球後部潰瘍の臨床―内視鏡的follow upを含めて

Clinical Aspects of Postbulbar Ulcer of the Duodenum: Including its endoscopic follow-up study

　内視鏡検査法の発達とともに，X線検査法では診断のむずかしい，微細な凹凸を伴う小病変も，色調の変化などより診断可能となった．ことに食道や十二指腸下行脚では，X線検査上，圧迫手技が行なえないだけに内視鏡検査の意義は大きい．最近Duodenofiberscopeまたはupper GI endoscopeによる球後部潰瘍の内視鏡的観察の報告がみられ始め¹⁾²⁾，従来X線検査のみにて行なわれた球後部潰瘍の診断について，新たな検討が必要となってきた．われわれはこれまでに11例の球後部潰瘍を経験したので，その成績について内視鏡的観察を中心として述べる．

　During the past five years postbulbar ulcer in the duodenum was diagnosed in 11 cases either by x-ray or endoscopy. The youngest patient was a 3-year-old male child, while the oldest was a man aged 78. The male outnumbered female in a ratio of 9 to 2. The chief complaint was epigastric pain in seven cases. The period of suffering was of shorter duration among the old and young. The first limb accounted for 3 ulcer, the segment above the papilla for 6 and that below the papilla for 1. One ulcer stretched over two limbs. Lesions in the first portion were most often seen in the lateral aspect, while those above and below the papilla were mostly located in the medial side. Duodenofiberscopy, performed in 8 cases, showed that fundamentally most of the ulcers were of round shape, with some linear or irregular-shaped. The positive initial rate of detection by endoscopy was higher than that of x-ray, as was pualitative diagnosis to determine whether ulcers were in healed stage. Cases followed up by endscopy were utilized to determine the stages of the coures of the illness. Four out of 8 lesions completely healed whthin 2 months as was confirmed by endoscopy. Of another 4 lesions that failed to heal, one was linear ulcer, procrastinating even after 5 months. The remaining 3 lesions were surgically treated on account of complications, which included stricture in 4 cases, active bleeding in 2 and perforation in 1. All in all 5 cases were surgically intervened, the sole reason for it being complications.

　Postbulbar ulcer of the duodenum, hitherto studied by x-ray alone, has been investigated in this paper from the viewpoint of duodenofiberscopy and upper GI endoscopy. Endoscopic observations have proved effective not only in the detection of postbulbar ulcer and its qualitative diagnosis but in the determination of healing along with classification of the stages of its course as well.