造影CatgutによるB-Ⅰ法残胃吻合部の観察

A Study of the Anastomotic Site in Billroth I Subtotal Gastrectomy by the Use of Radiopaque Catgut

はじめに

　筆者らはレ線造影可能なBarium加Catgutを創案し，吻合部の全層縫合に使用し，術後吻合部の研究に役立てた^1)～3)．しかし，このCatgutの造影期間はせいぜい2週間止りであった．そこで，Bariumの代りに図1～2のごとき直径0.04～5mmの金または銀線維をCatgutに撚入することにより，Catgutの強靱度は失なわれず，造影度と造影期間を延長することができた．これを前回同様全層縫合に使用し，術後経過を追って経口的造影剤とあわせレ線検査を行ない，Barium加Catgut使用症例では得ることのできなかった数々の知見を得た．

　A radiopaque catgut with silver fibers intermixed was recently made by us. It is of great advantage in visualizing by x-ray the anastomosed site for a long time after the operation. The material thus manufactured does not in the least lessen the original strength of an ordinary catgut.

　A stoma in Billroth I subtotal gastrectomy was serially observed for a long period postoperatively by using the radiopaque catgut for the Albert suture combined with barium meal examination. The results are as follows:

　1) Gold fibers have also been put to the test, but they are of no use because they easily come to pieces within a short time. At present silver fibers seem to be most suitable for admixing in a catgut.

　2) Shortly after the operation the stoma alters its shape very much, but within 3 to 4 months later it settles down to a round or oval shape.

　3) Differentiation between the anterior and posterior walls is made with ease when different suture techniques are employed in anastomosis, as, for instance, the usual continuous running suture for the posterior wall, and Schmieden suture for the anterior wall.

　4) The catgut in the continuous suture of the stoma later loosened in most instances, but in a few it was tightened instead. A case presented here is an example of the latter. There was no stenotic symptoms, however.

　5) The new catgut is also of great value in the study of spontaneous rotation of the stoma as observed in some cases.

　6) Lateral roentgenogram of the stoma thus made radiopaque furnishes a profitable aid to the correct interpretation of its frontal view.