難治性胃潰瘍―手術が施行された症例の検討

Studies on Operated Cases of Intractable Gastric Ulcer

要旨　難治性胃潰瘍と診断され手術された症例について，臨床経過，肉眼所見，組織学的所見，初診時検査所見について検討した．臨床的には再発潰瘍として経過していること，肉眼所見は基本的には不整，複雑な所見であり，組織学的には線維症分類（F分類），再生上皮分類（Reg分類）の組み合わせが難治性を表す方法として有用と思われた．初診時検査においても，潰瘍の不整さに注目する必要があると考えられた．

　Fourteen cases which had undergone gastrectomy with the diagnosis of intractable gastric ulcer were discussed here, especially on their clinical characteristics and pathological findings. Most of the patients had suffered from gastric ulcer for a long period and had experienced anti-ulcer therapy before their first visit to our hospital.

　Macroscopically, these ulcers in the resected specimens showed irregular shapes such as semi-round, triangle, sulcus, and so on. And histology revealed mixed findings of ulcer tissue and old scar. In evaluating pathological findings and staging gastric ulcer, the classifications according to mesenchymal condition (fibrous phase; F-classification) and regenerative condition of the epithelium (regenerative phase; Regclassification), proposed by Watanabe et al, were useful.

　As a conclusion, our retrospective studies suggested that irregularity of the shape of ulcer in the early phase of treatment seems to affect the prognosis of the disease.