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Stomach and Intestine(Tokyo) Volume 24, Issue 1 （January 1989）

胃と腸 24巻1号（1989年1月発行）

Japanese English

今月の主題噴門部陥凹型早期胃癌の診断

主題

噴門部陥凹型早期胃癌の見つけ出し診断―X線の立場から Studies on X-ray Diagnosis of Early Cancer of the Cardia 西俣寛人 ¹ , 政信太郎 ¹ , 西俣嘉人 ¹ , 下鑪研悟 ¹ , 西俣寿人 ¹ , 美園俊明 ¹ , 下野健治 ¹ , 河野裕一 ¹ , 吉中平治 ² , 愛甲孝 ² Hiroto Nishimata ¹ , Shintaro Tsukasa ¹ , Yoshito Nishirnata ¹ , Kengo Shimotatara ¹ ¹鹿児島大学医学部第2内科 ²鹿児島大学医学部第1外科 ¹The Second Department of Internal Medicine, School of Medicine, Kagoshima University pp.33-43

発行日 1989年1月25日 Published Date 1989/1/25

DOI https://doi.org/10.11477/mf.1403106366

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要旨　噴門部早期癌35症例を用いて，噴門部早期癌X線診断能を向上させるための基礎的検討を行い次の結論を得た．①噴門部早期癌は陥凹型が多かった（86％）．深達度は病変が小さくても（3.5cm以下）sm癌が多かった（60％）．組織型は分化型が多かった（89％）．②占居部位は1.1～2.0cmに病巣の中心が存在する症例が多かった（66％）．また，小彎（51％），後壁（40％）に多かった．③食道開口部の形態をX線学的に4型に分類し，X線像のEGJの位置を新鮮切除標本を反転しX線像と対比することで確認した．④噴門部早期癌をX線検査で拾い上げるために半立位腹臥位第1斜位～右側臥位と半立位第2斜位が必要で，拾い上げ所見は淡いバリウム斑と顆粒状陰影であった．⑤X線検査で拾い上げた噴門部早期癌の確定診断には正確な直視下生検が必要であった．

　1. Using 35 cases of early cancer of the cardia, basic matters required in x-ray diagnosis of early cancer of the cardia were studied.

　2. Pathologically, early cancer of the cardia was broken down to the depressed type, 30 cases (86%); and the elevated type, 5 cases (14%). By depth of invasion, there were many sm cancers, 21 cases (60%); and m cancer with 14 cases (40%). By tissue type, the differentiated type accounted for the most with 31 cases (89%), followed by the non-differentiated type with 4 cases (11%).

　3. The breakdown by site of early cancer of the cardia was as follows. The center of lesion was located 1 to 2 cm from the EGJ in 23 cases (66%) and 0 to 1 cm in 12 cases (34%). The site of occupancy by the lesion was the lesser curvature 18 cases (51%), and the posterior wall 14 cases (40%). Cases of lesion occupying the anterior wall were few, with 3 cases (9%).

　4. The roentgenograms for the opening of the esophagus were classified into 4 types, and the roentgenographic position of the EGJ in each phase was estimated. Preoperative roentgenograms were compared with reversed fresh specimens in the cases of early cancer of the cardia, and the positional relationship between the roentgenographic morphology and the EGJ was reported.

　5. As for the patient's posture in roentgenography for detection of early cancer of the cardia, half standing position, prone position, 1st oblique position, right recumbent position, and half standing position, 2nd oblique position were required.

　6. X-ray findings picked up in early cancer of the cardia were barium spots and granular shadows.

　7. In making decisive diagnosis for early cancer of the cardia by endoscopic direct vision biopsy, correctly identifying the site of lesions (particularly in relation to the EGJ) in roentgenographic findings is important.