胃潰瘍の再発率と再発の因子について

On Recurrence Rate of Gastric Ulcer and its Moments.

　胃潰瘍は再発・再燃を起しやすい疾患であることは諸家の一致した見解であり，Bockus¹⁾や丸谷²⁾は「胃潰瘍は再発しやすい疾患であり，胃潰瘍の再発を防ぐことは，活動性潰瘍を治すことよりも難しい」と述べているが，実に胃潰瘍は治りやすいが，また，きわめて再発を起しやすい疾患であり，これを防止することは至難のわざである．

　筆者らは「胃潰瘍は癌化するかどうか」の問題に興味をもち，果して潰瘍患者から癌患者が多発するかどうかを調べたいと考え，昭和36年4月，当院が開設されて以来，筆者らの取扱った胃潰瘍患者を丹念にfollow upして来た．その1つの副産物として，胃潰瘍の再発の実態をかなり，明確につかむことができた．今日はその再発の問題についてのみ言及してみたいと思う．

　The number of gastric ulcer cases treated in the author's hospital during the past nine years and two months now stands up at 2,132. Of these, 884 cases have been confirmed as completely cured. They were followed up both roentgenologically and endoscopically mostly every three months or so (within six months at the longest). Excluding 13 cases having malignant cycles, the author has investigated the remaining 871 cases. The incidence of recurrence increases as the time since the first healing of ulcer becomes longer. Of 84 cases with a history of five or six years’ duration since the healing of ulcer disease, it was seen in 39.3 per cent; of 82 cases with six-to-seven-yearlong hisory, in 42.9 per cent; and in 62 cases with seven-to-eight-year-long history, in 54.8 per cent. In 36 cases with more than eight-year-long history of ulcer disease, recurrence was seen in as many as 68.9 per cent. Of 261 recurred cases, 27.2 per cent did so within six months after healing of ulcer; and 75.2 per cent, within two years. Recurrence was most often found in the patients in the fourth, third and fifth decades, or in the prime of their lives. The ratio of ulcer incidence in the present study was predominantly higher in males, especially so in recurrent cases; male versus female in non-recurring cases; 3.4:1.0 and in recurred cases, 4.0:1.0. Gatsric juice showed in 39.6% of recurred cases hyperacidity, but not significautly hish statistically. There was no correlation between size of ulcer and the rate of recurrence. On the other hand, recurrence was slightly more often found in ulcer cases with more than 10 mm depth of lesion as confirmed by x-ray. As for occupations of the patients in the present study, higher rate of recurrence was seen in farmers, drivers, carpenters, seamen and police officers. It was lowest among clerks.

　In cases where it took more than nine months for the ulcer to heal, it recurred in fifty per cent. The site of recurrence in 183 cases was almost identical with that of initial ulcer. while in 64 cases it was quite different. In the former, when examined in the resected stomachs, recurred ulcers were mostly either at a slight distance from the original ulcer site or within the margins of healed ulcer.

　Study in predisposition to recurrence of the ulcer showed that mental overwork was responsible for ulcer in 61 per cent; worries, in 48 per cent; insomnia, in 46 and irregular dietary habit in 45 per ient. Healing of recurred ulcer required in many instances longer period as compared with that of initial ulcer.