大腸癌の診断に注腸X線検査は必要か―原則必要とする立場から：大腸の上皮性腫瘍における注腸X線検査の有用性

The Benefit of Barium Enema in the Assessment of the Epithelial Tumor of the Colon, Focused on the Colonic Cancer

要旨　大腸の上皮性腫瘍は，粘膜上皮から発生するため，大腸の内腔すなわち粘膜面を描き出す注腸X線検査と内視鏡検査は必須である．このうち前者の利点として，以下のことが挙げられる．①腸管外の変化を把握しやすい，②強い狭窄を伴った病変でも，口側の情報が得られる，③病変の連続性と多発性の把握，病変間の距離などが正確に把握できる，④癌では正面像のみならず腸管の伸展性と側面像における変形の程度から，深達度診断を行いやすい，⑤病変の部位の同定が，客観性をもって厳格に行うことができる，⑥全体像の把握のみならず病変の大きさが計測できるので，病変の自然史の研究に活用しうる．一方，最近問題となっている大腸のⅡc型早期癌のX線像について，胃との比較診断学の立場から述べた．

　Colonic epithelial tumor arises from the mucosa, therefore it is essential for barium enema (BE) and endoscopic examinations to evaluate the internal surface, i.e. the mucosal surface of the colon. The superiority of BE over endoscopic examination is summarized as follows: (1) It is easy to evaluate morphological change of the intestine associated with lesions outside, (2) Information of the oral side of severe narrowing lesions can be obtained by BE, (3) BE would detect continuity and/or multiplicity of the lesion, and the distance between the lesions can be measured more accurately than endoscopic examination, (4) In addition to the frontal view, distensibility of the intestine and degree of deformity of the lateral view enable to diagnose the depth of invasion more easily, (5) The location and size of the lesion can be assessed more objectively, therefore BE is helpful in the study of the natural history of the disease. Radiologic examination of the type Ⅱc early cancer of the stomach and that of the colon were compared.