胃底腺領域のⅡc型胃癌のスクリーニングX線検査―特に早期のlinitis plastica型癌の診断

Diagnostic Ability of Screening X-ray Examination to Pickup Type IIc Early Gastric Cancers in the Fundic Gland Area: Early Detection of Linitis Plastica Type Gastric Cancers

要旨　胃底腺領域のⅡc型癌（125例）の占居部位とX線による拾い上げ能を部位別に検討した．単発病変113例は胃体部小彎・後壁38％，胃上部28％，胃体部前壁17％，胃体部大彎17％で胃体部大彎の2例が内視鏡で発見された以外はX線で拾い上げていた．副病変（12病変）は胃体部前壁に50％，胃上部に41％あり，全病変見逃されていた．副病変は0.1～1.5cmのm癌で，切除標本では病変を指摘できなかった．このような病変の発見には，従来の検査体系，診断理論を再考する必要がある．linitis plastica型癌（22例）の原発巣はF線内部領域内にあり，胃体部大彎に40％，胃上部に40％あった．F線内部領域のUl（－）のsm以下に浸潤した例（13例）は，胃体部前壁41％，胃体部大彎41％であった．病変の占居部位と撮影体位との関係は，胃体部前壁病変は仰臥位二重造影像と，強い第1斜位二重造影像，圧迫像が有効，胃体部大彎は仰臥位の強い第1斜位，胃上部は半立位の腹臥位第1斜位，仰臥位第2斜位，正面，強い第1斜位の体位が有効であった．F線内部領域のⅡcは1.1～2.0cmの範囲の症例を効率よく拾い上げていた．

　1. The location of 125 depressed type gastric cancers (type Ⅱc early gastric cancers; 97 cases, Ⅱc-like advanced gastric cancers; 28 cases) in fundic gland area and diagnostic ability of screening x-ray examination to pickup those lesions:

　1) In all, 113 single gastric cancers were located. 43 (38% of the total) of these were found in the posterior wall and lesser curvature of the gastric body. 32 (28% of the total) were found in the upper portion of the stomach. 19 (17% of total) were found in the anterior wall of the gastric body. Another 19 (17%) were found in the greater curvature of the gastric body. Almost all of those lesions were picked up by screening x-ray examination. Two lesions in the greater curvature of the gastric body were detected by endoscopy (Table 1, Fig. 2).

　2) Twelve associated lesions of multiple gastric cancers were not detected by screening x-ray examination.

　2. Location of the lesions and position in taking the radiograph:

　Lesions in the anterior wall of the gastric body were demonstrated through supine double contrast radiograph, strong right anterior oblique double contrast radiograph, and compression radiograph. Lesions in the greater curvature of the gastric body were demonstrated by strong right anterior oblique double contrast radiograph. In the upper portion of the stomach lesions were demonstrated through prone left anterior oblique radiograph in semi-upright position, supine left anterior oblique radiograph in semi-upright position, supine radiograph in upright position, and strong right anterior oblique double contrast radiograph.

　3. Primary lesions of Linitis Plastica type gastric cancers (22 cases) were located in the fundic gland area. 9 cases (40%) were in the greater curvature of the gastric body, and 9 cases (40%) were in the upper portion of the stomach (Table 1).

　4. Five lesions invading deeper than the submucosa in the fundic gland area (13 cases, Ul(－)) were in the greater curvature of the gastric body (38%), and five others were in the anterior wall of the gastric body (38%) (Table 1).

　5. Almost all type-Ⅱc gastric cancers in the fundic gland area were 1.1～2.0cm in diameter (Table 2).