幽門前部潰瘍のX線診断

X-ray Diagnosis of Prepyloric Ulcer

はじめに

　胃の病変を，より微細に診断しようという努力は，最も病変の多い胃角部を中心として，高位や前壁の病変の診断をも可能にした．

　しかし，多くの研究者はつぎつぎと目標をかかげて，より高度の質的診断の可能性を求めて日夜努力を重ねている．

　こうしたなかで，胃前庭部の病変は変化が比較的強く現われる部位であるため，病変の特殊性が論じられているが，さらに，幽門近傍の病変になると疾患の数も少なく，その診断に関する報告も少ない．

　ここではあたえられた主題について，症例を供覧しながら幽門前部潰瘍のX線診断についていささか述べたい．

　Division of stomach into various portions and the nomenclature for these vary according to authors, giving some confusion. In this report, prepyloric ulcer after exclusion of duodenal ulcer was studied. Prepyloric ulcer occupies 4.1% of the whole gastric ulcer, and 8.6% of the gastric ulcer in the resected stomach. Six cases of ulcer of the pyloric canal, 5 cases of pyloric ulcer and 1 case of prepyloric ulcer probably resulted in perforation were selected for study from among cases of gastric resection in which diagnosis was possible on the x-ray film during the recent 5 years. Two cases of gastric vagotomy and pyloroplasty and 3 cases of prepyloric ulcer with follow-up studies were added. Among cases of gastrectomy, agreement of diagnosis was achieved in 2 cases of gastric and duodenal ulcer and one case of gastric ulcer. In 2 cases of gastric ulcer, erroneous diagnosis of gastric cancer was made. Erroneous diagnosis of gastric and duodenal ulcer was made in 1 case of gastric and duodenal ulcer. Erroneous diagnosis of duodenal ulcer was made in 2 cases of juxtapyloric ulcer, and in 2 cases of gastric and duodenal ulcer. In the x-ray diagnosis of this part of the stomach, compression method gives advantages. For definite diagnosis, demonstration of niche is mandatory. However, it is rather difficult in this portion due to various changes especially intense contracture.