Ⅰ型大腸sm癌の深達度診断指標の検討

抄録

Indication of endoscopic treatment to Type-I colon cancer is still controversial. In order to diagnose the cancerous depth invasion precisely, 65 lesions of Type-I were analysed in terms of endoscopic appearance.
1) Type-I sm cancers were split into two subdivisions : typical group (30 lesions) and modified group (35) .
2) Both groups significantly differed in the cancerous depth invasion (p<0.01, chisquare test) , resulting in the fact that modified group reaches much deeper than typical group (Table 1) . In typical group, sm₁ 80%, sm₂ 20%. In modified group, sm₁ 2.9%, sm₂ and sm₃ 97.1%. Furthermore, modified group comprised erosive-ulcerative, nodular, and mixed type. With erosive-ulcerative, all 18 lesions proved sm₂ or deeper. With nodular, 9 sm₂ but one sm₁. With mixed, all 7 lesions proved sm₂ or deeper.
3) Pertaining to the group and differentiation, group of typical and modified was significantly associated with the incidence of well/moderately differentiated cancer (p<0.01) . Typical group was linked with well differentiated cancer (73.3%) , modified group linked with moderately differentiated cancer (82.9%) .
4) With vessel invasion, ly (+) was significantly higher in modified group (p<0.01) , while also so was v (+) in modified group. Ly (+) by 20% in typical group while in modified, ly (+) 80%. V (+) by 3.3% in typical while in modified, v (+) by 31.4%.
To sum up, it was concluded that it is of the first importance to deal with Type-I sm cancer depending on the subdivision of typical group and modified group in order to discriminate sm₁ from sm₂ and deeper. This subdivision is useful to decide on a proper treatment between endoscopic removal and surgical operation with the precise preoperative diagnosis over cancerous depth invasion.