胃巨大雛襞症の診断基準について

ON DIAGNOSTIC CRITERIA OF GIANT RUGAE OF THE STOMACH

Ⅰ．はじめに

　主として胃体部大攣皺襞が異常に肥厚し，蛇行した状態をGiantrugae（巨大皺襞症）と呼称されているが，この疾患の本態は勿論のこと，病理組織学的な面もなんら統一された見解はないようである．従って診断面でも一定した基準も，検査方法もなく，多くの混乱を惹起している．そこで胃巨大皺襞症を一っの症候名として．胃体部大彎皺襞を一定した診断基準のもとに総括して，比較検討することが必要である．

　昨年来，我々は手術例9例を提示し，その術前愁訴，検査成績，病理組織学的所見等より，検討を加え，これらからは一定した基準は設けられず，ただ肉眼的に鐡漿肥厚状態より，びまん性，および限局性の2型に分類し，組織学的には萎縮性胃炎に連なる一断面として把握できることを指摘し，臨床的に胃巨大皺襞症に対する判定基準が今後の問題であることを強調してきた．

　その後，当消化器病センターを受診し，胃巨大皺襞症と診断された症例は昨年4月までに7例，計16例であるが（第1表），これら7例を巨大皺襞症と診断するに当り，我々の設けた診断基準について報告し，一般の御批判を仰ぎたい．

　Diagnostic criteria for giant rugae of the stomach have not well been established so far both clinically and histologically. Roentgenologically, they show a picture of firm masses protruding from the gastric wall and are most pronounced along the greater curvature.

　During the past 3 years, 11 patients having giant rugosity were operated on and 5 such patients have been followed up in the authors' clinic. This is a report of one of their attempts to set up diagnostic criteria for giant rugae of the stomach by observing endoscopically mucosal behavior which undergoes change according as air is sent into the gastric lumen. In this paper is also shown how these patients were diagnosed as such.

　As rlistensibility of gastric rugae is considered to be proportionate to intragastric pressure and not to the amount of air sent into stomach, the former was measured by a small polyethylene tube inserted through the biopsical hole of fihergastroscope (FGS-B) at the same time as the amount of air was measured by flowmeter.

　By this method it has been found that intragastric pressure is, more or less, proportinate to the amount of air in the stomach in each case and that air escapes out through the esophagus by belching when the pressure reaches the height of 21 mmHg on an average.

　Normal gastric rugae become smooth or straightened endoscopically when the pressure is more than 15 mmHg (classification Fl), while roentgenologically so-called giant rugae are confirmed as showing two types. In one group, mucosal folds gradually become narrower and less tortuous but not completely straightened out (FII). In the other, rugae remain tortuous and do not become narrower even when the pressure is over 15 mml-lg (Fill). On the basis of these observations, it is proposed that genuine giant rugae of the stomach should have a distinction that they show no distensibility and remain in their initial tortuous state even when intragastric pressure is over 15 mmHg and generally 1,700 cc of air is sent into the stomach.