胃と腸42巻8号

2007年07月発行

今月の主題 胃MALTリンパ腫―除菌無効例の特徴と治療戦略 主題

限局性胃MALTリンパ腫の長期経過―除菌療法抵抗例の臨床的特徴とその対策

著者： 赤松泰次¹ 須澤兼一² 金子靖典² 宮林秀晴³ 鹿間直人⁴ 佐野健司⁵ 太田浩良⁶

所属機関： ¹信州大学医学部附属病院内視鏡診療部 ²信州大学医学部消化器内科 ³独立行政法人国立病院機構松本病院消化器科 ⁴信州大学医学部放射線科 ⁵信州大学医学部附属病院臨床検査部 ⁶信州大学医学部保健学科

ページ範囲：P.1207 - P.1216

要旨　限局性胃MALTリンパ腫76例の臨床経過を調査し(平均経過観察期間44.4か月)，Helicobacter pylori(H. pylori)除菌治療の成績と除菌治療抵抗例の臨床的特徴およびその対策について検討した．H. pylori陽性胃MALTリンパ腫49例のうち，除菌治療のみで治癒した症例は38例(77.6％)であった．一方，H. pylori陰性例13例に対しても除菌療法を試みたが，治癒した症例はなく(77.6％ vs 0％，p＜0.001)，除菌治療抵抗例の臨床的特徴として"H. pylori陰性"が挙げられる．H. pylori陽性胃MALTリンパ腫における除菌治療有効例と抵抗例を比較すると，性，年齢，病期，病変の内視鏡所見，壁浸潤度，病変部位に有意な差を認めなかった．除菌治療抵抗例あるいはH. pylori陰性例30例のうち30Gy放射線療法で治癒した症例は29例中22例(75.9％)で，低容量放射線療法は"二次治療"として有用と考えられた．

参考文献

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17)伊東一博，赤松泰次，進士明宏，他．胃MALTリンパ腫に対する放射線療法後21か月目に診断された噴門部胃癌の1例．ENDOSCOPIC FORUM for digestive disease 21:159-162, 2005