胃潰瘍の微細血管構築―特に治癒および再発における役割

Vascular Structure of Gastric Ulcer, with Special Reference to the Role in Healing and Recurrence

　胃潰瘍の発生に関する研究は数多いが，潰瘍の治癒および再発に関する病因論は少ない．一方，創傷治癒には周辺の血行状態が大きな影響を持ち，血行不良の場合には下腿潰瘍にみられる如く難治性となり，また再発もおこり易いと考えられる．胃潰瘍をかこむ環境と一般創傷のそれとは非常に異なるとはいえ，生体の治癒反応という面では共通しているはずである．以上の観点から，潰瘍の治癒および再発には血管構築上の因子，すなわち血行が大きな役割りをはたしているのではないかと考え，われわれの改良工夫した血管造影法¹⁾により，胃潰瘍の微細血管構築を検討した．

　Our improved microangiographic approach has been performed in various types of peptic ulcer of the stomach to clarify its intractability and recurring tendency.

　On the microangiogram of chronic ulcer, there are three zones, i.e., avascular, brush vessel and radiating vessel zone; histologically they represent zone of exudation with necrosis, granulation and scar, respectively.

　From the standpoint of these findings, ulcers can beclassified to five types: active, resting, epithelized, recurrent and pair types. It is of interest to speculate that in course of time ulcer alters from the active to piar type.

　There is some difference between the oral and anal margins of the ulcer on the microangiogram. This seems to show that the oral margin contracts stronger the anal margin.

　In ulcer deeper than the proper muscular layer, abundant submucosal vascular network is destroyed, and there remains only fine radiating vessel (scar vessel). It can readily assumed that healing of deep ulcer is difficult. If it should heal, there appear weak points of blood supply, for the regenerated epithelium is supplied only by the poor radiating vessel. Moreover, the adjacent tissue cannot receive enough blood flow. This fact is compatible with recurrence of ulcer in the adjacent area.

　Our study reveals that intractable and recurred ulcers have deeper and wider radiating vessel, and in some cases there are multiple foci of radiating vessel, which is thought the result of healing and recurrens of ulcer. This microangiographic pattern is often recognized in linear, kissing, tadpole-shaped or irregular-shaped ulcers with surrounding wide scar tissue.