Analysis on the Diagnosis of the Surgical Gastric Diseases by Gastrocamera:particularly on diagnostic accuracy by com-bined method with X-ray examination, gastro-camera and exf oliative cytology.
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概要
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1) 548 patients with gastric and duodenal lesions were routinely examined by combined three methods beforee operation, and compared with postoperative histologic diagnosis.2) X-ray diagnosis was correct in 83.3% of gastric cancer and 75.2% of gastric ulcer, and gastrocamera was correct in 92.8% of gastric cancer and 86.5% of gastric ulcer. As generally accepted X-ray exami-nation is just schadow diagnosis, sometimes it may be difficult to differentiate between some kinds of lesions, for instances between duodenal ulcer and periduodenitis, if niche will not be detectable. From this point of view, when ability of fluoros-copat progressed more cases might be diagnosed as doubtful changes on the X-ray film. So these doubtful lesions are to be comfirmed by endoscopy and sometimes by cytology. But it still remains as the most important and reliable method in the field of gastric diagnosis.3) When X-ray examinations find the questionable lesions in the stomach as ulcers or polyps under suspicion of malignant changes, giant rugae gastritis, suspicion of superficial cancer endoscopic examina-tion was especially usefull. And at this time, if exact position of tip of the camera in the stomach is controlled under fluoroscopy, diagnosttc accuracy of the lesions are increased markedly. To decrease the blind zone of the gastrocamera, author tried some new methods. To photograph the posterior wall of the upper body of the stomach, two balloons were attached to the tip of the camera to increase the distances between apparatus and the lesions by inflation of the balloons within the stomach. In another method we changed the tip of the camera into steal, and attracted the tip by strong magnet through abdominal wall. So distance between the lesions and the tip of the camera was enlarged and enabled to look down the posterior wall of the body of the stomach. To get photograph of cardial zone we routinely used bent method.4) As the gastric cytology authors employed chymo-trypsin lavage technique as routine procedure under the control of X-ray. We used new radioopaque hard tubes, and added "UROKOLIN" 5g/dl as the contrast medium to the chymotrypsin fluid. We washed always perticullary doubtful parts of the stomach under fluoroscopic controll and we called this method as selective gastric lavage. According to this new method, we found the fact, that there are so little differences in the diagnostic accuracy between the cancer of antrum, pylorus, body and cardia. We get positive results in over 90% of cancer cases in any parts of the stomach. Then accuracy of the cytologic diagnosis of the stomach lesions was increased so much and false positive case was zero. So these methods have some weakpoints in each other, but when used combined at the same time, it is sure to increase accuracy in the detection of the malignancy of the stomach. Author could correctly diagnosed 99.5% of the stomach cancer with this method.
- 社団法人 日本消化器内視鏡学会の論文
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関連論文
- 112 白血球粘着阻止 (LAI) 試験による胃癌診断(第19回日本消化器外科学会総会)
- Analysis on the Diagnosis of the Surgical Gastric Diseases by Gastrocamera:particularly on diagnostic accuracy by com-bined method with X-ray examination, gastro-camera and exf oliative cytology.