早期胃癌と線状潰瘍の合併例―レ線学の立場から

oexistence of Early Gastric Cancer and Linear Ulcer: Roentgenologic comments

漠然としていた胃変形学

　昔から，schneckenförmige Einrollung，Beutelmagen，Senkrechtmagenという呼称はあった．本誌で，竹本教授らが詳細に述べられたことがある．そんな特殊な胃変形も，X線所見としての独立した価値あるものとはならず，たんに古典的な呼称として習慣的に使っていたにすぎなかった．なにしろ，当時は粘膜像がもてはやされていたときだから，胃変形を十分に利用もできない．したがって問題にもされていなかった．しかし，充満像にみられていたこの特殊な胃変形の所見は，臨床で生き続けていたのである．しかし，胃変形学にまで成長するには，充満像と二重造影像の併用診断が確立することが前提であった．そのあとに胃変形学が起こるわけである．

　Ulkus ohne Nischeという言葉についても同じことがいえる．胃潰瘍を臨床的に取扱うのに，Nische，というX線所見が，万能のように思われていた．あまりに評価されすぎた感がある．このために，Ulkus ohne Nischeという現実は，蔭に潜む結果となった．明らかに見逃されてきた形跡がある．臨床では，こんなものが，ほかの便宜的な診断名のもとに片付けられていた気配がある．

　Vague concept of the study of gastric deformity

　It is true that gastric deformity was designated by German roentgenologists in such various names as “schneckförmige Einrollung”, “Beutelmagen”, or “Senkrechtmagen”, and Prof. Takemoto once described them in this journal. However, such peculiar descriptive names have been employed in the past merely as a conventional way of describing the classical abnormality of the gastric contour without any independent importance attached to it as a roentgenologic finding. I think it is what was naturally to be expected, because at the time when these designations were first in use, mucosal relief picture was in most request, and deformed contour of the stomach was not fully utilized for an important landmark to the diagnosis of gastric ulcer. Consequently, it was not much disputed. Clinically, however, the peculiar deformity of the stomach demonstrable in barium-filled picture survived. Nevertheless, coemployment of barium-filled picture and double contrast view had to be established firmly before the study of gastric deformity can become an independent branch of diagnostics in the diseases of the stomach.

　The same can be said of the expression “ulcer without niche”. For clinical management of gastric ulcer, x-ray finding of niche was regarded as omnipotent. I personally feel that too much importance was attached to it. Indeed, so much so that the reality of “ulcer without niche” was buried in oblivion. There is enough evidence to corroborate this neglect. Clinically at least, there are indications that gastric defor mity was dismissed lightly under some other expedient diagnostic names.