大腸腺腫・早期癌診断における内視鏡の立場―total colonoscopy例による検討

Colonoscopy for Colorectal Polyps

要旨　total colonoscopy症例をもとに大腸の腺腫・早期癌の検討を行い次の結果が得られた．①小さなポリープは大腸内に比較的均一に分布した．②大きなポリープ，特に早期癌は左側大腸に多かった．③右側大腸にポリープが約20％，早期癌が約10％あった．④60歳以上では右側ポリープが全体の約1/4を占めた．⑤早期癌は症例で23％，個数で14％を占めた．m癌48個，sm癌7個であった．⑥癌化率は左側大腸で高い傾向がみられた．中高年者では腺腫・早期癌を目的にcolonoscopyを行うときにはtotal colonoscopyが望ましい．大腸の内視鏡検査では炎症性疾患が対象になるとき（若年者，血便）は病変の有無，したがって病変の一部を観察できれば，検査目的の大部分を達したことになるが，中高年者では全大腸をみて初めて，検査を行った，と言える．“all or nothing”である．

　Cases with adenoma and/or early cancer found by total colonoscopy were analysed (208 cases and 378 polys). The following results were obtained:

　(1) Smaller polyps were found distributed rather evenly throughout the large intestine.

　(2) Larger polyps especially early cancers were predominant at the left side colon and rectum.

　(3) Approximately 20% of all polyps and 10% of early cancers existed at the right colon.

　(4) Right-sided polyps were a quarter of all polyps.

　(5) Early cancers were found in 23% of patient with polyps. Fourteen of the total number of polyps were cancerous.

　(6) The rate of cancer among polyps was higher at the left-side colon.

Therefore, total colonoscopy was recommended for persons above fifty who consulted gastroenterologists.