噴門部陥凹型早期胃癌の見つけ出し診断―X線診断の立場から

Radiological Detection of Depressed Type of Early Gastric Cancer at the Cardia

要旨　噴門部陥凹型早期癌15例15病変について，食道胃接合部から癌の中心までの距離を測定し，食道胃接合部に接してほぼ存在し，1cm以内にあるもの（C1群），2cm以内にあるもの（C2群），2～4cmの噴門部近傍にあるもの（NC群）に分けて，X線の拾い上げの成績を大きさ，潰瘍の有無，占居部位の別に検討した．C1群は33.3％（3/9），C2群は100％（6/6），NC群は54.5％（12/22）が拾い上げられ，C1群では癌の大きさ，占居部位よりも潰瘍の有無が拾い上げの重要な因子であった．X線像で空気量が不十分で噴門が閉じたX線像では撮影体位に関係なく見逃され，C1群の潰瘍（－）例を捉えるためには空気量を多くし噴門部の粘膜ひだを伸ばし噴門が開いた状態での撮影が必要と考えられた．

　The authors treated 20 patients requiring gastrectomy for early carcinoma (5 elevated type, 15 depressed type) at the cardia, between 1968 and 1987, at Juntendo University. The incidence of early cancer at the cardia was 2.6% (20/766) and that of advanced cancer was 5.7% (44/775), so the detection rate of early carcinomas located at the cardia was considered to be insufficient. Pathological and radiological findings of the depressed type of early carcinomas were investigated to study the diagnostic problem, especially the radiological detectability in routine examination. The patients were divided into two gruops: 9 had carcinomas situated at a region 0-1 cm from the esophago-cardiac junction (C1 group) and 6 had carcinomas at the region 1-2 cm from the junction (C2 group). Three of the C1 group (33.3%) and all of the C2 group (100%) were detected by endoscopy, but none of the C1 group which were 10 mm or less in size and without ulcer scars were detected radiologically.

　The reason for this was that the amount of air in the stomach was insufficient to open up the cardiac region. Because of this the area was observed, and it was impossible to detect the carcinomas in the radiological picture.