Tajiri H, Mukai T, Yoshida S, Yamaguchi H, Saito D, Oguro Y
Dept. of Internal Medicine, National Cancer Center Hospital.
Gan To Kagaku Ryoho. 1988 Apr;15(4 Pt 2-3):1429-34.
We carried out a clinicopathologic and endoscopic investigation of the relationship between the presence/absence of lymph node or distant metastasis and several crucial factors using resected specimens of early gastric cancer, and concluded that endoscopic treatment was indicated for four types of early gastric cancer: 1) type IIa less than 2 cm in size, 2) focal cancer, 3) so called "gastritis-like" early cancer less than 2 cm in size and 4) polypoid type with mucosal involvement. Up to now, cases of early gastric cancer have been treated by polypectomy, strip biopsy and laser endoscopy. Residual cancer cells were found in 10 out of 20 resected cases. In 2 out of 54 cases followed up for more than one year without any surgical treatment, cancer cells were discovered by biopsy. The effectiveness rate was estimated to be 84% (62/74). Endoscopic treatment was able to provide high efficiency for early gastric cancer of the above types. Causes of ineffectiveness were a lesion more than 2 cm in size, vertical invasion of the lesion into the submucosa and the location of a lesion in a difficult area such as the prepylorus or the cardia.
我们利用早期胃癌切除标本，对有无淋巴结或远处转移与几个关键因素之间的关系进行了临床病理及内镜研究，得出结论：以下四种类型的早期胃癌适合内镜治疗：1）直径小于2 cm的IIa型；2）局灶性癌；3）直径小于2 cm的所谓“胃炎样”早期癌；4）有黏膜受累的息肉样型。到目前为止，早期胃癌病例一直通过息肉切除术、条形活检及激光内镜进行治疗。在20例切除病例中，有10例发现残留癌细胞。在54例未经任何手术治疗且随访超过一年的病例中，有2例经活检发现癌细胞。有效率估计为84%（62/74）。内镜治疗对上述类型的早期胃癌能提供较高的效率。无效的原因包括病变直径大于2 cm、病变垂直侵犯黏膜下层以及病变位于如幽门或贲门等困难部位。
