陥凹型早期胃癌の深達度診断―粘膜ひだ集中を持つⅡcのX線診断

Radiographic Diagnosis of Depth Invasion in Type Ⅱc Early Gastric Cancer with Converging Mucosal Folds

要旨　胃のⅡc病変では，粘膜ひだ集中を持つか持たないかで深達度診断が大きく左右される．持つⅡcのほうがより難しい．更に，その面倒な粘膜ひだ集中を持つⅡcは，胃壁硬化の程度により深達度診断に難易差がある．筆者らは，胃壁硬化の程度から粘膜ひだ集中を持つⅡcを4型に分けて検討してきた．その4型別の深達度診断は，①病変全体の胃壁硬化例は，深達度診断が不能，②部分的胃壁硬化例では，その範囲が広いとsmかpm，③瘢痕局所の限局性胃壁硬化例はmかsm，ただしsmであっても少量浸潤のsm，④病変内にmass形成がある例では，粘膜下層にmassを作っているのでmのことはなく，その深達度はsmかpm，という成績であった．

　Diagnosis of depth invasion is more difficult in type Ⅱc early gastric cancer with converging mucosal folds than without converging mucosal folds. Furthermore, the accuracy of such diagnosis in cases with converging folds is influenced by the degree of stiffness of the gastric wall as well.

　Authors subdivided type Ⅱc gastric cancer with converging mucosal folds into four types based on the degree of stiffness of the gastric wall. The results were as follows:

　(1) In cases with diffuse stiffness involving entire lesion, diagnosis of depth invasion was impossible.

　(2) Among cases with partial stiffness, stiffness involving larger area indicated sm or pm.

　(3) In cases with localized stiffness due to scarring, depth invasion proved to be m or sm with small invasion.

　(4) In cases with mass in the lesion, which implies mass formation in the submucosa, depth invasion was either sm or pm.