Out of the total 595 cases of gastric ulcer resection (390 cases in the Second Department of Surgery, Tokyo University during the 6 years and 3 months period from Novermber 1949 to February 1955 and 205 cases in the Department of Surgery, Showa Medical School during the 7 years period from 1953 to March 1960), 456 cases were found to have ulcers in the stomach. Of these 456 cases, 102 cases were excluded as they were the cases of linear gastric ulcer and the remaining 354 cases were employed in the statistic observation of their distribution and the tendency of healing made from the standpoint of histopathological findings.
1. Round and lanky ulcers occupied 44% of the total cases examined demonstrating that the majority of the cases employed were typical cases of gastric ulcer.
2. According to the classification based on the depth of ulcer, the majority were ul-IV degree occupying 61% of the total cases.
3. Ulcers of ul-III degree showed the best healing tendency, while the healing of ul-IV degree was extremely difficult.
4. The more typical ulcers were, the treatment was so much difficult.
5. As for the site of ulcer formation, most of the ulcers were found on the lesser curvature being 68% followed by the posterior wall and the anterior wall in the order listed. When viewed from the stand point of altitude, (distance from the pyloric ring) most ulcers were formed on the stomach angle or on the upper part of the stomach angle, followed by those formed on the pyloric ring. Ulcers formed on the pre pyloric sinus were relatively few.
6. As for the difference in the rate of repair depending on the locality of ulcer formations, shallow ulcers formed on the anterior and posterior wall were easy to heal, while it was recognized that the ulcers approaching to the ul-IV degree gradually lost their healing tendency. All the ulcers formed on the lesser curvature had a tendency difficult to heal regardless to their depth.
The rate of repair observed by the difference of altitude, moreover, showed that the shallow ulcers formed in the vicinity of the pyloric ring were easy to heal while those formed on the pre pyloric sinus were difficult to heal regardless to their depth. On the stomarh angle and the upper part of it, the ulcers of ul-II degree were rather difficult to heal, while those of ul-III degree were easy to heal. Ulcers of ul-II degree formed on the high altitude were extremely difficult to heal, while those of ul-III degree were quite easy to heal. Ulcers of ul-IV degree were difficult to heal regardless to the altitude of their site.
7. Regarding the distribution of ulcers by the difference of their depth, ulcers of the ul-II degree including both ulcerative stage and cicatrizing stage were mostly found on the pre pyloric sinus, especially, in the vicinity of the pyloric ring. Likewise, the ulcers of the ul-III degree were mostly distributed in the vicinity of the stomach angle and the pyloric ring without showing any difference between those on the ulcerative stage and those on the cicatrizing stage.
In the case of the ulcers of ul-IV degree too, they were mostly concentrated around the stomach angle of the lesser curvature without showing too much difference between the ulcers on ulcerative stage and those on cicatrizing stage. But those formed on the pre pyloric sinus were relatively few.
8. As for the rate of repair by the difference in the depth and locality, the ulcers of ul-II degree formed on the anterior wall were most easy to heal and those formed on the lesser curvature were most difficult. Ulcers of ul-III degree, regardless to the locality of their formation, were good in their healing tendency.
9. When observed by the difference of altitude, the ulcers of u-II degree formed in the vicinity of pyloric ring showed the best healing tendency. In the case of the ulcers of ul-III degree all showed good healing tendency except those formed on the pre pyloric sinus.
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