| 特集名 | 鏡視下手術時代の消化器手術適応 | |
|---|---|---|
| 題名 | 消化管 (3) 胃粘膜下腫瘍 | |
| 発刊年月 | 2008年 04月 | |
| 著者 | 大森 健 | 大阪大学医学系研究科外科学講座消化器外科／大阪警察病院外科 |
| 著者 | 中島 清一 | 大阪大学医学系研究科外科学講座消化器外科 |
| 著者 | 仲原 正明 | 大阪警察病院外科 |
| 著者 | 西田 俊朗 | 大阪大学医学系研究科外科学講座消化器外科 |
| 【 要旨 】 | 胃粘膜下腫瘍とは主病変が粘膜よりも下層に主座をおく隆起性病変の総称である．もっとも代表的な腫瘍は間葉系腫瘍であり，その多くは悪性の性質をもつgastrointestinal stromal tumor (以下，GIST) である． GISTは偽被膜をもち膨張性の発育を呈することが多く，転移様式は血行性転移が中心で，リンパ節転移は非常にまれである．外科的治療としては，系統的リンパ節郭清術は不要で，局所切除が選択される．とくに腫瘍径が小さい病変は低侵襲，機能温存術式が望まれ，鏡視下手術はよい適応であると考えられる． 本稿では胃粘膜下腫瘍に対する治療方針，鏡視下手術を含めた手術適応や手術手技について述べる． |
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| Theme | Surgical Indication for Gastrointestinal Diseases in the Era of Endoscopic Surgery | |
|---|---|---|
| Title | Gastric Submucosal Tumors | |
| Author | Takeshi Omori | Department of Surgery, Osaka University Graduate School of Medicine / Department of Surgery, Osaka Police Hospital |
| Author | Kiyokazu Nakajima | Department of Surgery, Osaka University Graduate School of Medicine |
| Author | Masaaki Nakahara | Department of Surgery, Osaka Police Hospital |
| Author | Toshirou Nishida | Department of Surgery, Osaka University Graduate School of Medicine |
| [ Summary ] | Submucosal tumors of the stomach arise from tissue the under mucosa. These include neoplastic as well as nonneoplastic lesions and inflammatory pseudotumors. These tumors include gastrointestinal mesenchymal tumors, and gastrointestinal stromal tumors (GISTs). GISTs are considered to be potentially malignant and are the most common variety. GISTs usually have a pseudocapsule and are prone to expansive growth. Lateral spreading within the gastric wall is unusual and lymphatic involvement is extremely rare. Surgical resection of GISTs has been the most effective therapy for these tumors. Wide resection and expansive lymphatic dissection are not commonly needed. Local resection with minimum surgical margins has been the treatment of choice. Furthermore, laparoscopic resection is considered to be a useful option as a minimally invasive surgery for the treatment of small GIST lesions. The surgical indications for gastric submucosal tumors, including laparoscopic approaches, and surgical procedures for the treatment of gastric submucosal tumors are described. |
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