Linitis plasticaの初期変化とその後の進展推移

Initial Findings and Developments of Linitis Plastica Type of Gastric Cancer

　近年の胃診断学の進歩に伴い，微小癌の診断，Ⅱb型早期胃癌の診断に代表されるように，胃癌の早期診断はめざましい進歩をとげた．しかしながら進行胃癌のなかでも，殊にlinitis plasticaの術後5年生存は，はなはだ稀であるとする報告が多く，その早期診断学の確立と病態についての解明が待たれている．本研究では，linitis plasticaの逆追跡による胃X線，胃内視鏡資料から，より早期像とそれらの進展推移について検討したい．

　ここでいうlinitis plasticaとは胃壁がびまん性肥厚を呈し，結合織性の変化が著しい胃癌で，限局性の腫瘤形成の認められない胃癌をいう^2)～4)．臨床上，胃スキルス¹⁾，Borrmann 4型胃癌として使用されているものの大部分はこれに含まれている．

　In order to evaluate the development of linitis plastica type gastric cancer, we have studied retrospectively 16 cases radiologically and endoscopically.

　The results were as follows;

　1) Initial abnormal findings were located mainly in the body. However, there was no predominance in their transverse distribution in the body.

　2) In most cases with ulcerative lesion in the initial picture, the figure of stomach developed into “leather bottle” appearance within 21 months. However, those with Ⅱc-like depression without obvious ulcerative lesion required longer time before showing “leather bottle” appearance.

　3) In these cases with localized mucosal swelling, figures of the stomach developed into “leather bottle” appearance between 12 and 21 months later. However, in those with diffuse swelling, the so-called “giant folds”, they changed to “leather bottle” within 10 months.

　4) Concerning the cases without mucosal swelling, the evolution time to “leather bottle” could be classifted into 2 groups. That is, in 4 cases out of 7, the stomach developed into “leather bottle” from 27 to 35 months later. In the other 3 they changed to “leather bottle” within only 6 months.