°Ê²¼¤Ï¡¢ºÇ½ª·Ù¹ð¡ª¤¿¤±¤·¤ÎËÜÅö¤ÏÉݤ¤²ÈÄí¤Î°å³Ø¤Ç°·¤ï¤ì¤Æ¤¤¤¿ÆâÍƤǤ¹¡£

º£Ç¯9·î¡¢°ß¥¬¥ó¤òÀë¹ð¤µ¤ì¤¿K¡¦Y¤µ¤ó(73)¡£ºÆ¸¡ºº¤Ç¬Äꤷ¤¿·ë²Ì¡¢´â¤Ïľ·Â2­ÑÄøÅÙ¤Îδµ¯·¿¤ÈȽÌÀ¡£¹¬¤¤Áá´ü¤Î¤â¤Î¤À¤Ã¤¿¤¿¤á¡¢ºÇ¿·¤ÎÆâ»ë¶À¼ê½Ñ¤ò´«¤á¤é¤ì¤Þ¤·¤¿¡£¤½¤·¤Æ2008ǯ10·î²¼½Ü¡¢ÆüËÜÍ­¿ô¤Î´âÀìÌçɱ¡¡Ö´â¸¦Í­ÌÀɱ¡¡×¤Ç¼ê½Ñ¤ò¼õ¤±¤ë¤³¤È¤Ë¤Ê¤ê¤Þ¤·¤¿¡£

K¡¦Y¤µ¤ó¤Î¼õ¤±¤¿¼ê½Ñ¤Ï¡¢Æâ»ë¶ÀŪǴËì²¼ÁØÇíÎ¥½Ñ(endoscopic submucosal dissection:ESD)¤È¸Æ¤Ð¤ì¤ë¤â¤Î¤Ç¤¹¡£ESD¤È¤Ï¡¢5Áؤ¢¤ë°ßÊɤξ夫¤é2ÈÖÌÜ¡ÖÇ´Ëì²¼Áءפ˥ҥ¢¥ë¥í¥ó»À¤òÃíÆþ¡£´µÉô¤òÀ¹¤ê¾å¤²¤Æ´âºÙ˦¤òºï¤®¼è¤ë¡¢Æâ»ë¶À¤ò»È¤Ã¤¿¼ê½ÑË¡¤Ç¤¹¡£

¤½¤â¤½¤â¡¢Áá´ü°ß´â¤ËÂФ¹¤ëÆâ»ë¶ÀŪ¼£ÎŤȤ·¤ÆÆâ»ë¶ÀŪǴËìÀÚ½ü½Ñ(endoscopic mucosal resection¡§EMR)¤¬ÉáµÚ¤·¤Æ¤¤¤Þ¤¹¤¬¡¢EMR¤Î¾ì¹ç¤Ï¤½¤ÎŬ±þ¤Ï2001ǯ¤ËÆüËÜ°ß´â³Ø²ñ¤Ë¤è¤Ã¤Æȯɽ¤µ¤ì¤¿´ð½à(°ß´â¼£ÎÅ¥¬¥¤¥É¥é¥¤¥ó)¤¹¤Ê¤ï¤Á
­¡Ê¬²½·¿Á£´â
­¢Ç´ËìÆâ´â
­£2cm°ÊÆâ
­¤ÄÙáç½ê¸«¤¬¤Ê¤¤

¤Ë§¤Ã¤Æ¹Ô¤ï¤ì¤Æ¤¤¤Þ¤¹¡£¤½¤Î¤¿¤á¡¢ËÜÎã¤Î¤è¤¦¤Ê¥±¡¼¥¹(ľ·Â2­ÑÄøÅÙ)¤Ç¤ÏEMR¤ÎŬ±þ³°¤È¤Ê¤Ã¤Æ¤·¤Þ¤¦¤ï¤±¤Ç¤¹¡£

