消化管癌のX線診断における側面像の意義―二重造影像による深達度診断

Significance of the Profile View in the X-ray Diagnosis of Cancerof the Digestive Tract: Diagnosis of depth invasion by double contrast study

要旨　二重造影像にて病変の側面像が撮られ，しかも大きさが3cm以下の，食道癌23例，“隆起性”胃癌21例，腸癌48例について，深達度診断をX線学的に行い，以下の結果を得た．①癌の深達度が深くなるにつれて，側面像における消化管の辺縁の変形とその程度は強くなっていた．Ⅱ消化管の変形には共通性がみられ，1側変形の型は，無変形，角状変形，弧状変形，台形状変形に分類することが最も妥当であると考えられた．③台形状変形を示す例では，癌巣は固有筋層またはそれ以下に中程度量以上浸潤しており，明らかな進行癌の所見とみなしうる．④弧状変形を示す揚合は，癌巣は粘膜下組織にmassiveに浸潤しているか，固有筋層にも少量浸潤している所見とみなしうる．⑤角状変形を示す例では，粘膜下組織層に中程度量浸潤していると考えられる．⑥無変形（病変自体による辺縁不整と直線化，硬化所見を伴うも，明らかな変形とはみなしえない程度のもの）では，癌巣は粘膜固有層内にとどまっているか，または極く少量が粘膜下組織層に浸潤しているとみなしうる．以上より，消化管癌の深達度診断に際しては，積極的に病変の側面像を撮影し，管の辺縁の変形の有無とその程度を解析することが重要である．また変形には，食道，胃，大腸に共通する型が認められた．

　X-ray diagnosis of cancer invasion to the wall was attempted in 23 cases of esophageal cancer, 21cases of the so-called protruded type of gastric cancer and 48 cases of cancer of the colon; all less than 3cm long and their profile view was taken in double contrast study. We obtalned the following results.

　1) As the cancer invasion becomes deeper, the shape and degree of the outline of the digestive tract wall is closely connected with the depth of cancer invasion.

　2) The deformity of the lesions in the digestive tract has something in common to each other. It is most pertinent to classify the deformity into: none; wedge shape; semilunal; and trapezoid.

　3) In cases with trapezoid deformlty the lesion usually invaded the proper muscle Iayer or deeper beyond in more than moderate degree. These findings could be regarded as those of advanced cancer.

　4) In cases with semilunal deformity cancer lesion represented either massive infiltration into the submucosal tissue layer or minute invasion to the proper muscle layer.

　5) In cases with wedge shape deformity cancer invasion could be regarded as infiltration into the submucosal layer in moderate degree.

　6) In cases with no deformity of the outline (accompanied with irregular or straightened margin or its rigidity but could not be regarded as apparent deformity) cancer lesion usually remained in the mucosal proper layer or else was accompallied with minimum infiltration into the submucosal layer.

　The above-mentioned fact sseem to show us that in the diagnosis of cancer invasion profile view should be taken actively and to analyze the absence or presence of the deformity of the digestive tract wall and its degree. A type of deformity was recognized common to the sophagus, stomach and colon.