Antrumの良性病変

Benign Lesions in the Antrum

　幽門前庭部の良性病変は極めて多く，胃内の良性病変でこの部に存在しない病変は皆無に近いと言って良い．したがって，これらすべての病変について限られた誌面で言及することは困難でもあり，各々の疾患については本誌でも詳細な解説がたびたびなされているので，いまさらくり返す必要もあるまい．

　そこで本論文においては一診断施設における連続一万例の有愁訴患者の疾患別頻度を部位別に検討した成績について簡単にふれ，さらに最近Ⅱc型早期胃癌と鑑別を要する疾患として，たびたび取り上げられている幽門前庭部の“急性対称性潰瘍”に重点を置き，その臨床症状，形態，経過，胃液分泌面などについて述べ若干の考察を加えてみたい．

1. Incidence of all the diseases belonging to the benign lesions of the antrum has been studied on 10,000 patients at one institution who had subjective symptoms pertaining to the stomach. The frequency of cancers, polyps and submucosal tumors in the pyloric antrum was respectively about 50 per cent. Peptic ulcer in this region was far less frequent, but it had a tendency to multiple occurrence.

2. “Acute symmetrical ulcers,” presenting a peculiar pattern in the pyloric antrurn, showed in 10 removed cases that they were all shallow, mostly Ul-Ⅱ, and in cases undergoing surgical operation soon after subjective symptoms has set in the ulcers presented acute phase histologically as well, with striking edema and neutrophile cell infiltration in a wide area in both the mucosa and submucosa. Twenty cases, medically managed and followed up, have all healed up within a short time with no recrudescence or recurrence in the same site. Because of their peculiar patterns they must be differentiated from Ⅱc type early cancer. These patterns also undergo various changes within a short period, so that the authors are of the opinion that they should be divided into three stages: acute, healing and scarring. Their discrimination from skirrhus, RLH, Ⅱc and Ⅱa has also been referred to. In addition, clinical pictures and secretion of gastric juice in these have been described.

　Acute peptic ulcer in the pyloric antrum is in many respects quite different from chronic ulcer and its origin has been investigated.