Takemoto T, Sasaki N, Tada M, Yanai H, Okita K
Yamaguchi Rosai Hospital, Japan.
J Clin Gastroenterol. 1991;13 Suppl 1:S125-8. doi: 10.1097/00004836-199112001-00020.
Gastric and duodenal ulcer healing and scarring were evaluated with a highly magnifying endoscope. The appearance of scar was classified into three types: Sa, with a depression at the center; Sb, with a pattern of regenerated mucosa reaching the center; and Sc, with a uniform pattern throughout. The relationship between regenerative mucosal patterns and histologic findings of biopsy specimens was investigated in 58 patients with gastric ulcer. Mucosal regeneration was sufficient in 26.7% of patients with Sa pattern, 79.2% of patients with Sb pattern, and 100% with Sc pattern. From prospective endoscopic follow-up observations, the relationship between endoscopic findings of ulcer scars and ulcer relapses was investigated in 80 patients with gastric ulcer and 56 patients with duodenal ulcer. As a result, patients who completed the cycle of ulcer healing from Sa pattern through Sb to Sc patterns had rarely relapse. In contrast, patients with a Sa pattern of mucosal scar showed a high rate of recurrence: 88.8% for gastric ulcer, and 88.0% for duodenal ulcer. Our method of evaluation of gastric and duodenal ulcer healing with a highly magnifying endoscope may have important prognostic and therapeutic implications. It may indicate a population of patients (with Sa scarring pattern) with a high risk of ulcer recurrence and therefore requiring prolonged prophylactic treatment.
使用高倍放大内镜评估胃和十二指肠溃疡的愈合及瘢痕形成情况。瘢痕外观分为三种类型：Sa型，中央有凹陷；Sb型，再生黏膜模式延伸至中央；Sc型，整体呈均匀模式。对58例胃溃疡患者的活检标本再生黏膜模式与组织学结果之间的关系进行了研究。Sa型患者中26.7%黏膜再生充分，Sb型患者中79.2%黏膜再生充分，Sc型患者中100%黏膜再生充分。通过前瞻性内镜随访观察，对80例胃溃疡患者和56例十二指肠溃疡患者溃疡瘢痕的内镜检查结果与溃疡复发之间的关系进行了研究。结果显示，从Sa型经Sb型至Sc型完成溃疡愈合周期的患者很少复发。相比之下，黏膜瘢痕为Sa型的患者复发率较高：胃溃疡为88.8%，十二指肠溃疡为88.0%。我们使用高倍放大内镜评估胃和十二指肠溃疡愈合的方法可能具有重要的预后和治疗意义。它可能提示了一类溃疡复发风险高（Sa型瘢痕模式）的患者群体，因此需要延长预防性治疗时间。
