瘢痕期潰瘍の内視鏡診断に関する検討
1973 年 33 巻 4 号 p. 475-488
詳細
1973 年 33 巻 4 号 p. 475-488
A study was carried out on the degree of ulcer reparation by utilizing complete serial sections of 19 lesion which were indicated to be cicatrical by findings from totally resected stomachs and preoperative gastrocamera pictures. They were selected from 1, 373 cases of gastrectomy, which was resected at the Department of Surgery, Showa University, School of Medicine, during approximately 14-years period from July, 1927 to August, 1971. As a result, ulcers at the cicatricial stage were found in 8 lesions with depths of ulcer III or IV. A comparative study was done upon the findings of totally resceted stomachs and endoscopic and histopathologic observations, in order to examine the endoscopic diagnosis of the degree of ulcer reparation. The obtained results are as follows.
1. Endoscopic findings corresponding to reparation degree 3 b were represented by a) concentrated folds and grandliform irregularities or b) concentrated fine folds and recesses, the attachment of fur and redness. At reparation degree 3, there were concentrated folds, recesses and attachment of fur in all cases. Redness was present in 4 of 5 cases.
2. The presence of thin fur is not necessarily a clue to endoscopic differential diagnosis of ulcer at cicatricial stage but was actually observable at reparation degree 3b or even 3a. Here, the presence of erosion-induced fur attached to regenerative epithelia should be taken into consideration.
3. Disappearance of redness at the center of a cicatrix does not always means the completeness of the ulcer reparation. The presence of redness is not an indicator for differentiation between reparation degrees 3a and 4.
4. The presence of recesses and granuliform irregularities on the surface of cicatrix are mostly an incomplete expression of regeneration of the mucosa. Here it is shown, inasmuch as even a slight recess is present, that the stature of regenerating epithelia is lower than that of the surrounding mucosa. Granuliform irregularities indicate uneven stature of regenerating epithelia, suggesting that the indented regino may correspond to reparation degree 3a. The same degree of reparation appeared to be expressed by the presence of fine sulci at the center of cicatrix, as was observed in isolated stomach.
5. It may be concluded that the diagnosis of reparation degree 4 is not based on the presence of redness but on the absence of any recess, granular irregularity of fine sulcus.
