十二指腸潰瘍の超音波内視鏡像

The Diagnosis of Duodenal Ulcer by Endoscopic Ultrasonography (EUS)

要旨　水浸下EUSを施行した十二指腸潰瘍切除標本1例，EUSを施行した臨床例13例を対象として，十二指腸潰瘍の診断におけるEUSの有用性を検討した．切除標本ではEUSによる深さの判定と組織所見との一致をみた．臨床的検討においては，対象症例13例のうち，定期的な通常内視鏡観察が可能であった10例中9例が，年齢・性別，潰瘍の既往歴，使用薬剤，EUSで判定した潰瘍の深さに関係なく，8週間以内に瘢痕化した．H₂-blockerを使用した1例（Ul-Ⅳ）のみが10週を経過しても瘢痕化せず，外科手術となった．この症例の治癒期のEUS像では，潰瘍底深部に低エコーがみられるという特徴が存在した．潰瘍の深さがUl-Ⅳの他のH₂-blocker使用例3例には，この所見がなく，いずれも4週もしくは8週以内に瘢痕化した．十二指腸潰瘍のEUSにおいて，治癒期にみられる潰瘍底深部の低エコー所見は，H₂-blockerに難治性あるいは抵抗性を示す潰瘍を診断するうえで重要な所見になると考えられた．

　The usefulness of EUS on the diagnosis of duodenal ulcer was evaluated in this study. In a basic study using a resected specimen with duodenal ulcer, findings of EUS showed a good coincidence with that of histology. In a clinical study, EUS was performed in thirteen cases with duodenal ulcer and ten out of thirteen case were followed-up periodically by usual endoscopy. Nine out of these ten cases healed to ulcer scar within eight weekes without relationship with age, sex and previous ulcer history of patients, drugs used in treatment and the ulcer depth which was diagnosed by EUS. One out of ten cases was not healed even after ten weeks, although this case was treated by H₂-blocker. The ulcer depth of this case was diagnosed as Ul-Ⅳ by EUS and a hypoechoic area was seen at the ulcer bottom on echograms.

　This echographical finding could not be observed in other three cases with the ulcer depth of Ul-Ⅳ which were treated by H₂-blocker.

　Therefore, this hypoechoic area at the ulcer bottom as visualized by EUS in healing stage of ulcer was thought to be a very important finding on the diagnosis of H₂-blocker resistant duodenal ulcer by EUS.