大腸癌早期発見の立場からみたX線・内視鏡同日併用検査のメリット・デメリット

Merits and Demerits of Co-Examination by Sigmoidoscope and Barium Enema Study for Colon Disease: With a View to an Early Diagnosis of Colon Cancer

要旨　大腸癌の早期発見を目的とした場合，全大腸にわたる隆起性病変を探索しなければならない．この観点から，われわれはS状結腸ファイバースコープ

と注腸X線検査による同日併用検査を考案し，本法のメリット・デメリットについて検討した．検査対象は，大腸集検で発見した早期大腸癌13例（16病変），大腸ポリープ116例（148病変）と大腸集検以外で発見した早期大腸癌7例（7病変），大腸ポリープ27例（67病変），総計163例（238病変）である．同日併用検査のメリットは，①疾患の多い直腸，S状結腸のダブルチェック，すなわちX線像の重複による病変の見落としの防止，②X線併用により深部結腸が診断可能，③下部大腸を主として内視鏡で観察するため，骨盤部のX線撮影を省略することもでき，放射能被曝の軽減化につながる，④長尺ファイバースコープによる検査の苦痛の軽減，⑤より多くの小ポリープの発見，などであった．一方，デメリットは，①手数が掛かる，②コスト高，③ファイバースコープを先行させるため，腸管への刺激と腸管内に空気が入り二重造影像の条件が悪い，④放射能障害の問題，⑤ファイバースコープの消毒不完全，などであった．

　With a view to an early diagnosis of colon cancer, we investigated merits and demerits of co-examination of the colon carried out on the sameoccasionusing both sigmoidoscope and barium emema study. There were 145 cases, 118 of which were investigated in the course of a mass survey.

　The method was as follows;

　At first, from the anus, we studied the rectum and sigma to a depth of about 25cm, or to the sigmadescending junction, using a sigmoidoscope. After allowing the patients to rest a little, we next madean x-ray examination using barium enema.

　Conclusion:

　1. Merits of co-examination by sigmoidoscope and barium enema study.

　1) We could on the same occasion, make a double check of lesion in rectum and sigma by barium enema study after sigmoidoscope study.

　2) We could find colonic lesion in oral side from sigma by barium enema study on the same occasion.

　3) It is possible to omit barium enema study at rectum and sigma, as we mainly study rectum and sigma by sigmoidoscope.

　4) As fiberscope is advanced as far as 25cm, almost none of the patients complain of abdominal pain.

　5) We could find a number of small polyps at the rectum and sigma by fiberscope.

　2. Demerits of co-examination by sigmoidoscope and barium enema study.

　1) The method involved. much trouble.

　2) The method is costly.

　3) As we performed sigmoidoscope study, colon spasm was apt to be induced and therefore the condition for barium enema study was worse than we encounter in ordinary barium enema study.

　4) There is the problem of damage by radioactivity, if this method is used as first screening in mass surveys.

　5) If this method is used as the first screening in mass survey, the disinfection of the fiberscope instrument is imperfect.