Suzuki S, Murakami H, Suzuki H, Sakakibara N, Endo M, Nakayama K
Int Adv Surg Oncol. 1979;2:223-41.
The long term survival rate of gastric cancer has been much improved, and the 5-year survival rate in our institute was 42% with a significant difference between 29% in the advanced stage and 94% in the early stage. This result means that gastric cancer must be detected and treated early as possible. However, the diagnosis of early gastric cancer may remain extremely difficult even for an excellent endoscopist. Therefore, in order to clearly recognize early gastric cancer, an endoscopic staining method with methylene blue has been studied. In this method, one capsule of 150 mg methylene blue is swallowed with a small amount of proteinase solution 3 hours before endoscopy. Gastroscopy is performed routinely after this preparation. This procedure was performed on 153 gastric cancers and 137 of them (89.5%) have been successfully dyed in dark blue. In several cases, with this method, the actual borderline between the normal mucosa and the malignant extent was clearly recognized and resection line was decided. Introduction of methylene blue into the stomach could also stain the intestinalized epithelium of the gastric mucosa. Differential diagnosis of the dyed intestinal metaplasia and the dyed carcinoma seems to be very easy, because both gastric lesions have the characteristic dyed patterns. Mechanism of this phenomenon has been considered to be due to an absorption of the dye in the intestinal metaplasia, and in the gastric cancer, many factors may be involved, among which are the infiltration or diffusion of the dye into the cancerous tissue, the absorption from the abnormal epithelium, and the staining of the necrotic tissue.
胃癌的长期生存率有了很大提高，我院的5年生存率为42%，晚期为29%，早期为94%，两者有显著差异。这一结果表明，胃癌必须尽早发现并治疗。然而，即使对于优秀的内镜医师来说，早期胃癌的诊断可能仍然极其困难。因此，为了清晰识别早期胃癌，人们研究了用亚甲蓝进行内镜染色的方法。在该方法中，在内镜检查前3小时，将150毫克亚甲蓝胶囊与少量蛋白酶溶液一起吞服。在此准备后常规进行胃镜检查。对153例胃癌患者进行了该操作，其中137例（89.5%）成功染成深蓝色。在一些病例中，通过这种方法，可以清楚地识别正常黏膜与恶性病变范围之间的实际边界，并确定切除线。将亚甲蓝引入胃中还可以使胃黏膜的肠化生上皮染色。染色的肠化生和染色的癌之间的鉴别诊断似乎非常容易，因为这两种胃部病变都有特征性的染色模式。这种现象的机制被认为是由于染料在肠化生中的吸收，而在胃癌中，可能涉及许多因素，其中包括染料向癌组织的浸润或扩散、从异常上皮的吸收以及坏死组织的染色。
