| 特集名 | 消化管粘膜下腫瘍 -- 診断の進歩と治療方針 | |
|---|---|---|
| 題名 | 十二指腸・小腸粘膜下腫瘍 -- 診断と治療方針 | |
| 発刊年月 | 2001年 03月 | |
| 著者 | 本多 啓介 | 川崎医科大学消化器内科II |
| 著者 | 飯田 三雄 | 川崎医科大学消化器内科II |
| 【 要旨 】 | 過去5年間における本邦での十二指腸，空・回腸の粘膜下腫瘍を集計した．十二指腸，空・回腸とも，良性では平滑筋腫，脂肪腫が，悪性では悪性リンパ腫，平滑筋肉腫が多かった．十二指腸ではブルンネル腺腫，カルチノイドの報告も多くみられた．症状に特異的なものはなかったが，腹痛，出血，貧血，腫瘤触知が多かった．診断は十二指腸では内視鏡および超音波内視鏡が主となり，空・回腸ではX線造影が主で，腹部超音波，CT,MRIは補助的検査と考えられた．鑑別診断は臨床像，各種画像検査を総合して行う必要がある．治療は悪性はもとより，良性でも有症状の際には手術対象となるが，内視鏡や腹腔鏡を用いた侵襲の少ない治療法が推奨される． | |
| Theme | Gastrointesinal Submucosal Tumor -- Advances in the Diagnosis and Treatment | |
|---|---|---|
| Title | Submucosal Tumors of the Duodenum and Small Intestine -- Epidemiology, Diagnosis and Treatment | |
| Author | Keisuke Honda | Division of Gastroenterology, Department of Medicine, Kawasaki Medical School |
| Author | Mitsuo Iida | Division of Gastroenterology, Department of Medicine, Kawasaki Medical School |
| [ Summary ] | Submucosal tumors (SMT) of the duodenum, jejunum, and ileum (small intestine) were analyzed, in Japan, over the past 5 years (1995～1999). The most common type of benign lesions were leiomyoma and lipoma. The most common malignant lesions were malignant lymphoma and leiomyosarcoma. Brunner's gland adenoma and carcinoid tumors were more common in the duodenum. There was no difference in patient age between types of SMT. Chief complaints with SMT were abdominal pain, hemorrhaging, anemia and abdominal masses. Abdominal pain was the most common intial symptom for malignant lymphoma. Hemorrhaging and anemia were frequent in myogenic tumors. Abdominal masses (consisting of tumors or distended bowels or both) were palpable in cases of malignant SMT. However, the majority of SMT were asymptomatic in the early stages. Small bowel SMT should be considered as one of the less frequent causes in differential diagnoses of unexplained abdominal pain, chronic anemia, and/or occult gastrointestinal (CI) bleeding. Barium studies were the first diagnostic modality for SMT of the small intestine. Endoscopy and non-ivasive modalities also played important roles. Further investigation after barium studies depends on what kind of tumor is suspected. CT was useful in detecting tumor-specific appearance, invasion of adjacent organs and metastatic lesions. MRI was less useful than CT. Although angiography is not routinely performed on patients with suspected SMT, it is often indicated if the cause of GI bleeding is not revealed by barium studies or endoscopy. All SMT that are causing bowel symptoms should be treated. Depending on the size and nature of SMT, endoscopic resection may be selected. Further easy, non-invasive therapeutic modalities are recommended. |
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