外科と胃生検

Surgery and Gastric Biopsy

まえがき

　胃生検は，近年急速に発達した分野である．従来，X線検査，内視鏡検査が主要な胃疾患への精検の方法として著しい発展を遂げているが，より微細な変化を問題にするようになってから，胃生検の必要性が強調されるようになった．

　そしてほとんど悪性徴候の見られない胃潰瘍から検査の結果癌が証明されたり，癌がいわゆる悪性サイクルを繰り返すことなどが明らかになって来たが，この面への生検の役割は大きい．こうして生検はX線検査や内視鏡検査の進歩に，大きな貢献を果たしつつある現状である．

　The significance of gastric biopsy, now being adopted as one of a series of routine methods of examination for thorough study of gastric diseases, has been considered in this paper from the stand point of surgery.

　Roughly speaking, gastric biopsy has two objectives. The one is qualitative diagnosis of gastric diseases, and the other is to estimate the area of cancer distribution so as to be helpful for surgical intervention. These two are explained in this paper giving examples of early and advanced cancer as well as cancer of the gastric remnant.

　In early gastric cancer, biopsy is used to confirm the existence of a very minute cancer or slight mucosal change grossly hard to identify, in addition to the estimation in the diagnosis of Ⅱc or Ⅱb of the area of cancer infiltration toward the cardiac region in order to determine the extent of resection.

In advanced carcinoma or non-epithelial tumors showing similar findings, biopsy is employed in the discrimination between cancer and sarcoma; between leiomyoma and leiomyosarcoma. It is further expected that it shall gain more weight in the determination of the extent fo gastric resection.

　Cancer of the gastric remnant presents various types of cancer lesion peculiar to it at the stump anastomosis. Biopsy now plays cardinal role in its qualitative diagnosis.

　The importance of gastric biopsy must be evaluated on the basis of the results of gastric endoscopy and x-ray study. It is thus essential for accurate diagnosis to estimate systematically all the data obtainined. False negative results lead the examinaer astray so that cancer is apt to be overlooked for a long time.

　Biopsy is also supplemented by cytological diagnosis during the operation, a very important adjunct in determining the extent of gastric resection.