大腸癌の見つけ出し診断―注腸X線検査，全大腸内視鏡検査，S状結腸，内視鏡検査＋注腸X線検査の比較

Routine Examination of Colorectal Cancer: A Comparative Study on Barium Enema Examination, Total Colonoscopy, and Sigmoidoscopy Combined with Barium Enema Examination

要旨　当院胃腸センターにてルーチン検査を受け切除されたm癌を除く大腸癌508例526病変の発見過程を分析し，注腸X線検査（BE）と全大腸内視鏡検査（TCF），S状結腸内視鏡検査＋注腸X線検査（SCF＋BE）の拾い上げ診断能を比較し，大腸ルーチン検査法のあり方を考察した．拾い上げ診断能は，BE97.4％，TCF96.7％，SCF＋BE99.6％であった．いずれも早期癌（sm癌）の見逃しはなかった．BEの見逃しは，注意深い読影と撮影法の改善で容易に防げると思われた．また，CFの見逃しは，直腸（Rb）と多発病変に注意し，全大腸を観察すれば容易に防げると思われた．結論的には，各検査法の拾い上げ診断能に優劣はつけ難く，大腸ルーチン検査法の第一選択は，各施設または各自が得意な検査法を選べばよいと思われた．

　The detecting ability of colorectal cancers excluding mucosal cancer by barium enema examination (BE), total colonoscopy (TCF) and sigmoidoscopy combined with barium enema examination (SCF＋BE) was evaluated upon 526 pathologically-proved lesions of 508 resected specimens detected by routine examination of the colon in Gastrointestinal Center of Matsuyama Red Cross Hospital. The results were as follows:

　(1) BE found 188 out of 193 lesions (97.4%), TCF 60 out of 62 lesions (96.7%), and SCF＋BE 270 out of 271 lesions (99.6%).

　(2) Overlooked lesions by each routine examination were all advanced cancer of the colon and rectum.

　(3) The causes of misdiagnosis by BE were a failure of perception for 3 lesions and technical error for 2 lesions.

　(4) The cause of misdiagnosis by TCF was an unsuccessful examination in both 2 lesions.

　(5) In SCF＋BE, 20 lesions being missed by SCF were found by BE.

　In conclusion, the detecting ability of colorectal cancer, by BE, that by TCF, and that by SCF+BE were equal. The first choice of routine examination for detecting colorectal cancer was a favorite method which may be different in each institute and each individual.