内視鏡所見による胃潰瘍の良・悪性鑑別診断―良性腫瘍とⅢ，Ⅲ＋Ⅱc，Ⅱb＋Ⅲの鑑別

Differential Diagnosis between Benignancy and Malignancy of Gastric Ulcer

要旨　Ⅲ型早期胃癌の診断の手掛かりを求めて，内視鏡検査時に良性潰瘍と診断された胃癌47例の診断学的問題点を分析した．これら症例は陥凹型胃癌の3.2％に相当したが，見直しで36例（76％）は癌またはその疑いがあると診断できた．11例は癌との鑑別は不可能であったが，手術までの短期の経過で，9例はⅡc部が明瞭となり癌と診断可能となった．Ⅲ型癌の内視鏡検査またはX線検査による診断は不可能で，Ⅲ＋Ⅱcになって初めて診断可能と思われた．

　Forty seven cases of early gastric cancer, diagnosed as benign ulcer at initial endoscopy, were reviewed, seeking for clues to better diagnosis of type Ⅲ gastric cancer. These cases comprised 3.2% of the depressed type gastric cancers resected at our hospital from April 1980 to March 1991. On the review, 36 cases (76%) were diagnosed as cancer or being doubtful about their benignancy, while the rest remained not detectable of malignancy. In 9 cases of the latter ones, however, Ⅱc portions became clear in a short period before operation, and were diagnosed correctly. It is suggested that the endoscopic or radiographic diagnosis of type Ⅲ gastric cancer is not possible, unless the lesions demonstrate type Ⅲ+Ⅱc features in their clinical course.