十二指腸潰瘍の診断とその問題点―レ線所見から見た治癒判定について

Diagnosis of Duodenal Ulcer and the Problems at Issue: On the criteria of ulcer healing based on x-ray findings

　今日では，十二指腸潰瘍を探し出すことはレ線的にも内視鏡的にもさほどむずかしいことではない．しかし見つけ出された潰瘍が，まだ活動性なのか，もう治癒しているのかという治癒判定の基準については，各研究者により，また研究方法により種々であり，いまだに確たるものはない．今回はレ線所見と切除標本とを対比検討し，レ線所見をしてどこまで治癒判定に結びつけることができるかということを目的として検討を行なった．

　十二指腸潰瘍の治癒判定に関しては，確立されたレ線学的業績はない．病理に関しては，村上¹⁾岩堀²⁾が修復度からみた治癒判定の基準を設けている．レ線診断に関しては，平山・日野³⁾，山形⁴⁾，岡部・八尾⁵⁾らの経過観察の報告，八尾⁶⁾，白壁⁷⁾らの組織像とレ線像との対比の報告などがあるくらいのものである．

　These have been as yet no definite criteria established from the viewpoint of both x-ray and endoscopy regarding the determination of healing in duodenal ulcer. In this paper are compared x-ray findings of duodenal ulcer with excised specimens in order to determine how far x-ray findings can possibly be connected with the determination of ulcer healing.

　The subjects of the present study are 40 cases with 55 ulcer lesions histologically and radiographically thoroughly examined, selected out of 143 cases of duodenal ulcer encountered at the First Department of Internal Medicine, Chiba University College of Medicine, during the 8 years 1965～1972.

　The degree of vertical involvement of the duodenal wall as well as that of repairing process was divided into four stages according to Prof. Murakami's classification. X-ray findings were also divided into four groups: niche, barium fleck, dotted shadow and fine mucosal convergency. All the findings were based on those obtained by compression in upright posture.

　Results

　1. Comparison of the degree of ulcer repair with x-ray findings showed that niche was recognized in the area where ulcer repair was either in the degree 1 or 2. Barium fleck was seen in the area of 2 or 3 degree, and fine mucosal convergency was seen in the area where the degree of ulcer repair was 3.

　2. If ulcer repair in or over the degree 2 be considered healed stage, x-ray findings showing no more than barium fleck can be regarded as a definite sign of healed ulcer. On the other hand, if ulcer repair in or over the degree 3 be considered as showing healed stage of ulcer, corresponding x-ray findings are no more than dotted shadows or fine mucosal convergency as signs of ulcer healing. Consequently, these findings can be construed as a picture of ulcer scar.

　The cases presented here are illustrated with x-ray pictures showing barium fleck, dotted shadow and fine mucosal convergency.