胃切除後残胃における内視鏡学的並びにレ線学的研究

～特に吻合口を中心としての観察～

抄録

One hundred and forty two cases of gastric remnant were examined by gastro-fiberscopic camera during the period from January, 1964 till December, 1965.
Those patients were checked by fiberscope at 3 to 4 weeks, 3 months, 6 months and one year after the gastrectomy and simultaneously the fluoroscopic examination were also performed. The results obtained are as follows:
1) The types of anastomosed stoma were classified as three criteria, a) closed type b) semi-open type c) open type. As the time elapses closed type and semi-open type gradually became open type, and at 6 months after the surgery most of them showed open type.
2) Comparing with Billroth I method of gastric resection, Billroth method of gastric resection had more tendency to become open type at earlier stage.
Within one month of gastric resection the remnant of chronic gastritis cases relatively revealed closed type comparing with other gastric diseases.
3) Within one month after gastric resection, two-third gastric resected groups showed less tendency to become open type comparing with subtotal gastric resected groups.
There were no close relation between the diameter of gastric stoma at the time of surgery and their type after one month post-operatively.
4) Within one month after the operation the patients who showed high acidity of gastric juice pre-operatively became open type more likely.
5) In several cases erosion and ulcer which probably caused by anastomosed sutured silk at the stoma were frequently observed, but those patients had not always post-operative complaints.
6) At the early stage of Billroth I method operation, duoderial stasis mostly observed and formed so called “Ersatz-Magen”.
7) There were certain relation between post-operative gastritis of the remnant and post operative complaints. The patients who comlained post operative gastritis had mostly suffered from hazard of passage in anastomosed portion right after the operation.
8) By using atropine or pilocarpine the movement and function of anastomosed portion were weakened or stimulated.
9) The discharge of content in gastric remnant was greatly influenced by tonicity of anastomosed jejunum.
10) By deep breathing anastomosed stoma showed deformed movement.
11) Among some cases of Billroth I method, the jejunal mucous membrane just under anastomosed stoma formed lengthwise folds after 6 months of surgery.
12) After 3 months of Billroth II resection, some cases showed tendency to move the location of efferent loop of anastomosed jejunum to left side of the gastric remnant.