早期胃癌臨床診断の実態―とくに内視鏡診断の立場から

Present Status of Clinical Diagnosis for Early Gastric Cancer: chiefly from the standpoint of endoscopy

　われわれが胃内視鏡検査を本格的に始めたのは1956年1月であるが，ルーチンな検査として，さかんに行なうようになったのはV型胃カメラが作られた1960年からである．1964年11月までに延べ7,415例に検査を実施している．

　1964年になり，アメリカのHirschowitzのファイバースコープの開発に刺激されて，国産ファイバースコープが製作された．われわれは同年11月より町田製のFGS-Aおよびオリンパス製のGTFを使用し，1967年11月までに延べ9,390例に胃内視鏡検査を施行した．

　Endoscopic examination of the stomach was first put into practice in our Department in 1956, but it was not until 1960, when V type gastrocamera has come to be widely used, that this examination method became a routine procedure with us. Up to Nov. 1964, already 7,415 cases were ex amined by gastric endoscopy. Since Dec. 1964, FGS-A and GTF have been used as well, and by Nov. 1967 a total of 9,390 cases weae examined thereby. Endoscopic examination of the stomach has become far easier since Dec. 1967, when GTF-A was initiated into our study. Up to the present, a total of 27,391 cases have been investigated. Apart from this figure, we have 9,000 cases of gastric mass x-ray survey to which endoscopic examinations were co-employed.

　Gastric biopsy, on the other hand, was tried since Aug. 1965 on 82 cases by means of old B Type fiberscope (Machida). The percentage of success was then only 60, a pretty low figure. Biopsied cases greatly increased in number since the initiation in Dec. 1966 of both Machida B₆ type fiberscope and Olympus GTF, both equipped with an angle device at the tip. In 1970 Olympus GF-type B was put into use, and up till now we have biopsied 2,693 cases. Diagnostic accuracy in early gastric cancer is 98％ and in advanced one, 99％.

　With the development of gastroscopic instruments the number of detected early gastric cancer cases accordingly increased.

　In 1963 we have found 2 early gastric cancer, in 1964, four; in 1965 and 1966 each,1 1; in 1967, 17; in 1968, 14; 1969, 39 and in 1907, 40 and in 1971 up to the time of writing this summary, 40 totalling to 168 cases so far. Before gastric biopsy was employed, there had been many erroneous qualitive diagnosis, but since its establishment in daily examination in 1967 we had no further failure in qualitative diagnosis of gastric cancer. Incidence in the detection of early gastric cancer is steadily increasing. This is due not only to the improvement of instruments but also to the increased diagnostic ability of clinicians.