除範囲をどう決めるのか―内視鏡診断を中心に

How to Determine Resection Area for Gastric Cancer Based on Endoscopic Findings

要旨　胃癌の切除範囲の決定について内視鏡診断を中心に検討した．粘膜内浸潤については，色素散布による粘膜面の観察と共に，胃生検を応用した点墨法が切除範囲の決定に有用であって，胃中部に最も多く認められる早期癌で，特に胃体下部に占居する症例では，口側粘膜浸潤範囲を術前に確定しておくことが，ow(＋)の防止に必要である．粘膜下層以下の浸潤については，linitis plastica型癌を含む4型癌で胃体下部から幽門部に主座を持つ症例では，口側浸潤範囲の内視鏡診断が困難な場合があって，従来の左側臥位に，胃上部を伸展して観察しうる右側臥位を併用すべきであろう．食道浸潤ならびに胃多発病変についても検討し，特に多発胃癌の検討から，胃上部の内視鏡的検索に当たって，限局した発赤粘膜病変に注目すべきである．

　Validity of endoscopic findings was examined with respect to determining resection area for gastric cancer.

　In patients with intramucosal invasion, dye-spraying method and black ink injection method with application of biopsy were useful in determining resection area.

　It was mandatory to preoperatively define the area of mucosal invasion on the oral side in order to obtain an adequate margin in patients with early cancer in the parts of middle and the lower body of the stomach in particular.

　When there is an invasion below the submucosa, right decubitus view, which expands upper portion of the stomach, should be combined with left decubitus view because defining endoscopically invasion on the oral side is occasionally difficult in patients with Borrmann 4 cancer (including linitis plastica type) occupying the lower body through the antrum.

　Discussion was also made regarding esophageal invasion and multiple lesion in the stomach.

　Localized reddish mucosal lesion was a particularly useful finding in endoscopic examination of the upper portion of the stomach.