中枢神経障害による胃粘膜障害の研究 第1編 ヒト脳血管障害における内視鏡的検討

脳障害に伴う急性上部消化管病変についてCushing1)は1952年,脳腫瘍術後患者に発生した食道,胃,十二指腸潰瘍の自験例について詳細に報告している.その後,中枢神経障害に合併する胃・十二指腸病変はCushing ulcerと呼ばれ多くの報告がなされているが,臨床例に対して内視鏡的検討を行なった報告は少ない.著者は脳血管障害による急性上部消化管病変をごく早期より内視鏡的に観察し,両者の関係について検討したので報告する.

Endoscopic examinations were performed in 59 patients under general anesthesia just before or after surgery for cerebrovascular accidents. Acute gastric mucosal lesions were observed in 32 cases (54.2%). By the second day after the cerebrovascular accident, gastric petechiae and/or erosions in the corpus of the stomach were mainly observed. Acute duodenal ulcer became obvious from the third day after the accident. These upper gastrointestinal lesions were observed frequently in cases with low consciousness levels and cases with large hematomas. Gastrointestinal bleedings was observed in 19 cases. Bleeding in 6 cases observed by the second day after the cerebrovascular accidents was relatively mild. In contrast, bleedings in 7 cases observed 3days after the third day from the accident was serious. Three patients died, and 2 cases underwent surgery stop to the bleeding. These data suggest that it is important to perform endoscopic examination in patients with cerebrovascular accidents as soon as possible to check for acute upper gastrointestinal lesions and bleedings. Mild bleeding observed by the second day after the accident can be treated conservatively. In contrast, since the bleeding observed after the third day can potentially be severe, immediate endoscopic treatment or an emergency operation may be necessary to stop the bleeding.