胃の潰瘍性病変の経過―とくに早期胃癌の経過について

FOLLOW-UP STUDIES ON HEALING ULCER IN THE EARLY CARCINOMA OF THE STOMACH

Ⅰ．はじめに

　胃潰瘍は，加療によってよく癒る．少くとも入院させて食餌療法と薬物療法を行うと，とにかく瘢痕の状態まで，ひとまず到達させ得ることが多い．しかし，中にはどうしても癒らないものもある．そういうときは一応癌の疑いをかけよう．胃癌のクラーテルは小さくならないのが普通である．―こういういい方は，一般的には正しい，が例外もあるようだ．胃癌のクラーテルが小さくなったという報告は，古くからある．例外を集めてみると，そこに何か真理を明かす糸口を発見できることがあるのではなかろうか．

　最近トピックになっている胃癌内潰瘍の消長について自験例の検討をしたので，以下にその概略を記述する．

　The ulcer in early gastric cancer tends to heal by anti-ulcer therapy alone in the same way as benign one. Both are essentially peptic in their etiology. But the crater in the former ceases to heal as cancerous infiltration proceeds into deeper layers of the gastric wall.

　No specific correlation is found between this healing tendency and the depth of ulcer, the extent of intramucosal cancerous infiltration, or gastric acidity.

　Even among advanced carcinomas, there are a few cases whose malignant ulcers show some healing tendency, simulating early cancer under endoscopic and macroscopical observation.

　The crater in advanced carcinoma in general develops from slight mucosal depression in early cancer, so it is essentially different from ulcer crater in early carcinoma except for a small number of malignant ulcers.

　The ulcer in early carcinoma is, in its active stage, sometimes difficult to differentiate from benign one. When it comes to healing or scarring stage, differentiation is less troublesome. Follow-up studies are very important on that account.

　In the endoscopical determination of malignancy of healing ulcer, it is of utmost importance to find thin, white slough which follows in the wake of regenerating mucosa.

　The interval between the beginning of scarring stage and surgical operation exerts much influence on the pathological findings of the “Ulcer Carcinoma”. Cases of the marginal type are more often found in the shorter interval group, while those of the diffuse type are more numerous in the longer interval group.