食道アカラシアの診断―X線診断

The Radiographic Evaluation of Achalasia

要旨　食道アカラシア診療において，X線造影検査は，拡張，狭窄，通過状態などの病態把握から，病悩期間および発癌の危険性を含めた予後評価のために重要な役割を担っている．形態と病悩期間および機能との関連についての教室例の検討では，病悩期間および病態が進行するに伴い，拡張型は紡錘型（Sp），フラスコ型（F），S状型（S）の形態を呈し，拡張度はⅠ度，Ⅱ度，Ⅲ度となる．特に，S型の因子が病態の進行を反映しており，SⅢ型では平均病悩期間は16.2年で内圧波形B型が68.8％を占め，高度に進行した病変を示す．X線造影を中心とした諸検査による病態把握と経過観察が，適切な治療計画のために不可欠と考えられる．

　In the treatment of achalasia, radiographic evaluation is necessary to estimate the grade of dilatation of the esophagus and the passage disturbance at the stenosis of the lower esophagus. Moreover, it is useful to estimate the period from onset of the disease and to predict the high risk group for carcinogenesis. In this study, the shapes of the esophagus of 394 cases of achalasia depicted by radiogram were investigated, and the relationship between the shape and the length of the period of the disease or the manometric features were estimated. As a result, it was found that, according to the progression of the disease, the shape of the diseased esophagus changed from the spindle type to the sigmoid type. The sigmoid type over 6.0 cm in width was the most progressive stage manometrically, as well as being the most progressive period during the course of the disease.