臨牀消化器内科 Vol.13 No.8(10)


特集名 安全な内視鏡的粘膜切除術
題名 大腸病変の粘膜切除(一般的な方法)
発刊年月 1998年 07月
著者 小山 洋 小山消化器内科
【 要旨 】 内視鏡的粘膜切除術(endoscopic mucosal resection;EMR)は,内視鏡治療手技の一つである.粘膜下層に生理食塩水などを注入して,病変を機械的に剥離し,挙上させて,周囲の正常粘膜とともに一括切除する.EMRの適応となる病変は,表面型の粘膜内癌(m癌)または腺腫,結節集籏様病変,小さな直腸カルチノイドなどである.粘膜下への注入を行っても病変が挙止しない場合は,粘膜下層以深に浸潤した癌の可能性が高いので,EMRは中止しなければならない.EMRは治療の安全性と確実性の両面からすぐれた方法である.出血や穿孔などの偶発症も非常に少ないが,しかし皆無ではない正確な内視鏡診断に基づく慎重な実施が要求される.
Theme Safety Procedures in Endoscopic Mucosectomy
Title Endoscopic Mucosal Resection of Colorectal Lesions
Author Hiroshi Koyama Koyama Gastroenterology Clinic
[ Summary ] Endoscopic mucosal resection (EMR) is one type of endoscopic treatment for colorectal lesions. In this treatment the lesion was separated mechanically from the submucosal layer by submucosal injection of a physiological saline solution. Then the artificially raised lesion along with the normal mucosa surrounding it was cut using a high frequency current. Indications for this treatment are intramucosal cancer or adenoma, especially superficial type lesions nodule-aggregating lesions and small carcinoid tumors of the rectum. If the lesion is not lifted by submucosal injection EMR must be stopped at this point, because the lesion would probably invade the submucosal layer or deeper tissues. EMR is a good method of endoscopic treatment with its safety and reliability. While only a small number of complications such as bleeding or perforatiol occur when using EMR, it must be performed carefully along with exact endoscopic diagnosis.
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