| 特集名 | 内視鏡的粘膜下層剥離術 (ESD) のトレーニングとリスクマネージメント | |
|---|---|---|
| 題名 | ESD習得後に必要とされる基本事項 (3) 切除病変の評価と術前診断の検証 | |
| 発刊年月 | 2006年 08月 | |
| 著者 | 豊永 高史 | 岸和田徳洲会病院消化器内科 |
| 著者 | 西野 栄世 | 岸和田徳洲会病院病理 |
| 著者 | 筑後 孝章 | 近畿大学医学部附属病院病理学 |
| 著者 | 野田 佳寿 | 岸和田徳洲会病院消化器内科 |
| 著者 | 植田 知恵 | 岸和田徳洲会病院消化器内科 |
| 著者 | 廣岡 大司 | 岸和田徳洲会病院消化器内科 |
| 【 要旨 】 | 内視鏡的粘膜下層剥離術 (ESD) の最大のメリットは過不足のない正確な切除と一括切除標本による詳細な病理組織診断が可能な点にある．そのためには切除標本を適切に取り扱い，術前診断を検証することが不可欠である．標本は愛護的に回収し，術前の状態を反映した形まで伸展固定する．付着組織などを除去した後，標本を観察・計測し写真撮影を行う．ライティングがとくに重要である．切り出しは断端の評価が確実にできる向きに割を入れ必ず全割する．切り出し幅は胃，大腸では2 mm間隔，食道は2 mm以下である．切り出し後または割線入りの写真撮影も必須である．病理組織診断，マッピングに基づき治療効果判定，術前診断の検証を行う．治療後の方針決定は画一的には行えない場合も多いので平素から病理医との連携を深めておかなければならない． | |
| Theme | Training System and Risk Management for Endoscopic Submucosal Dissection (ESD) | |
|---|---|---|
| Title | Histopathological Assessment of Specimens and Preoperative Diagnosis for Endoscopic Submucosal Dissection (ESD) | |
| Author | Takashi Toyonaga | Department of Gastroenterology, Kishiwada Tokushukai Hospital |
| Author | Eisei Nishino | Department of Pathology, Kishiwada Tokushukai Hospital |
| Author | Takaaki Chikugo | Department of Pathology, Kinki University School of Medicine |
| Author | Kazu Noda | Department of Gastroenterology, Kishiwada Tokushukai Hospital |
| Author | Chie Ueda | Department of Gastroenterology, Kishiwada Tokushukai Hospital |
| Author | Takashi Hirooka | Department of Gastroenterology, Kishiwada Tokushukai Hospital |
| [ Summary ] | The major advantages of endoscopic submucosal dissection (ESD) are the possibility of accurate, minimal resection of the target area, and extensive histopathological assessment of specimens resected in an en bloc fashion. To this end, it is essential to appropriately handle the resected specimen, and verify the preoperative diagnosis. The specimen must be carefully recovered and fixed as extended to reflect the preoperative conditions. After adhering tissue, etc. is removed, the specimen is examined, measured and photographed. Lighting is of paramount importance. The entire specimen must be cut into pieces. When cutting the specimen, incisions are made in a direction which enables an evaluation of the margins. Cutting intervals must be 2 mm for the stomach and large intestine, and less than 2 mm for the esophagus. The cut pieces or the incised specimen must also be photographed. Based on histopathological diagnosis and mapping results, therapeutic effects are determined and the preoperative diagnosis is verified. Since standardized policy is often unalterable after treatment, the endoscopist must always maintain close connections with the pathologist. |
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