胃腸吻合部の良性病変―吻合部潰瘍と吻合部ポリープ

Benign Lesions at Gastroenterostomy Site: Stomal ulcer and stomal polyp

　胃腸吻合部の良性病変としては吻合部潰瘍と吻合部ポリープがこの部に特異的である．吻合部潰瘍については発生機序をめぐる基礎的研究をはじめとし，臨床的な立場からX線および内視鏡的診断学ならびに治療法，さらに発生防止のための手術法の検討などについて多くの研究が見られる．今回は今まであまり重視されなかった病理組織学的立場からの観察から吻合部潰瘍につき検討を行なうものである．

　吻合部ポリープはLittler and Gleibermann（1972）がgastritis cystica polyposaとして記載した病変に相当し，本邦でも散発的に報告されているが^1)7)21)，われわれ（古賀ら，1976）の研究で，癌腫や他の良性ポリープと鑑別しうる特徴をもつ反応性の粘膜の増生であることがわかっている．この病変に関しては，肉眼ならびに，組織学的特徴を述べるとともに組織発生に関する新たな知見を加えて報告する．

　The present paper deals with two representative benign lesions in the gastroenteric stoma, i.e. stomal ulcer and stomal polyp. Specimens of the second resection from 46 patients who had previously undergone gastric operation for various diseases of the stomach or duodenum were collected from several institutes and hospitals for the pathologic study.

　Out of 21 patients with the stomal peptic ulcer, 16 had been operated on because of duodenal ulcer. The stomal ulcers were located almost invariably in the jejunum within the scope of gastroenteric stoma, and never developed in the afferent or efferent loops. The so-called suture line ulcer occurred in one patient. The antrum partiall remained in approximately 30 per cent of the patients with stomal ulcer who had undergone a partial gastrectomy. Pseudopyloric-gland metaplasia of the fundic glands developed in the mucosa near the stoma in almost every case. The glands should be distinguished from the original pyloric glands in the antrum.

　As to the polypoid change at the gastroenteric stoma, the lesion,“gastritis cystica polyposa”, described by Littler and Gleibermann represents one extreme end of morphologic spectrums. We have recently shown that essentially the same lesions of varying lesser degrees develop in the gastric mucosa at the stoma on many occasions (Koga et al., 1976). Another review of the specimens convinced us that these lesions were peculiar mucosal changes of a reactive nature probably caused by the duodenal juice flowing backward. The changes consisted basically of hyperplasia of young foveolar epithelium and pseudopyloric-gland metaplasia with cystic dilatation of the glands, occurring in the mucosal folds to produce polypoid protrusions. We propose to call this spectrum of lesions “stomal polypoid hypertrophic gastritis”.