各種胃疾患における胃壁在神経要素の病理組織学的, 並びに臨床的研究

抄録

One hundred and twelve patients with gastric diseases (46 gastric carcinoma, 40 gastric ulcer, 11 duodenal ulcer, 9 chronic gastritis, 2 gastric polyp, 1 sarcoma and 3 normal stomach) who had gastrectomy at the 1st Department of Surgery, Tokyo Medical and Dental University were chosen for this study. The specimens were silver-impregnated by Kubota's method and intramural nerves were observed together with the other pathological changes of the stomach, clinical signs and symptoms.
1) The pathological changes of intramural nerves in gastric carcinoma were varied with the types of infiltration by carcinoma (INF) and were minimal in INF γ, and/or scirrhous carcinoma.
2) Normal myelinated nerve fibers were identified in the center of carcinoma in 13 cases and were interpreted as regenerated sensory fibers. They were seen more in INF γ and/or scirrhous carcinoma and were correlated with clinical complain of pain.
3) The pathological changes of intramural nerves adjacent to gastric ulcers (Ul II & III) revealed that they were not primary factor for the genesis of ulcer.
4) Neuroma or bundles of normal appearing nerve fibers were seen at the base of ulcer and were interpreted as regenerated sensory fibers as seen in gastric carcinoma.
5) The pathological changes of submucosal nerves were varied with degrees of mucosal changes in cases with gastritis and were interpreted as secondary to gastritis.
6) The intramural nerves in gastric polyp were not identified. The pathological changes of intramural nerves in gastric lymphosarcoma were less than those with carcinoma.
7) The pathological changes of intramural nerves were correlated with clinical signs and symptoms such as anorexia, nausea, vomiting and low proteinemia.
8) The abnormal tension and peristalsis of the stomach and the abnormal HCl secretion were due not only to changes of muscularis propria and gastric mucosa but also to those of intramural nervous changes.