高位の胃病変の生検・細胞診

Gastric Biopsy and Cytology of Lesions Located in the Upper portions of the Stomach

　従来高位の胃病変は解剖学的に，X線的にも内視鏡的にも他部位に比して診断が困難であった．しかし，胃疾患に対するX線診断技術の進歩により現在では全胃粘膜の診断が可能となった．

　胃内視鏡は経口的に行なう限りにおいて噴門を通過して胃内に挿入されるので，噴門部，穹窿部および胃体上部の観察は解部学的な制約があり不充分であった¹⁾．しかし胃カメラの反転²⁾ファイバースコープにアングル機構の装着³⁾あるいはJ-turn⁴⁾，二曲式胃ファイバースコープの開発⁵⁾により漸次該部の観察診断も可能となって来た．

　Until recently it was difficult to examine eitherendoscopically or roentgenologically lesions located in the upper gastric body, but development of instruments like gastrocamera and fiberscope and improvement of technique have made possible not only endoscopic diagnosis but also gastric biopsy and cytology under direct vision by the fibergastroscope for those lesions.

　Eight or 88.9% out of 9 cases with early gastric cancer and 43 or 95.6% out of 45 cases with advanced gastric cancer, both located in the upper gastric body, were diagnosed correctly by gastric lavage cytology under direct vision.

　In 6 cases of gastric sarcoma located in the upper gastric body a total of 5 cases consisting of 3 of leiomyosarcoma and 2 out of 3 cases of malignant lymphoma was positive by gastric cytology under direct vision.

　Eleven or 84.6% out of 13 lesions of early gastric cancer and 62 or 77.5% out of 78 cases with advanced gastric cancer both located in the upper gastric body, were histologically proved by gastric biopsy under direct vision.

　Five cases or 83.3%, consisting of 3 cases of leiomyosarcoma and 2 out of 3 cases with malignant lymphoma, were diagnosed correctly as gastric sarcoma by gastric biopsy.

　In the begining of those series of gastric biopsy and cytology under direct vision, results for the lesions located in the upper gastric body were inferior to those for the lesions located in other portions of the stomach. At present, however, development of instruments and improvement of technique have brought no difference between these results.

　Successful results were obtained by fiberesophagoscope in the lesions of the upper gastric body, in which a fibergastroscope was not insertable.

　Biopsy and cytology under direct vision were useful to get qualitative diagnosis of squamous cell carcinoma of the stomach. In 2 of 4 cases of it in the cardia a definite diagnosis was made by both these methods for the first time.

　Above mentioned gastric biopsy and cytology under direct vision are exceedingly useful in discriminating various kinds of lesions located in the upper gastric body.