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Stomach and Intestine(Tokyo) Volume 26, Issue 9 （September 1991）

胃と腸 26巻9号（1991年9月発行）

Japanese English

今月の主題 Ⅲ型早期胃癌の診断に迫る―潰瘍の良・悪性の鑑別

主題

良性潰瘍とIII型あるいはⅢ＋Ⅱc型胃癌の鑑別診断 Differential Diagnosis of Gastric Ulcer and Early Gastric Cancer Type Ⅲ or Type Ⅲ+Ⅱc 清水宏 ¹ , 馬場保昌 ¹ Hiroshi Shimizu ¹ , Yasumasa Baba ¹ ¹癌研究会附属病院内科 ¹Department of Internal medicine, Cancer Institute Hospital キーワード：陥凹型早期胃癌 , 胃潰瘍 , Ⅲ＋Ⅱc型 , X線診断 , 鑑別診断 Keyword: 陥凹型早期胃癌 , 胃潰瘍 , Ⅲ＋Ⅱc型 , X線診断 , 鑑別診断 pp.971-984

発行日 1991年9月25日 Published Date 1991/9/25

DOI https://doi.org/10.11477/mf.1403102629

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要旨　X線診断の立場から，良性胃潰瘍とⅢ～Ⅲ＋Ⅱc型胃癌の鑑別について検討した．対象は1965年から1989年までに癌研病院で切除されたⅢ型3例，Ⅲ＋Ⅱc型8例である．なお，比較対照として粘膜下層に浸潤したⅢ～Ⅲ＋Ⅱc型2例と良性潰瘍1例を用いた．要約すると以下のごとくになる．（1）X線・内視鏡検査時にはⅢ～Ⅲ＋Ⅱcによく遭遇する．しかし，手術切除時ではⅢ～Ⅲ＋Ⅱcは極めて少ない．これは陥凹型早期胃癌に合併した潰瘍は一般に浅く，手術までの短期間に潰瘍部が治癒しやすいことが考えられる．（2）良性潰瘍とのX線的鑑別診断：①Ⅲ型は極めて難しい．②Ⅲ＋Ⅱc型ではニッシェ周囲の不整な淡い陰影斑が目安になる．特に分化型癌では不整な陰影斑の境界が棘状を呈することがわかった．（3）X線検査：①Ⅲ＋Ⅱc型のⅡcが狭い病変では圧迫検査が適している．②Ⅲ＋Ⅱc型のⅡcがやや広い病変では，潰瘍部に造影剤を流しながら撮影する必要がある．

　Studies were carried out on 3 patients with early gastric cancer type Ⅲ and 8 patients with early gastric cancer type Ⅲ+Ⅱc who had the lesions resected at the Cancer Institute Hospital between 1965 and 1989. two patients with early gastric cancer type Ⅲ+Ⅱc infiltrating the submucosal region and 1 patient with benign ulcer were also admitted to study as controls. The findings and results obtaind in this investigation may be summarized as follows.

　(1) Early gastric cancers type Ⅲ or Ⅲ+Ⅱc are often encountered in x-ray and endoscopic examinations, but are found very rarely during surgical resection procedures. This seems presumably because ulcers complicating depressed types of early gastric cancer are generally so shallow that they are liable to spontaneously heal in short periods of timebefore surgical intervention.

　(2) Radiologic differential diagnosis of early gastric cancers and benign ulcers: a. Early gastric cancers of type Ⅲ are extremely difficult to differentiate. b. In the case of early gastric cancer type Ⅲ+Ⅱc, irregular faint barium spots around the niche can be a clue to differentiation. In the case of differentiated carcinoma, in particular, the boundary of such barium spots presents with spiculation.

　(3) X-ray examination: a. The compression method lends itself to differential diagnosis of early gastric cancer of type Ⅲ+Ⅱc where Ⅱc lesions are narrow. b. In early gastric cancers of type Ⅲ+Ⅱc where Ⅱc lesions are relatively broad it is necessary to make the barium reach the ulcer lesion when obtaining a spot film.