超音波内視鏡による胃潰瘍の検討―特に胃潰瘍治癒過程について

A Study on the Healing Process of Gastric Ulcers Using Endoscopic Ultrasonography (EUS)

要旨　胃潰瘍症例46例（50病変，延べ83回施行）を対象として超音波内視鏡（EUS）により胃潰瘍治癒過程につき検討した．胃潰瘍のEUS像を，陥凹部周囲に拡がる低エコー域をulcer echo，陥凹底の径をW，sm層の中断径をD-sm，pm層のulcer echoの径をD-pmとして内視鏡時相別に分析を行った．胃壁内のulcer echoは胃壁深層ほど大きく，その拡がりはUl-Ⅲ，Ⅳ易治性，Ⅳ難治性の順に大きくなる傾向があり，治癒の進行と共に縮小した．D-sm，D-pmの縮小速度は難治性潰瘍で遅い傾向がみられ，4週以後その差は顕著であった．内視鏡時相H期のW/D-pmの比により易治性潰瘍と難治性潰瘍の鑑別がある程度可能であり予後の判定に有用と思われた．

　From April, 1986 to December, 1987, EUS was performed in 46 patients in order to analyze the healing process of gastric ulcers. We determined parameters of EUS-appearance of gastric ulcer as follows (the term ulcer echo is defined as the low echoic area surrounding an ulceration) : W＝width of ulcer base (i.e. diameter of white coating) ; D-sm＝diameter of ulcer echo at the submucosal layer ; D-pm＝diameter of ulcer echo at the proper muscle layer ; D-ssm (only used for Ul-Ⅱ ulcer)＝diameter of ulcer echo at the surface of submucosal layer ; D-dsm (only used for Ul-Ⅱ ulcer)＝diameter of ulcer echo deep in the submucosal layer. In general, the ulcer echo has been found to be wider in the deeper layers of the gastric wall than in the superficial layers independent of the depth of the gastric ulcer. However, with increasing depth of gastric ulcer the ulcer echo in creases in diameter. So if W is of the same size, Ul-Ⅳ intractable ulcer has the largest diameter of ulcer echo in all layers. During the process of healing, the diameter of ulcer echo always decreases. Reduction speed of D-sm and D-pm of Ul-Ⅳ intractable ulcers is less than that of other ulcers after the first 4 weeks. If the ratio of W/D-pm is less than 0.4 during endoscopic H stage, the ulceration will not heal within three months.