胃体部腺領域の病変―部位別にみた胃病変

Gastric Diseases in the Fundic Gland Area

はじめに

　胃の病変を部位別に眺めると，病変の種類によって，その存在部位にそれぞれ好みのあることがわかる．ごくおおまかには，胃中部に多く，下部に，ついで上部に発生することが多いが，非上皮性腫瘍は上皮性腫瘍に比して中部から上部よりに（後者は中部から下部よりに）好んで発生するという傾向がある．一方，非上皮性腫瘍のうちでも，平滑筋由来のものは中部から上部に生ずることが比較的多い．

　本稿では，胃を組織学的にみて，体部腺領域，幽門腺領域にわけ，特に前者に生ずる疾患を中心に考察を加える．

　The majority of gastric lesions are usually found either in the pyloric region or in areas distal from the middle corpus. Lesions in the upper corpus or in more upper segments of the stomach have been considered to be far fewer in their incidence. However, according to the types of gastric lesions, their incidence and the site of their origin naturally vary. For instance, most of epithelial tumors histologically develop in the pyloric gland area, which is also a predilection site for gastric ulcer. In the fundic area a single ulcer is of rare occurrence. On the other hand, among tumors of nonepithelial origin a neoplasm arising out of smooth musculature is fairly often seen in the fundic gland area, while one originating from reticulum cell is most frequently seen in the pyloric gland area. Epitheial tumor, or lesion arising from the lamina propria mucosae is in some way related with the fact that some basic lesions such as inflammation occurrs there early and disticntively.

　In this paper 1578 cases of gastric diseases excluding chronic gastritis have been collected and those arising histologically out of the fundic gland area have been investigated. The reslut is as follows: Of 853 cases of gastric ulcer, that originating in the fundic gland area was seen in 27 (3.1%); of 575 cases advanced carcinoma, one (0.18%) was of fundic origin; of 180 lesions of early cancer, 2 (1.1%); of 105 cases of polyp, 17 (13.7%); and of 13 of leiomyoma, 4 (30.8%) arose from the fundic gland area. In total, of 1578 cases of gastric diseases, those arising out of the fundic gland area numbered 49, or 3.1 per cent.

　It also has been known that majority of gastric ulcer originating from the fundic gland area are relatively shallow and are already under repair; it is more often seen in stomachs with slighter degree of intestinal metaplasia; it is of fairly high incidence among women; it has nothing to do with gastric juice acidity; it is more often seen on the posterior wall; the duration of subjective complaints in this variety of ulcer is mostly within 3 months; and that there are many who complain of tarry stool.