| 特集名 | 消化器癌の鏡視下治療 | |
|---|---|---|
| 題名 | 内視鏡下治療:各論 (2) 胃癌 | |
| 発刊年月 | 1999年 02月 | |
| 著者 | 細川 浩一 | 国立がんセンター東病院内視鏡部 |
| 著者 | 田尻 久雄 | 国立がんセンター東病院内視鏡部 |
| 【 要旨 】 | 国立がんセンター中央病院・東病院における早期胃癌の根治的治療を目的とした内視鏡的粘膜切除術(EMR)の適応は，(1)分化型腺癌，(2)肉眼型:IIa,IIC，(3)潰瘍所見のないこと，である．病変の大きさに制限はなく，粘膜下浸潤が疑われる症例も診断的治療として対象としている．EMR症例は年々増加しており，1996年には早期骨癌症例の約40%がEMRを施行された．1987年から1996年にEMRが施行された早期胃癌440例において切除断端陰性例は320例(72.7%)であったが，うち43例に粘膜下浸潤を認め，治癒切除例は277例(63.0%)であった．1994年から1996年の3年間では切除断端陰性率は81.5%と向上がみられている．EMR後に粘膜下浸潤癌と判明した症例は全体で85例(19.3%)であった．非治癒切除例を含めてこれまでに原病死は経験されていない．より大きな病変を一括切除するために，1995年より独自に開発した粘膜切開用ナイフ(insulationn-tipped diathermic knife : ITナイフ)を導入した．東病院におけるITナイフを用いたEMRとstrip biopsy法の比較では，径11～20mmの病変において有意にITナイフを用いたEMRが一括切除率が高かった．切除断端陰性率は近年80%以上と向上しているが，今後，より確実な一括切除のために手技的な開発が必要と考えられる． | |
| Theme | Laparoscopic and Endoscopic Therapy for Digestive Organ | |
|---|---|---|
| Title | Recent Advances in Endoscopic Mucosal Resection for Early Gastric Cancer | |
| Author | Koichi Hosokawa | Division of Endoscopy, National Cancer Center Hospital East |
| Author | Hisao Tajiri | Division of Endoscopy, National Cancer Center Hospital East |
| [ Summary ] | Our indications for Endoscopic Mucosal Resection (EMR) for early gastric cancer (EGC) as a radical treatment are as follows, (1) Histology:Intestinal type, (2) Macroscopic type :IIa and IIc, (3) Without ulcerative change. We do not put restrictions on the size of the lesion. Lesions which are suspected to have submucosal invasion are recieve EMR for diagnostic purposes. The ratio of EMR cases in relation to total EGC cases has increased in recent years and amounted to about 40% of EGCs treated at the National Cancer Center Hospital in 1996. From 1987 to 1996,we had 440 cases of EGCs (intestinal type, histologically) at National Cancer Center Hospital and National Cancer Center Hospital East. Eighty five cases (19.3%) turned out to have submucosal invasion. The overall rate of cut-end-free cases was 72.7%. And the overall rate of curative resection (excluding cases with submucosal invasion) was 63.0%. Though we had 37 reccurent cases after EMR, we have had no fatalities resulting from the original disease with additional treatment or observation (due to complications or age). To resect larger lesions in one piece, we have begun EMR with cutting the mucosa around the lesion using a newly improved endoscopic devise named an insulation-tipped diathermic knife (IT knife) from 1995. With the IT knife， we could resect 75% of lesions from 11 to 20mm in size in one piece, while we could resect 29% with the conventional method (strip biopsy). Though the results of EMR have improved in recent years, new endoscopic techniques for easy and dependable EMR are expected to be developed soon. |
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