胃潰瘍難治化の要因と再発因子およびその対策

Factors for the Intractability of Gastric Ulcer and Predisposing Factors to its Recurrence: Measures How to Meet Them

　胃潰瘍は容易に治癒するが，6カ月の内科的治療でも治癒しえないものが約15％ある．このような難治の要因は何であろうか．この問題は今までも何度か本誌上で，あるいは学会で討論されてきたが，ここでもう一度考察を加えてみたい．また，どんな潰瘍が再発をきたしやすいか，そしてそのような再発を起こさせる因子は何か，またそのような難治，再発例を予知し，これを防止，あるいは治療できないものか，など検討を加えてみたい．

難治潰瘍について

　1．定義未だこの定義は明確にされていないが，川井¹⁾は4カ月で治癒しないものを，田中²⁾は3カ月で治癒しないものを，春日井・加藤³⁾らは，外来で3ヵ月，入院で2カ月治療し，治癒しないものを，それぞれ難治と考えている．私どもの観察では，表1に示すごとく，治癒率は4カ月までは，かなりの率で上昇し，その後は比較的ゆるやかな上昇となることが認められた．しかしここでは問題の特徴をつかむため，6カ月以上の内科的治療でも治癒しなかったものを，難治潰瘍としたことを断わっておく．

　Should gastric ulcer failing to heal after more than 6 months of medical management be called intractable ulcer, 14.9 percent of our treated cases belonged to this category.

　The male outnumbered female in this group of ulcers with a ratio of 5.4: 1.0. The patients most affected by it were 40-69 years of age, as, for instance, 33.6 percent in people in the forties and 32.3 in the fifties. There was no preferential site for intractable ulcer.

　Large ulcers more than 2 cm in diameter were seen in 21 percent of intractable cases, by far a higher figure as compared with ulcer cases of random sampling, which showed only 5.2 percent. The rate of healing for large ulcer in the period of 1-2 months was low.

　Linear ulcers more than 3 cm long were seen in 7.3 percent of intractable ulcers, while in random sampling cases seen in only 2.1 percent. The rate of healing in 6 months for linear ulcer was as low as 49.4 percent.

　Multiple ulcers were also seen in 24.2 percent of intractable cases, a statistically high and significant figure as compared with random sampling cases of ulcer, which showed them in only 9.2 percent. Kissing ulcers were easier to heal on the anterior wall than those on the posterior wall.

　No definite difference was seen in the rate of recurrence between the male and female. In both, recurrence was most often seen in patients in the prime of life from the thirties to fifties. Recurring ulcer did not show any predicable site.

　Larger ulcers tended to recur (87/162 or 55.4%) more often than smaller ones less than 0.5 cm in diameter (54/173 or 31.1%). Multiple ulcers showed a higher rate of recurrence (57/131 or 43.5%).

　An also statistically important difference was seen in the rate of recurrence between the patients who took medicine regularly (83/206) and those who gave up taking medicine (97/133 or 72.9%). Of course ulcer recurred in some of patients during medication.

　Predisposing factors to recurrence of ulcer included smoking, mental and physical overwork, insufficient sleep and irregularity of the time for meals.