胃潰瘍の良・悪性の鑑別―H2ブロッカーと悪性サイクル

Differential Diagnosis between Gastric Ulcer and Ulcerated Early Gastric Cancer: Special References to the Endoscopic Findings in Patients to whom H2-blockers Were Administered

要旨　胃潰瘍の良・悪性の鑑別診断は潰瘍辺縁の“Ⅱcのはみ出し”，“不規則な発赤”を捜し，その部位から的確に生検標本を採取することで行う．不整形の潰瘍，線状潰瘍の辺縁から生検を行うことも必要である．H₂ブロッカーが投与された悪性サイクル例の12例のⅡc部分を検討すると，Ⅱcの境界の不明瞭な例，また，Ⅱc面が顆粒状となったり，より平滑になる例がみられた．これらの所見は厳密に考えるとⅡcの診断をより難しくする所見である．潰瘍合併早期癌には今後，H₂ブロッカーが投与される機会が増えることが予想されるので，これらの症例の診断にはいっそう注意が必要である．

　The endoscopic findings were studied in twelve patients with ulcerated early gastric cancer to whom, before operation, H₂-blockers had been administered.

　At the initial endoscopic observation, the diagnoses were type Ⅲ+Ⅱc (n=6), Ⅱc+Ⅲ (n=3) early gastric cancers and benign gastric ulcer (n=3). Because of patients' complaints or due to an incorrect diagnosis, H₂-blockers were administered before and just after endoscopy during 2.5 months ( mean value ). All cases proved to be malignant after biopsy examination.

　The course of the malignant cycle was observed in all cases. Endoscopy revealed that, after a short period, the ulceration had diminished in size with marked fold convergency. The margin of the Ⅱc lesion was not so clearly demarcated. In the surface of the Ⅱc area an increased granularity with few eroded areas was observed in most cases. The final diagnoses were type Ⅲ+Ⅱc, Ⅱc+Ⅲ and Ⅱc on two, two and eight cases, respectively. These observations correlated well with the macroscopic and histological findings on the resected specimen.

　We advise that much attention should be paid to patients with suspected ulcerated gastric cancer to whom H₂-blocker have been administered.