胃癌の浸潤範囲のX線診断

Radiological Diagnosis of the Extent of the Gastric Carcinoma

　胃疾患に対するX線，内視鏡および生検などの各種診断法の最近の進歩は著しく，胃癌の性状診断については，ほとんど確立された観がある．胃癌の性状診断の決め手となるX線学的な特徴としては，粘膜すう襞の中断，太まり，細まり，虫くい，不整な陥凹，陥凹周辺の隆起，胃小区の変北，隆起等がある．この様な形態的な特徴は，比較的X線写真に表現されやすいため，現在のところ，我々にとって最も信頼できる所見である．しかし，これは，病変を全体として（病変を面として）とらえた場合であっ断，太まり，細まて，きわめて部分的に見た場合，粘膜すう襞の中り，虫くい，不整陥凹の陥凹線，周辺隆起等がそのまま健常部分と癌との境界になるかどうかは問題である．

　このように，胃癌の浸潤範囲を正確に決定することは，必ずしも容易なことではないが，臨床的には，胃切除範囲の決定に欠くことができない．また，肉眼的に癌の境界がはっきりしないが，組織学的に癌の存在が確認された部位のX線像を詳細に検討することは，とりもなおさず，平坦型のⅡb～Ⅱb類似の癌のX線所見を検討することになる．したがって，胃癌の初期像の分析をすることになり，X線診断の限界を伸ばすのに役立つと思われる．

　Although radiological criteria for the diagnosis of gastric carcinoma such as abrupt cessation, clubbing and tapering off of the mucosal folds, marginal elevatio of the lesion together with alteration of gastric areas, are most reliable findings and can well be demonstrated by x-ray, it remains unestablished whether they have anything to do with the boundaries of the lesion.

　By reviewing x-ray films, resected specimens and histological sections in 60 cases of gastric cancer, we have tried to clarify their correlation and obtained following results.

　1) Interruption of the mucosal folds and margins of depressed lesion mostly represent the boundaries of malignant lesions.

　2) Clubby swelling and/or tapering off of the folds and marginal elevations do not exactly represent borders of the lesion, although they constitute indispensable criteria for gastric malignancy. This was confirmed by reviewing histological sections.

　3) Changes in the gastric areas, a corner stone in the diagnosis of Ⅱb in our opinion, were varied, and it was very difficult to draw a line between the normal and abnormal. Regular x-ray films are not always good enough in determining the boundaries of lesions.

　By 4-hold magnified radiography of resected specimens with double contrast method, gastric areas were well delineated. This method is of great use in determining the nature and boundaries of the lesion. Changes of normal mucosal hue in endoscopic study is also useful in confirming the borders of a malignant growth.