Kitamura Tadashi, Tanabe Satoshi, Koizumi Wasaburou, Mitomi Hiroyuki, Saigenji Katsunori
Department of Gastroenterology, Shizuoka Red Cross Hospital, Shizuoka City, Shizuoka, Japan.
Gastrointest Endosc. 2006 Jan;63(1):48-54. doi: 10.1016/j.gie.2005.08.009.
Argon plasma coagulation (APC) is a noncontact technique for tissue coagulation. APC has been used to treat early gastric cancer in patients who cannot undergo EMR or open surgery, but a standard procedure for APC is lacking.
Our objectives were to assess the clinical usefulness of APC in patients with early gastric cancer.
This was a small, retrospective pilot study.
All patients were treated at the Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Japan.
We studied 40 patients with early gastric cancer in whom both EMR and open surgery were contraindicated. The macroscopic tumor type was superficial elevated in 11 patients, superficial depressed in 27, and superficial elevated plus superficial depressed in two. The histologic classification was intestinal type in 37 patients and diffuse type in 3.
From January 1998 through March 1999, all patients received one session of APC. From April 1999 through August 2001, all patients received two sessions of APC. From September 2001 through March 2002, an additional session of APC was given only to patients who had large protruding lesions, depressed lesions 2 cm or greater in diameter, or submucosal invasion.
The main outcome measurements were residual tumor or recurrence of early gastric cancer.
Intestinal-type intramucosal carcinoma disappeared after one or two sessions of APC. Submucosal and diffuse-type tumors had a high risk of residual tumor cells because of inadequate treatment after one session of APC. However, such lesions were locally controlled by follow-up APC.
This was a small, retrospective pilot study. Confirmation of long-term outcome is required.
Small early gastric carcinomas can be successfully treated by a single session of APC. Larger protruding-type lesions and submucosal tumors are likely to require two sessions of APC.
氩离子凝固术（APC）是一种非接触式组织凝固技术。APC已被用于治疗无法接受内镜下黏膜切除术（EMR）或开放手术的早期胃癌患者，但目前缺乏APC的标准操作流程。
我们的目的是评估APC在早期胃癌患者中的临床实用性。
这是一项小型回顾性试点研究。
所有患者均在日本相模原市北里大学东医院胃肠病科接受治疗。
我们研究了40例早期胃癌患者，这些患者均不适合接受EMR和开放手术。宏观肿瘤类型为浅表隆起型11例，浅表凹陷型27例，浅表隆起加浅表凹陷型2例。组织学分类为肠型37例，弥漫型3例。
1998年1月至1999年3月，所有患者接受1次APC治疗。1999年4月至2001年8月，所有患者接受2次APC治疗。2001年9月至2002年3月，仅对有大的突出病变、直径2 cm或更大的凹陷病变或黏膜下浸润的患者额外进行1次APC治疗。
主要观察指标为早期胃癌的残留肿瘤或复发情况。
肠型黏膜内癌在接受1次或2次APC治疗后消失。黏膜下和弥漫型肿瘤由于在接受1次APC治疗后治疗不充分，残留肿瘤细胞的风险较高。然而，通过后续的APC治疗，此类病变得到了局部控制。
这是一项小型回顾性试点研究。需要确认长期疗效。
小型早期胃癌可通过单次APC治疗成功治愈。较大的突出型病变和黏膜下肿瘤可能需要进行2次APC治疗。
