exulceratio simplex（Dieulafoy）の4例と過去14年間の本邦報告例の文献的考察

Exulceratio Simplex (Dieulafoy), Report of Four Cases and a Review of the Literature

要旨　4症例5病変のDieulafoy潰瘍を経験し，全例緊急内視鏡検査で診断し，緊急手術にて救命しえた．本疾患の病態は動脈硬化の二次的な変北による動脈瘤説と動脈走行異常説とがあるが，最近の文献では後者の説が多い．過去14年間に本邦にてDieulafoy潰瘍として報告された28例に，胃粘膜内動脈瘤破綻例2例を加えた総計34例35病変の文献的考察を行った．年齢は11歳から80歳に及び，平均年齢は男57歳，女59歳であり，男女比は4：1であった．90％は吐血を主訴とし，全例ショックまたはプレショックで受診し，病巣は不明1例を除き，全例胃体中部以上にあった．吐血から診断または外科的処置まで平均5.7日を要し，救命率70.5％，死亡率8.8％，不明20.5％で，本症の認識と緊急内視鏡検査の重要性が強調された．

　Five lesions of exulceratio simplex (Dieulafoy) in four patients are reported. All of them were diagnosed by urgent endoscopy and survived by operation (partial gastrectomy in two cases, total gastrectomy and wedge resection in each one case). Regarding the nature of these lesions there were two schools of thought; that it is a miliary aneurysm due to acquired arteriosclerosis, or it is a congenital vascular malformation. Recent literature agrees with the latter theory. From Japanese references we collected 28 cases which were reported as“Dieulafoy”, and two cases of ruptured microaneurysm. Of the 34 patients including our cases, sex predominance was noted, with a male to female ratio of 4: 1. The age range was 11 to 80 years with an average of 57 (male) and 59 (female). Hematemesis was present in all except three cases and each had melena alone. The locations of these lesions except one unknown case have been recorded in the oral side from the middle corpus. Mean time from onset (hematemesis) to endoscopic diagnosis or surgical treatment was 5.7 days and so survival rate was 70.5%; mortality rate was 8.8% and unknown cases was 20.5%. It is important to know this entity and perform urgent panendoscopy for cases of unexplained gastrointestinal hemorrhage, especially hematemesis.