切除胃を中心としてみた胃・十二指腸潰瘍の時代的変貌

Yearly Changes of Gastroduodenal Ulcer from the Viewpoint of the Resected Stomachs

　どのような疾患も時代の移り変わりとともにその頻度が増減したり内容が変化する要素をもっており，感染症はその最たるものといえよう．かつてわが国に結核が蔓延し国民病といわれる時代もあったが，治療薬の開発，衛生思想の普及や生活環境の向上によって，この病気はもはや予防し治療しうるものとして国の医療上の重大問題ではなくなってきた．

　これに対して非感染性の疾患は概して病因が複合的で内外の諸因子が複雑に絡み合う場合が多く，国民の平均寿命の延びによって象徴されるような社会環境の改善や医療知識，医療内容の向上によって各疾患の頻度に多少の消長や盛衰はあるにしても，感染症ほどに著しいはやりすたりはない．しかし公害病によって代表されるように時代社会の影響が敏感に反映されるものもあり，ストレスが主因とされる胃や十二指腸の潰瘍症も生活環境とは決して無縁ではなく，そのような意味でこの疾患カテゴリーに入れて差し支えがないかもしれない．

　Unlike gastric cancer, there is difficulty in grasping the yearly changes of gastroduodenal ulcer. From the viewpoint of internal medicine, general trends data about its details. Observation from the point of surgery, on the other hand, has some limitations for the purpose, such as indication for operation. Other factors, such as changes in mean age of the patients and changes in criteria of resection according to the progress of diagnosis intervene in these problems.

　The followings are summaries of the examinations of gastroduodenal ulcer conducted by surgery and internal medicine together, over a period of 25 years in one private gastroenterological hospital.

　1. The number of peptic ulcer patients detected by x-ray examination shows slight increase in the recent years.

　2. Among the patients with ulcer detected by x-ray, the rate of those who received stomach resection has been decreasing yearly.

　3. The rate of resection for duodenal ulcer is slightly increasing.

　4. From the viewpoint of the resected stomach the yearly changes of peptic ulcer can be summarized as decrease in number of chronic types and a relative increase of non-chronic types.

　5. Classification of the resected ulcer into several may be observed, but it is difficult to obtain accurate types-those with shortening of the lesser curvature, linear ulcer, acute ulcer, acute exacerbating ulcer, giant ulcer, multiple ulcer, those requiring urgent operation, marginal ulcer in anastomosis -support the observation noted in no.4.

　6. The rate of open ulcer with scars is increasing according to increase in number of follow-up cases.

　7. Although still low in frequency, ulcer thought to be based on reactive lymphoreticular hyperplasia is becoming evident.