胃癌の胃変形について

DEFORMITY OF THE STOMACH DUE TO GASTRIC CANCER

Ⅰ．はじめに

　いまX線所見で大切だとされているものに，胃変形，胃辺縁の異常，壁硬化，伸展不良，粘膜異常像などがある．この中で，胃変形と辺縁異常像だけで行なうX線診断の価値を考察してみた．早期癌の精密検査が行なわれている現在，また，内視鏡検査も併用してその診断の限界を追いつめている現在，なぜ，こんな余りにも古典的な行き方を主張しなくてはならないのか，という疑問がわく．今までに苦心していろいろな撮影術式を使って見つけた症例について，全く古典的な手法を当てはめ，立位充満像の変形と辺縁異常像の2所見だけを取り上げて，その診断価値の限界を改めて知ろうというのである．

　どんな変形が，現状では役立つのであろうか．現時点では，どんな変形と辺縁異常をひろい上げなくてはならないか．また，その組み合わせが役立つのであろうか．Gutmannが指摘した像に，さらに何か別な所見を補足できるであろうか．どんな像をみたら，他撮影像の読影に一そうの注意を払わなくてはならないのか．また，集検問接フィルムを読むとき，どんな変形と辺縁異常像を取捨選択すればよいであろうか．これは，集検の能率化にも関係することでもある．

　Deformity of the stomach due to its cancer is diversified in its aspect. Not only does it embody that by classical gastric cancer but also that due to early gastric cancer now at issue. It can readily assumed that the latter, as the nature of its lesion implies, is sometimes hard to discriminate from the deformation of the stomach caused by benign lesions as well as by its quasideformity possibly presented by normal stomach with no lesion at all. This has been often experienced before, being especially perplexing to all concerned in routine examinations of the stomach or in its mass surveys. A foothold must therefore be established in the differentiation of gastric deformity: a means to dispense with waste of time and unnecessary exposures.

　For materials of this study, operated cases have been studied in 50 of advanced carcinoma, 77 of early gastric cancer as against those in 36 of duodenal ulcer and 53 of gastric polyp, in addition to 79 of non-operated cases as contrasts.

　A most efficient method is described in this paper to diagnose gastric cancer by barium-filled picture alone. It is first to pick out a most suitable film for this purpose out of many seriarograms; and secondly to check up the deformity of the stomach and any abnormality of its contour. The purport of this paper may be otherwise expressed as a methodology and its evaluation in the study of the deformity of the stomach, or a fresh development of this methodology on condition that it must be of practical help actually at present.