多発性胃潰瘍の内視鏡学的研究
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概要
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MATERIAL 66 cases of multiple ulcers of the stomach which were examined with X-ray and endoscopy in The First Department of Internal Medicine, Chiba University, and were resected in The First and The Second Surgical Departments, Chiba University, during 6 years, 1960-1965, were studied. RESULTS 1) Incidence of Multiple Ulcers The incidence of multiple ulcers cases is 33.1% of the gastric ulcer cases resected during the same period of time. The cases with kissing ulcers are 9 cases, and the incidence of the kissing ulcers cases in the multiple ulcers cases is 13.6%. 2) Ratio of Active Ulcers and Scarred Ulcers 169 lesions of the 66 cases of multiple ulcers were consisted of 88 lesions of active ulcer and 81 lesions of scarred ulcer. The active ulcers are slightly larger in number than the scarred ulcers. 3) Location of Ulcer 61% of the lesions including both active and scarred ulcers were found in the gastric body, 27.2% in the region of incisula angularis and 11.8% in the antrum the majority of the ulcers are found in the gastric body. 23.2% of the ulcers were found on the anterior wall, 40.8% on the lesser curvature, 32.5% on the posterior wall and 3.5% on the greater curvature. Ulcers occur first on the lesser curvature and second on the posterior wall. 4) Arrangement and Number of Ulcers 54.5% of the multiple ulcers were arranged on a line parpendicular to the lesser curvature. This type of arrangement is most frequent. 33.4% of the ulcers were arranged with no uniformity on the resected specimen. 59.1% of the cases were consisted of two ulcers. As the numbers of ulcer become more, so the cases decrease in number. 5) Age of Cases The majority of the cases with kissing ulcers were rather at an advanced age, and other multiple ulcers than kissing ulcers were found relatively in the young. 6) Sex Incidence The ratio of occurrence of the multiple ulcers of male to female is 2.9:1. 7) Subjective Complaints Hematemesis and melena occurred in slightly high frequency in cases with multiple ulcers, and pain in the epigastrium highly occurred in cases with multiple ulcers in comparison with single ulcer cases. 8) Detective Ability 35 cases, 53.0%, out of the 66 cases could be correctly diagnosed even the numbers of ulcers in the cases. 15 cases of the 66 cases could be diagnosed as multiple ulcers, but numbers of the ulcers could not be correctly diagnosed in these 15 cases. In total, 50 cases, 75.8%, of the 66 cases could be diagnoses as multiple ulcers. As to the numbers of the ulcers, 122 lesions, 72.2%, out of the 169 ulcers could be diagnosed. 9) X-ray Diagnosis and Endoscopic Diagnosis in Comparison 76.4% of the multiple ulcers cases can be diagnosed by X-ray examination, and 81.9% of the multiple ulcers cases can be diagnosed by endoscopic examination. 11 cases, 84.6%, out of 13 cases which were diagnosed as single ulcer by X-ray examination could be confirmed as multiple ulcers by endoscopic examination. On the contrary, 7 cases, 70.0%, out of 10 cases which were diagnosed as single ulcer or were impossible to diagnose by endoscopic examination could be correctly diagnosed as multiple ulcers by X-ray examination.