大腸早期癌の治療法選択における内視鏡下局注法の有用性についての研究

DOI 被引用文献5件 参考文献22件

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  • Usefulness of Submucosal Saline Injection for Planning Therapeutic Methods of Early Colorectal Cancer.

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The purpose of this study was to evaluate the effectiveness of endoscopic submucosal saline injection method (injection method) in diagnosing the infiltration degree of early colorectal cancer and in planning therapeutic method. The degree of elevation by injection method was evaluated for each lesion : a case in which the lesion was completely elevated was defined as a positive lifting sign, a case in which the lesion was incompletely elevated or not elevated was defined as a negative lifting sign. We investigated the relationship between lifting sign and the depth of cancerous invasion. Furthermore, we also examined lifting sign by endoscopic ultrasonography (EUS). We performed injection method for 66 lesions of mucosal cancer (m-cancer), 37 lesions of submucosal invaded cancer (sm-cancer) and 5 lesions of muscularis propria invaded cancer (mp-cancer). Sm-cancers were divided into two groups (sm-slight and sm-massive cancer), according to the degree of cancerous invasion within the submucosal layer. The results were as follows : 1) Positive rates of lifting sign were 97% in m-cancers, 100% in sm-slight cancers, 48% in sm-massive cancers and 0% in mp-cancers, respectively. In 27 lesions of sm-massive cancer, lifting signs were positive in 13 lesions and negative in 14 lesions. 2) On the assumption that positive lifting sign suggested the indication of endoscopic therapy (m-cancer and sm-slight cancer), and negative lifting sign suggested the indication of radical operation (sm-massive cancer-), overall diagnostic accuracy by injection method was 86% (93/108 lesions). 3) EUS findings after injection method were well correlated with lifting sign. It is concluded that the evaluation of lifting sign by injection method is useful in diagnosing the infiltration degree of early colorectal cancer and in planning therapeutic method. But in cases of sm-massive cancer, positive rate of lifting sign was high, so it is necessary to use other diagnostic methods (such as EUS) with injection method in diagnosing the depth of cancerous invasion.

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