巨大皺襞を示す胃疾患の外科臨床的考察―特に巨大皺襞症について

Surgical Consideration of Gastric Diseases Showing Giant Folds: Especially with reference to giant hypertrophic gastritis

　胃巨大皺襞症は1888年フランスのMénétrierの記載に始まるが，その概念は現在必ずしも統一されておらず，胃巨大皺襞症を表現する用語は多数みられる．

　巨大皺襞という用語と巨大皺襞症という用語は本来区別して用うべきであって，巨大皺襞を示す胃疾患のうちで癌・肉腫などを除外した胃粘膜の良性，非腫瘍性，増殖性疾患を巨大皺襞症として取り扱うべきであろう．われわれは巨大皺襞を示す胃疾患について臨床的ならびに病理学的立場から検討し，特にその中で巨大皺襞症の病態について考察を加えたので報告する．

　Non-neoplastic and proliferating benign diseases showing giant rugae in the stomach are called giant hypertrophic gastritis in this paper, and they have been compared with the giant rugae produced by tumor.

　Four cases of giant hypertrophic gastritis showed more thickened, tortuous folds than those of the usual type of hypertrophic gastritis. Their surface was finely rough in two cases and smooth in the other two. They were classified into diffuse type and localized type on the basis of their gross findings. Histologically, they were also classified into two types; a group which showed marked proliferation of the foveoler cells and decreasing in number of proper glandular cells, and another group which showed both proliferation of the foveolar cells and the proper glandular cells in a normal ratio.

　In the case of the giant rugae produced by cancer, the folds were irregular and ulcerated cancer was observed in them. In the case of sarcoma, the folds were extremely irregular and showed extended tumor-like appearance.

　For the treatment of giant hypertrophic gastritis, gastrectomy is recommended only in the cases accompanied with the signs of protein losing syndrome.