大腸診断学の歩みと外科

Changing Trends of Surgical Management of Colorectal Disease in Relation to Recent Advances of Diagnostic Methods

要旨　大腸癌，ポリープ(腺腫)，潰瘍性大腸炎，Crohn病における診断学の進歩を外科的治療とのかかわり合いの面から眺めてみた．外科的治療と最も関係が深いのはポリペクトミーの開発であり，これによって従来行われてきたようなポリープに対する手術的治療法はほとんど不必要となってしまった．また，この新しい診断・治療法からsm癌をどのように治療すべきかという新しい問題が提起されることになった．ポリペクトミーの発展以外には，診断学の進歩よりは疾患概念の正しい理解と思考の転換によって，外科的治療方針が著しく変化してきたことが示唆された．直腸癌に対して前方切除，局所切除が，潰瘍性大腸炎に対して括約筋温存術が，正しい適応のもとにより頻繁に行われ，良好な成績を収めつつあることは外科的治療学の進歩であると考えられる．大腸癌の診断学がほぼ確立された現在，より早期の癌をより多く発見するためには，high risk群の選別法，スクリーニング法の確立など，新しい分野の進歩が必要であろう．

　Changing trends of surgical management of colorectal disease was reviewed in view of recent advances of diagnostic methods. The most striking change was noticed in the way of management of colonic polyps. Colonoscopic polypectomy facilitated quick diagnosis and safe treatment at the same time, and prevented unnecessary laparotomy. Despite remarkable advances of diagnostic techniques by x-ray and endoscopy the proportion of Dukes C cases was not changed much over the past 20 years, and therefore new method such as mass-screening or surveillance for high risk group has to be employed in order to detect malignancy in its earlier stage. However, from increasing experience and knowledge anterior resection or local excision for rectal carcinoma, and sphincter saving operation for ulcerative colitis has been increasingly performed over the last 10 years which contributed improving quality of life for patients a great deal. These changes of surgical procedures are mainly due to changing attitude of surgeons towards functionpreserving operation and careful selection of surgical indication. By detecting colorectal disease in much earlier stage minor operation could be employed more frequently.