¤Ç¤¹¤¬¡¢2cm¤òĶ¤¨¤ëÂ礭¤ÊÉÂÊѤËÂФ·¤Æ¤â°ì³çÀÚ½ü¤¬²Äǽ¤Ç¤¢¤ëEMR¤ÎÊÑË¡¤¬³«È¯¤µ¤ì¤Þ¤·¤¿¡£¤½¤ì¤³¤½¤¬¡¢Æâ»ë¶ÀŪǴËì²¼ÁØÇíÎ¥½Ñ¡Êendoscopic submucosal dissection¡§ESD)¤Ç¤¹¡£Å¬±þ¤Ï¤Ò¤í¤¬¤ê¤Þ¤·¤¿¤¬¡¢ESD¤ÏEMR¤ËÈæ¤Ù¤ë
­¡¼£ÎÅ»þ´Ö¤¬Ä¹¤¤¡£
­¢¶öȯ¾É(½Ð·ì¡¢Àü¹¦)¤¬µ¯¤³¤ê¤ä¤¹¤¤¡£
­£¼êµ»¤Î½¬ÆÀ¤¬Æñ¤·¤¤¡£

¤Ê¤É¤Î·çÅÀ¤â¤¢¤ê¤Þ¤¹¡£¤Ç¤¹¤¬¡¢2006ǯÅÙ¤«¤éÊݸ±Å¬±þ¤¬¤Ê¤µ¤ì¤ë¤è¤¦¤Ë¤Ê¤ê¡¢ÈñÍѤÎÌ̤ǤÎÌäÂ꤬¥¯¥ê¥¢¤µ¤ì¡¢»Ü¹Ô»ÜÀߤâ¤ß¤é¤ì¤ë¤è¤¦¤Ë¤Ê¤Ã¤Æ¤¤¤Þ¤¹¡£

ESD¤ÎÍøÅÀ¤È¤·¤Æ¤Ï¡¢²¿¤È¸À¤Ã¤Æ¤â´µ¼Ô¤µ¤ó¤ÎÉéô¤¬¾®¤µ¤¤¤³¤È¤Ç¤·¤ç¤¦¡£Ä̾ï¤Î°ß´âÀÚ½ü¼ê½Ñ¤Î¾ì¹ç¡¢³«Ê¢¤·°ß¤ÎȾʬ°Ê¾å¤òŦ½Ð¤¹¤ë¤¿¤á¡¢ºÇÄã¤Ç¤â2½µ´Ö¤ÎÆþ±¡¤¬É¬ÍפǤ¹¡£¤·¤«¤·ESD¤Ê¤é´µ¼Ô¤ÎÉéô¤ÏÂçÉý¤Ë·Ú¸º¤µ¤ì¤Þ¤¹(³«Ê¢¤ÎɬÍפ¬¤Ê¤¯¤Ê¤ë)¡£¤½¤Î·ë²Ì¡¢3Çñ4Æü¤È¤¤¤¦Ã»´ü´Ö¤ÇÂౡ¤Ç¤­¤ë¤è¤¦¤Ë¤Ê¤ê¤Þ¤¹¡£

ESD¤Î¼ê½ç¤Ï¡¢°Ê²¼¤Î¤è¤¦¤Êή¤ì¤Ë¤Ê¤Ã¤Æ¤¤¤Þ¤¹¡£
¤Þ¤ºÄÃÀźޤǴµ¼Ô¤µ¤ó¤Î°Õ¼±¤ò¤Ê¤¯¤·¤Þ¤¹¡£¼¡¤Ë¸ý¤«¤éÆâ»ë¶À¤òÁÞÆþ¤·¤Þ¤¹¡£ÉÂÊÑÉô¤Î´â¤ò³Îǧ¤·¡¢°ßÊÉÁ´ÂΤËÀ÷¿§±Õ¤ò»¶ÉÛ¤·¤Þ¤¹¡£¤¹¤ë¤È¡¢´â¤ÈÀµ¾ï¤ÊÁÈ¿¥¤Î¶­¤¬¡¢¤Ï¤Ã¤­¤ê¸«¤¨¤ë¤è¤¦¤Ë¤Ê¤ê¤Þ¤¹¡£

¤½¤ì¤«¤éÅŵ¤¥á¥¹¤ò»È¤¤¡¢´â¤ò°Ï¤à¤è¤¦¤Ë°õ¤ò¤Ä¤±¤Þ¤¹¡£¼¡¤Ë5Áؤ¢¤ë°ßÊɤÎ2ÁØÌÜ¡¢¸ü¤µ¤ï¤º¤«2¡Á3 mm¤ÎÇ´Ëì²¼Áؤˡ¢¥Ò¥¢¥ë¥í¥ó»À¤òÃíÆþ¤·¤Þ¤¹¡£¤¹¤ë¤È¡¢ÀÚ½ü¤¹¤ëÉôʬ¤òÀ¹¤ê¾å¤¬¤Ã¤Æ¤­¤Þ¤¹¡£

