胃と腸39巻3号

2004年03月発行

今月の主題 胃MALTリンパ腫―除菌治療後の経過と予後 主題

除菌無効胃MALTリンパ腫の治療法の選択とその時期

著者： 千葉勉¹

所属機関： ¹京都大学医学部消化器内科

ページ範囲：P.309 - P.315

要旨　胃MALTリンパ腫のH. pylori除菌療法が無効の場合，まずAPI2-MALT1遺伝子の有無を確認する．本遺伝子陽性の場合は早急に治療する必要はなく，場合によっては経過観察もありうるが，一般的には放射線療法，化学療法，手術療法のいずれかを行う．一方API2-MALT1遺伝子陰性の場合は，治療後慎重に経過観察し，不変あるいは増大傾向がみられれば迅速に放射線療法，化学療法，手術療法のいずれか，場合によってコンビネーション治療を行う．特に本遺伝子陰性例の中には，除菌療法終了後急速に悪化する例がみられるので，治療直後は厳重な経過観察が必要である．全体として最近特に放射線療法で手術療法と変わらない良好な成績が得られており期待がもたれている．

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