胃癌診断におけるルーチン検査の確かさ―内視鏡・X線併用からみて

Validity of Routine Examination Methods for the Diagnosis of Gastric Cancer: a study based on combined use of roentgenographical and endoscopical methods

要旨　（1）X線，内視鏡検査両者併用によるルーチン検査の診断について部位と大きさの面から検討した．（2）対象として5mm間隔で全割された早期胃癌238病変（切除標本の検索によって発見されたものを含む）を用いた．（3）238病変の分布は壁別にみると大彎＜前壁＜小彎＜後壁で，区分別にみると区分法1では噴門部＜幽門部＜A＜M＜C，区分法2では噴門部＜幽門部＜胃角部＜前庭部＜胃体部であった．（4）X線，内視鏡検査両者併用によって発見できなかった病変が60病変あった．5mm以下が63.3％を占め，11～20mmに見落としが5病変8.3％あった．（5）20mm以下の早期癌の発見率は74.8％で大きさ別にみると5mm以下40.6％，6～10mm 69.6％，11～20mm 95.8％であった．（6）区分別に発見率をみると，区分法1では幽門部，Aの後壁，大彎，Mの大彎，Cの前壁が低く，区分法2では幽門部，前庭部，後壁，大彎，胃角部前・後壁が低かった．

　(1) Usefulness of routine examinations with combined use of roentgenographical and endoscopical methods was studied with relation to location and size of cancer lesions.

　(2) Specimens obtained from 238 early gastric cancer lesions less than 20 mm in diameter found in resected stomachs, each sliced wholly in 5 mm thickness, were subjected to our study.

　(3) Distribution of the 238 lesions, according to classification I in Fig. 1, was known to A＜M＜C and the greater curvature＜the anterior wall＜the lesser curvature＜the posterior wall in frequency.

　On the other hand, according to classification Ⅱ in Fig. 1, the distribution showed angulus ventriculi＜antrum＜corpus ventriculi trend.

　(4) Lesions which could not be detected by combined roentgenographical and endoscopical methods amounted up to 60 in number. Among those undetected 63.3% of them were less than 5 mm in diameter, while those in 11-20 mm bracket were 5 in number (8.3%).

　(5) Lesion detection rate was 74.8% in 0-20mm, 40.6% in 0-5mm, 69.6% in 6-10 mm and 95.8% in 11-20 mm brackets.

　(6) The detection rate was low in the pyloric part, the posterior wall and the greater curvature in A, the greater curvature in M, the anterior wall according to classification Ⅰ.

　On the other hand, the rate of detection was low in the pyloric part, the posterior wall, the greater curvature on the posterior wall, and the anterior and the posterior wall inthe angle.