¤½¤·¤ÆIT¥Ê¥¤¥Õ2¤È¸Æ¤Ð¤ì¤ëºÇ¿·¤ÎÅŵ¤¥á¥¹¤ÇÇö¤¯ºï¤°¤è¤¦¤Ë´µÉô¤òÀÚ½ü¤·¤Þ¤¹¡£ÀÚ½üÃæ¤Ë½Ð·ì¤¬¤ß¤é¤ì¤ì¤Ð¡¢ÄÌÅŤˤè¤Ã¤Æ¶Å¸Ç¤ò¹Ô¤¤¤Þ¤¹¡£ÀÚ½ü¸å¤ËŦ½Ð¤ò¹Ô¤¤¤Þ¤¹(°ß¡¢¿©Æ»¡¢¸ý¹Ð¤òÄ̤äƤ½¤Î¤Þ¤ÞŦ½Ð)¡£

ºÇ¸å¤Ë´µÉô¤Î½Ð·ì¤ò»ß¤á¤Þ¤¹¡£»ß·ì¥¯¥ê¥Ã¥×¤ò¥»¥Ã¥È¤·¤Æ½ªÎ»¤Ç¤¹¡£»ß·ì¥¯¥ê¥Ã¥×¤Ï½ý¤¬¼£¤ì¤Ð¼«Á³¤Ë¤È¤ì¤ÆÂΤγ°¤ËÇӽФµ¤ì¤Þ¤¹¡£½çÄ´¤Ë¤¤¤±¤Ð¡¢Á´¹ÔÄø¤Ç1»þ´ÖÄøÅ٤Ǥ¹¡£³«Ê¢¼ê½Ñ¤ËÈæ¤Ù¡¢¤ï¤º¤«3ʬ¤Î1¤È¤¤¤¦¥¹¥Ô¡¼¥É¤È¤Ê¤Ã¤Æ¤¤¤Þ¤¹¡£
¡¡
¼ÂºÝ¤Ë¸á¸å2»þ²á¤®¤Ë»Ï¤Þ¤Ã¤¿K¡¦Y¤µ¤ó¤Î¼ê½Ñ¤Ï¡¢¤ª¤è¤½1»þ´ÖȾ¸å¤Ë½ªÎ»¤·¤Þ¤·¤¿¡£Æþ±¡2ÆüÌÜ¡¢ÀÚ½ü¤·¤¿Éôʬ¤Ë½Ð·ì¤¬¤Ê¤¤¤«¤òÆâ»ë¶À¤Ç³Îǧ¤·¤Þ¤¹¡£½Ñ¸å¤Î·Ð²á¤ÏÎɹ¥¤Ç¡¢Ãë¿©¤«¤é¤Ï¤â¤¦Î®Æ°¿©¤Î¿©»ö¤¬½ÐÍè¤ë¤è¤¦¤Ë¤Ê¤ê¤Þ¤·¤¿(½ÅÅò¤Ê¤É)¡£Æþ±¡3ÆüÌܤ«¤é¤Ï¸Ç¤¤Êª¤ò´Þ¤à¿©»ö¤ò3¿©¿©¤Ù¤ë¤³¤È¤¬½ÐÍè¤Þ¤·¤¿¡£¤½¤·¤Æ4ÆüÌÜ¡¢K¡¦Y¤µ¤ó¤Ï3Çñ4Æü¤Î¼£ÎŤò½ª¤¨¡¢Ìµ»öÂౡ¤·¤Þ¤·¤¿¡£

ESD¤Î¾Ü¤·¤¤ÍͻҤʤɤÏÁá´ü°ß¤¬¤ó¤ÎÆâ»ë¶ÀŪ¼£ÎŤ˼̿¿ÉÕ¤­¤Ç·ÇºÜ¤µ¤ì¤Æ¤¤¤Þ¤¹¡£

¡Ú´ØÏ¢µ­»ö¡Û
ËÜÅö¤ÏÉݤ¤²ÈÄí¤Î°å³Ø¡¡¾ÉÎ㽸

ËÜÅö¤ÏÉݤ¤¸¡ºº·ù¤¤¡Ý°ß´â