胃潰瘍の治癒判定―病理の立場から

Histological Findings on the Clinically Healing State of Gastric Ulcer

要旨　111症例145病変の円形潰瘍および円形瘢痕を対象として，胃潰瘍の組織学的治癒過程，内視鏡的ステージ分類の組織学的背景および治癒判定について述べた．胃潰瘍が開放性であるうちは，再生上皮の先進部は一層平坦な幼若再生上皮を呈し，剝脱像を認めることが多かった．一方，潰瘍底が再生上皮により完全に覆われるころには，再生上皮も成熟し，再生腺管（偽幽門腺）が出現しはじめ，剝脱像も比較的まれであった．以上より潰瘍底が再生上皮により完全に覆われ，しかも瘢痕中心部の再生上皮に再生腺管が出現しはじめた時期をもって，胃潰瘍の治癒判定を行うべきであると考えられた．

　Histological changes of the gastric ulcer of initial type with the lapse of time were studied on 111 stomachs surgically resected and histological findings about the clinically healing state were described.

　In healing or healed peptic ulcer, the most immature regenerating epithelium, a single layer of regenerating epithelial cells, was predominantly seen at the central portion where the epithelium was often exfoliated. Several regenerating pseudopyloric glands appeared one to two months after the onset of gastric ulcer and therein erosion or ulceration was far more infrequent.

　From these findings mentioned above, the histologically healing state is regarded as the state in which ulcer base is covered by regenerating epithelium with several pseudopyloric glands formation.