胃結核

TUBERCULOSIS OF THE STOMACH

Ⅰ．はじめに

　胃結核は1924年Berkhausenによって初めて報告されて以来，まれな疾患であることと共に感染経路，診断，さらに悪性腫瘍との合併などの困難な問題があり，多くの研究者の努力にもかかわらず，今日に至ってもなお明らかにされていない．わが国では1888年肥田¹⁾の結核性潰瘍の報告以来，年々症例報告も散見され，1965年には山形ら²⁾による詳細な報告がある（現在までの報告例は約70例である）．胃結核はこれまでに術前診断をなしえたものはほとんどなく，悪性腫瘍，腹部腫瘤，幽門狭窄などの診断にて開腹手術を行ない，病理学的組織検査の結果，はじめて胃結核の診断がなされている．抗結核剤が進歩するにつれ術前診断が重要視されるようになってきており，最近のレントゲン検査，内視鏡検査の進歩に期待されるところが多い．

　Some general considerations of stomach tuberculosis are given in this paper with reference to its literature published so far. In addition, a case of this disease recently encountered is presented, as it is an ailment of rare occurrence and its preoperative diagnosis is therefore all the more difficult.

　Tuberculosis of the stomach is sometimes hard to discriminate from a malignant neoplasm, and at times the latter is found concomitantly. These facts carry great weight in deciding the course of treatment.

　As marked progress is now being made in the field of X-ray and endoscopy diagnosis and by virtue of improved forceps employed in direct vision biopsy, positive diagnostic rate of stomach tuberculosis will assuredly increase, and more cases of this disease are expected to undergo thorough examinations by X-ray and endoscopy. Accumulated endeavors of all concerned will thus expedite more fruitful diagnosis of this rare ailment.