Masanori Tada

Colonic mucosal resection using a transparent cap-fitted endoscope

Recently, we have had increased chances of f inding flat lesions in the colon as the resu l t of improved technology for colonoscopy. These lesions include ear ly colon cancers t ha t can be completely removed by endoscopic mucosal resection. 14 However , it is not always easy to remove large flat lesions by endoscopic mucosectomy. We have been performing endoscopic mucosal resect ion us ing a t r a n s p a r e n t cap for flat lesions of the colon and found t ha t this me thod enabled us to per form a safe and easy mucosal resection. 5, 6

Ultrasonographic examination for lateral lymphatic spread and local recurrence of rectal cancer

PURPOSE: A preoperative evaluation of the lateral lymphatic spread is essential to decide the indication of autonomic nerve preserving operation for rectal cancer. For this evaluation, we used common ultrasonographic examination of the lower abdomen. We also performed this examination on postoperative patients in whom local recurrence had been suspected. Results and effectiveness of examination were evaluated. METHOD: First, we identified arteries in the pelvic cavity (common, external, and internal iliac arteries), and then we sought lymph nodes in the spaces between these arteries, urinary bladder, and rectum. RESULTS: We performed this examination on 40 preoperative patients with rectal cancer and could detect lymph nodes in 12 patients. By the size and features of these lymph nodes, five patients were considered lateral lymphatic spreadpositive. After the operation, resected specimens revealed three patients were pathologically positive, and the two others were false-positive. Only one patient was false-negative. Total accuracy of the examination was 92.5 percent; however, the positive lymph node around middle rectal artery and obturator artery had been overlooked. We also performed this examination on postoperative patients in whom local recurrence had been suspected. In one postoperative patient, a recurrent lesion of 30 × 3.5 cm in size was detected along the right external iliac artery and could be resected by the retroperitoneal surgical approach. CONCLUSION: We consider this examination very effective for detecting lymph node metastasis preoperatively and recurrent lesions in the pelvic cavity.

Disorder of Anorectal Function after Sphincter-Saving Operation for Rectal Cancer and the Therapy. Motility of the Oral Side of Anastomosis.

直腸癌に対する肛門括約筋温存手術後の排便機能障害とその対策について, 吻合部より口側の結腸の部分に注目して検討した. 検査の方法は, コントロール15例と直腸癌術後患者40例の直腸に5cmごとに圧感応型microtip transducerの付いたカテーテルを挿入し, 肛門縁より5, 10, 15, 20cmの部位の内圧を連続的に測定し, 同時に行った排便機能アンケートや肛門機能検査の結果と比較検討した. アンケートの結果により分類された機能良好群23例, 機能不良群17例を比較すると, 吻合部の低さ・コンプライアンスで有意差があり術後経過月数も良好群が長い傾向があった. 定度による内圧スコアに有意の相関が認められ, 吻合部の口側の腸管の繁張と不安定さが術後排便機能障害の重要な要因の一つと考えられ, 口側腸管や神経の温存なども重要と推測された.

A Comparative Study on Retrospective Evaluation of the Prognosis of the Colorectal Calcinomas Using New TNM and General Classifications.

昭和49年から62年までに切除された大腸癌258例を対象に, 1987年に改定された新TNM分類と現行の大腸癌取扱い規約の2つの分類に沿ってretrospectiveに病期分類を行い.2つの分類法の特徴について検討した.その結果, 新TNM分類による生存率曲線は比較的バランスのよい形を保って下降していた.亜分類された各深達度の5生率には余り差がなく, pN1, pN2, 3の間の5生率には統計学的有道差が得られた.規約分類による生存率曲線ではstage III, IVの曲線が近接していた.またsinomoの5生率は85.7%と良好でn1とn2の5生率は52.3%, 64.1%と逆転していた.Dukes分類に準じた新TNM分類は大腸癌の予後を良く反映していたが, リンパ節の転移度は病期に反映させるべきであろうと思われた.規約分類のstage III, IVの分類法には臨床的限界があり, 特にリンパ節の分類法は再検討されるべきであった.