ファイバースコープによる直視下胃壁内注射に関する研究

A Study on Intramural Injection of the Stomach under Direct Vision by Means of Fiberscope

　ファイバースコープの出現は，胃内視鏡の活動分野を急速に拡大し，病巣の部位を弁別して生検試料をえることすら可能にした．いわば体内にある胃壁をあたかも体表に直視しうる臓器のように我々の手ちかな対象にしてくれた．いまこの胃壁に対して自由に注射が行なえるとすれば，次のような広範囲の目的に有効であろうとは誰しも容易に想いいたるところである．

　Various kinds of medicine have been injected into the gastric wall under direct vision in order to study pathophysiological aspects of gastric diseases as well as to apply this study to diagnostic and therapeutic advantages; in order to study (1) whether or not constancy is seen in the relation between ridges and grooves of the gastric mucosa in a physiological state; (2) lymphatic system within the gastric wall by x-ray observation of the stomach after contrast media have been injected intramurally; (3) confirmation of repair mechanism of gastric ulcer, and the site of its recurrence or recrudescence; (4) exact correlation of extent of early gastric cancer as confirmed by endoscopy with that in gross specimen; (5) facilitation in determining the site of a lesion when some coloring matter is recognized on the serosal side injected through the mucosal side of a lesion; and (6) topical treatment by means of anti-ulcer and anticarcinogen substances, and the possibility of removing necrosis from a peclunclatecl polyp.

　By attaching a long vinyl tube around GTF or by inserting an injection needle or biopsy forceps for injection about 120 cm length various substances such as Evans blue, Bleu patenté, Indian ink, Mitomycin C and Popiodol have been injected into the adjacent areas of lesions. This maneuver was successful in 18 out of 21 gastrectomized cases.

　The state of the gastric mucosa at the time of injection as well as shifting of coloring matters within the mucosa after they have been injected has been studied by endoscopy and in resected specimens. It also has been studied histopathologically on tissue reaction due to coloring matter.

　For a long-term landmark within the gastric wall Indian ink is most suitable; for a short one Bleu patenté most befitting. Histopathologically, no finding suggestive of infection has been recognized.