2年余の観察を行なった胃結核症の1例

A CASE OF STOMACH TUBERCULOSIS OBSERVED FOR OVER TWO YEARS

Ⅰ．はじめに

　消化管の結核症は腸に比較的多くみられるのに反し，胃結核症は稀であり，わが国で臨床的に報告されたのは，1917年愼の例以来40数例にすぎない．しかも臨床的特徴がないため，胃癌や胃潰瘍の診断のもとに手術をうけ，切除胃の組織所見によりはじめて発見されているのが現況である．

　われわれも胃腫瘤を触れ，胃X線像及び胃内視鏡所見で確診し得ず，開腹試験切除で本症と判明し，その後化学療法により約2年間観察した症例を経験したので報告する．

　Though more than 40 cases of stomach tuberculosis have been reported in our country, they were all based upon the histological diagnosis of the excised stomach. Thus we did not know whether stomach tuberculosis was curable by internal treatment.

　This is a case of a housewife, 47 years of age, hospitalized because of the suspicion of stomach cancer. Though X-ray and endoscope observations did not confirm the existence of cancer, tumor was reason enough for the operation.

　The stomach wall and the mucous membrane displayed mere swelling, and we suspected inflammation rather than tumor in this case. So we decided to perform experimental excision only, and the stomach tuberculosis was determined by the histological analysis.

　Chemotherapy was employed for the following two years, with streptomycin, PAS and INAH.

General observation was carried out with X-ray and endoscope, as well as the analysis of gastric juice and blood contents, etc.

　For the first six months treatment was not too successful, but from about one year the patient underwent normal progress toward recovery. Swelling of the mucous membrane arising from anemia, lowering of the acid content, and poor peristalsis all disappeared or experienced satisfactory improvement.

　This case is believed to be infected through the blood stream from the tuberculosis of the genital organs. Histologically speaking, there were found many tubercles in the mucous membrane and in the submucosal layer. Giant cells of Langhans Type were also detected. By the endoscope observation, it falls under the category of hypertrophic and infiltrating type.

　With the application of stomach biopsy we may be able to detect other types such as multicentric ulceration type, cirrhotic inflammation type and others. Or we may have to alter this classification as we come to know more about this ailment.