大腸結節集簇様病変に対する適切な内視鏡的粘膜切除術の検討
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概要
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Nodular aggregated lesions of the colon are best removed by endoscopic mucosal resection. Since these lesions sometimes invade deeply into the submucosal layer, it is important to assess the depth of invasion before treatment. This study classified appropriate methods of therapy for nodule aggregating lesions into three types. Endoscopic and radiological analysis was carried out to identify the character of the surface; histopathological investigation was carried out to ascertain the vertical distance of sm-invasion in the cases of sm-cancer, positive rate of ly, v and n, which are important factors when determining the method of therapy. For nodule aggregating lesions composed of constituent components less than 10 mm in size, the rate of sm 2, 3 was very low with a value of 3 %. Hence, EMR should be selected for these lesions. As for 12 cases of nodule aggregating lesion with relative depression, the rate of sm 2, 3 was high in the depressed area with values of 83%, and metastasis to lymph nodes were often observed with values of 25%. Hence, surgical operation with a thorough cleanup of lymph nodes is necessary for these cases. In the cases of nodule aggregating lesions with large nodules more than 10 mm in size, the rate of sm 2, 3 was 31%, but no metastasis to the lymph nodes was observed. Therefore EMR, on condition that the large nodules be entirely resected or operated under laparoscopy, is considered to be appropriate for these cases. In granular type cases, selection of method of therapy should be done taking the difference of the size of constituent components, that is, protrusion component, in the surface and the existence of relative depression into consideration.
- 学校法人 昭和大学・昭和医学会の論文