胃の多発潰瘍と線状潰瘍との関連

Relationship between Multiple Ulcers and Linear Ulcer of the Stomach

　従来，胃の多発潰瘍・巨大潰瘍・線状潰瘍は，胃潰瘍のなかであたかも特殊な位置を占めるがごとく取り扱われてきたが¹⁾²⁾，これらは個数あるいは形態の相違こそあれ，胃に発生した潰瘍としては，単発円形潰瘍と等価であると考えられるから³⁾，同一のレベルで論ずることがよりすぐれていると思われる．このような方法論をとると，各潰瘍の相互関係がより一層明らかになると期待される．本論文は，この見地に立って，切除胃における全胃潰瘍を病理組織学的に検討し，とくに多発潰瘍と線状潰瘍との関連から，線状潰瘍の成因について論じたものである．

　Multiple ulcers, giant ulcers and linear ulcers of the stomach have so far been identified as rather outcome of special situations among gastric ulcers. However, they merely differ in number, size, and shape, and should be essentially equivalent to a single round ulcer.

　This paper is to report histopathological, analysis of gastric ulcer with special reference to the mechanism of linear ulcer formation.

　Our material consisted of 516 cases of resected gastric ulcer with 750 lesions. All of the lesions were step-sectioned with each slice being 5 mm in thickness for histopathological study. The ulcers were divided into single and multiple ulcers ; round ulcers less than 2 cm in maximum dimension ; giant ulcers larger than 2 cm in oval shape ; and linear ulcers longer than 2 cm. Single and multiple ulcers were encountered in 346 (67.1%) and 170 (32.9%) cases respectively. The incidence of round, giant, and linear ulcers were 522 (69.6%), 120 (16.0%) and 108 (14.4%) lesions respectively.

　Linear ulcer usually runs parallel to the longitudinal axis of the stomach and the mechanism of its development is considered to be mainly either one of 1) diminution in one direction of giant ulcer or 2) fusion of multiple ulcers. In the meantime, round or giant ulcers have one focus (center), but linear ulcers often have two or more foci, and over a half of linear ulcers (over 4 cm in length) tend to have multiple foci. Besides, multiple ulcers located in transverse direction are frequently accompanied by linear or pre-linear ulcers. From above findings, it would be reasonable to assume that longer linear ulcers are probably formed by fusion of transversely located multiple ulcers.