胃軸捻転について

ON VOLVULUS OF THE STOMACH

Ⅰ．まえがき

　胃軸捻は従来比較的まれとされていた．文献に現われる最初の報告例は1866年にBerti¹¹⁸⁾が剖検で発見した例で，その後同様の報告が相ついだが1897年にはBerg¹¹⁹⁾が急性胃軸捻2例の手術治験例を報告した．レントゲン的には1920年にRoselet⁹¹⁾が無症状例で最初に発見した．1952年Dalgaard⁹⁶⁾は文献より150例を集め，Gottlieb⁹⁸⁾は192例に自験例20例を加えて報告している．本邦では1912年山村¹⁾が第1例を報告して以来発表が相つぎ，黒川²⁾（1956），山形³⁾（1962）の詳細な考察もなされている．近年，胃集検が広く行なわれるようになり，胃軸捻は決してまれではなくなった．しかし，症状の少ない慢性例が多いので，詳細な例数の報告は少ないようである．著者は山形の1912年～1960年における本邦集計（225例）以降に文献に現われた80報告，182例を集め，自験例20例を加えて考察を行なった．

　Volvulus of the stomach, considered in the past as of rare occurrence, is now far oftener encountered with popularization of x-ray study and gastric mass survey. In addition to 225 such cases studies in this country in 1962 by Yamagata, another 182 cases since then reported in 80 papers, together with 20 cases personally encountered, are studied in this paper as to its frequency, classification, etiology, symptoms, as well as its diagnosis, complications, treatment and prognosis.

　It took 48 long years from 1912 to 1960 for Yamagata to collect 225 cases of gastric volvulus, while as many as 182 such cases have been reported in a comparatively short space of 8 years thereaften Its increase in incidence is really remarkable. Most of cases are chronic and of short axis rotation. The etiology of gastric volvulus is classified, in the order of its frequency, into four types: idiopathic, diaphragmatic, one caused by adjacent organs and the last by diseases of the stomach itself. Symptoms, treatment and prognosis vary according to whether it is acute or chronic as well as to the degree of axis rotation. Its diagnosis is clone with ease by x-ray examination, except in cases in which symptoms are so severe that patients can not stand it.

　Discrimination from other diseases then becomes necessary. Acute axis rotation constitutes an absolute indication for emergency operation. Surgical procedure is also sometimes needed in asymptomatic chronic case depending on its etiology.

　Marked decrease in mortality at and after operation of gastric volvulus; a rapid growing number of its reports: these two facts call attention to itself as compared with its former reports.