胃と腸39巻8号

2004年07月発行

今月の主題 家族性大腸腺腫症―最近の話題 主題

家族性大腸腺腫症における十二指腸乳頭部病変の取り扱い

著者： 高橋正純¹ 鬼頭文彦¹ 福島恒男¹

所属機関： ¹横浜市立市民病院外科

ページ範囲：P.1127 - P.1135

要旨　家族性大腸腺腫症の十二指腸乳頭部癌の相対危険度は高く，予防的大腸全摘後の予後因子として十二指腸病変の取り扱いが課題となっている．上部消化管内視鏡によるサーベイランスは重要で，特に乳頭部周囲の観察には注意を要し，Spigelman's stage IVとなる高度の十二指腸腺腫症や増大傾向のある乳頭部腺腫は癌化の危険度が高いことから予防的切除の対象となる．また，内視鏡的粘膜切除やアルゴンプラスマ凝固療法は有用と思われ，その適応や施行の拡大が望まれる．内視鏡によるサーベイランスにも限度があり，分子生物学的アプローチでは遺伝子解析などによる癌化しやすい亜群分類の研究が期待されている．手術療法では縮小手術として幽門温存，または膵頭温存十二指腸切除が選択される機会が増えると思われる．化学予防においては選択的COX-2阻害剤の有効性が認められ，今後の新たな展開が予想される．

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