Takemoto T, Yanai H
Gan No Rinsho. 1986 Aug;32(10):1077-81.
It is obvious that surgical resection is a superior therapy for gastric cancer. In this sense, endoscopic therapy could be regarded as an orphan in this field. However, in the combination of endoscopic therapy and ultrasonic endoscopy, endoscopic therapy for gastric cancer should be acknowledged to be equal to surgical therapy. We have treated early gastric cancer by means of endoscopical photocoagulation using a Nd-YAG laser, particularly in inoperable cases due to other complication or old age. Forty-seven lesions found in 41 patients have so far been photocoagulation and followed up. By this treatment, cancer cells disappeared in 42 out of 47 lesions, although 2 cases died of other diseases and recurrence was experienced in 3 cases. In addition to photocoagulation therapy using a laser, we have recently developed a large-biopsy technique called strip biopsy in order to get sufficient tissue for diagnosis in comparison with bite biopsy. By this method, we are able to resect the full thickness of the mucosa including the submucosal layer up to a size of about 4 cm, without any severe complication such as hemorrhage and perforation. We succeeded in resecting the early gastric cancer in 34 lesion in 31 patients. The combination therapy of endoscopical photocoagulation and strip biopsy seems to be reasonable for the therapy of early gastric cancer.
显然，手术切除是治疗胃癌的一种更优疗法。从这个意义上讲，内镜治疗在该领域可能被视为一种边缘疗法。然而，在内镜治疗与超声内镜相结合的情况下，胃癌的内镜治疗应被认为等同于手术治疗。我们使用钕钇铝石榴石激光通过内镜光凝治疗早期胃癌，特别是针对因其他并发症或高龄而无法进行手术的病例。到目前为止，已对41例患者发现的47个病灶进行了光凝治疗并随访。通过这种治疗，47个病灶中有42个的癌细胞消失，尽管有2例死于其他疾病，3例出现复发。除了激光光凝治疗外，我们最近还开发了一种称为条状活检的大活检技术，以便与咬取活检相比能获取足够的组织用于诊断。通过这种方法，我们能够切除包括黏膜下层在内的全层黏膜，大小约为4厘米，且没有出血和穿孔等任何严重并发症。我们成功地对31例患者的34个病灶进行了早期胃癌切除。内镜光凝和条状活检的联合治疗似乎是早期胃癌治疗的合理方法。
