左肋骨弓下に没した胃体部粘膜のDosierte Kompressionによる画き方―Ashizawa's Sandwich Method

A Method of X-Ray Examination to Delineate the Mucosal Patterns of Gastric Corpus Hidden under the Left Costal Margin, by a Proper Sandwich Compression

　胃のX線検査ほど，患者には「透視」ということばで知られ，放射線専門医の手をかりなくても，一般臨床医によって手軽く，しかも広く行なわれている造影検査はない．その反面，透視による的確な病変部位の把握も行なわずに，明るい部屋でがぶっとバリウムを飲ませて撮影するに過ぎない簡略な方法から，微小焦点廻転陽極管を使用したテレビ透視下での狙撃分割撮影をfullに行なった詳細な検査法まで区々である．

　検査にあたっては，まず装置の優劣，胃液¹⁾や粘液²⁾の存否，造影剤³⁾⁴⁾の良悪ないし胃内外陰性造影剤（発泡剤⁵⁾や人工気腹⁶⁾⁷⁾）を併用するかどうかなどが問題となるが，いずれも胃の粘膜像をより見落とし少なく，広範かつ正確に画き出そうとする試みにほかならない．従来，多くの研究者によっていろいろな工夫がなされてきたが，いずれも適当な体位⁸⁾で，適量の圧迫dosierte Kompression⁹⁾を加えて粘膜像を現わすことが基本となっている．

　PURPOSE

　The gastric corpus hidden under the left ribs is part where the cancer is apt to originate. However, cancer in this part shows its symptoms late, and it is difficult to palpate it. The roentgen examination also presents some special difficulties.

　First, the polisography is not effective because the peristaltic movements of this part of the gastric corpus are faint. Secondly, in the upright position, the contrast meal does not stick to the part easily. Thirdly, it is very difficult to visualize the mucosal patterns of this part, even when it is possible to press the part very skilfully.

　In spite of such difficulties, the roentgen examination of the part is very important for diagnosis.

　METHOD

　The filling mucosai pattern is obtained, while some amount of contrast meal, with gastric juice, flows out into the bowels; the gastric cavity opens well and the gastric wall expands fairly. At this time, the patient is placed in supine posture with two cotten balls on both sides of the abdomen and back. These cotten balls measure from 5cm to 6cm and are laid opposite to each other. (This is the reason why it is called the Ashizawa's Sandwich Method.) The photograph is taken giving pressure to the left ribs through two cottenballs during the fluoroscope. The results of comparison between the usual radiogram taken by pressing only the abdominal region and the radiogram by the Sandwich Compression method are as follows.

　FINDING

　The examinations with the above mentioned method were done on a hundred patients by free choice. “Advantage” (+) in the table shows the cases in which the radiogram taken by the Sandwich Method was more valuable than the usual one taken by pressing only the abdominal region. “No difference” (+-) shows the cases in which the former was as valuable as the latter. “Disadvantage” (-) shows the cases in which the former was less effective than the latter.