大腸X線検査法・診断法の歴史と今後の展望

History and Prospects of Diagnostic Radiology of Colorectal Disease

要旨　大腸のX線診断学の歴史は，X線検査法の歴史と深く相関しており，次の4つの時期に区分すると理解しやすい．すなわち，Ⅰ期：X線が発見され蒼鉛剤などが，造影剤として使用された時期，Ⅱ期：造影剤として硫酸バリウムが経口的または注腸的に用いられたが，充盈法や粘膜レリーフ法が主体であった時期，Ⅲ期：注腸二重造影法が開発・導入された時期，Ⅳ期：腸洗が不要な直接二重造影法が主流となり，また粘膜の基本像が定まり，微小・微細診断が確立した時期，である．まず，各時期における先達者の業績とX線診断学への意義について述べ，次に，本邦における大腸X線診断学の歩みを述べた．その中で白壁・市川により思想的に質的転換が行われ，わが国独自の消化管診断学確立への大きな礎となったことを明らかにした．また，過去20年間における大腸X線診断学で，世界をリードしえた主要な業績について概説した．最後に，二重造影法および形態学に対する筆者の見解を示し，今後の展望については，“X線病態学”，“X線病態生物学”を指向した私見を述べた．

　The history of diagnostic radiology of the colon is closely related to that of the methodology of x-ray examination, thus, its history is easily understood by dividing it into four periods. Namely, the first covered the period when substances such as bismuth had been used as the contrast medium after the discovery of x-ray. The second period was when barium sulphate was used as the contrast medium with oral or enema study during the time when barium filling method or mucosal relief method was in the main stream. The third, when the double contrast method with barium enema had been developed and put into practice, and the fourth, when the direct double contrast method free from the washing of the colon was the main stream and during which time the principal pattern of the mucosa and the minute and precise diagnosis had been established. The achievements of the forerunners in each period and their significance in diagnostic radiology were compiled. This was followed by a study into the history of diagnostic radiology of the colon in Japan, in which it was clarified that Dr. H. Shirakabe and Dr. H. Ichikawa brought forth a qualitative transformation in the philosophy of such diagnosis and contributed to the making of a firm foundation of establishing gastrointestinal diagnosis unique to Japan. Also, a study of the main world-leading achievements of diagnostic radiology of the colon in Japan during the past 20 years was made. In conclusion, our opinions regarding the double contrast method and morphology including their prospective and retrospective studies were described based on our expectations toward “clinicoroentgenology” and “x-ray clinicalpathobiology”.