右側結腸における大腸早期癌診断能の比較

Comparison of the Diagnostic Capability in Early Carcinoma of the Right Colon between X-ray Examination and Colonofiberscopy

要旨　過去20年間に当教室で経験された右側結腸（ここでは盲腸および上行結腸に限った）の早期癌は6症例8病変であり，いずれも切除例であった．術前診断は十分になされたとは言えず，存在診断が得られたのはX線検査で8病変中3病変，内視鏡検査で8病変中6病変であった．X線検査による診断成績が悪かったのは，病変の形態の特殊性（Ⅰp型1例，Ⅱa型5例，Ⅱa＋Ⅱc型1例，Ⅱb型1例）が一因と考えられたが，多くは右側結腸におけるX線検査の未熟さによるものと考えられた．しかし内視鏡検査において完全に見落とされた病変があることを常に念頭に置く必要がある．

　Eight lesions of early carcinama of the right colon (cecum and ascending colon) were encountered in six patients during the last two decades in our department. All lesions were resected by operation. Four of these early carcinoma were limited to the mucosa and others had submucosal invasion. Two of four lesions without submucosal invasion were less than 20mm in size, but none of four sm carcinoma were under 20mm in size. The shapes of these lesions were all non-pedunculated but there was one lesion of type Ip.

　Preoperative diagnosis of these lesions were not sufficient. Only three of these eight lesions were detected by x-ray examination, six of the eight by colonofiberscopy. One of the reasons for the bad results of x-ray diagnosis was due to the unusual shapes of these lesions, i. e. two IIa type, one IIa + IIc type, and one IIb type. The poor technique of x-ray examination in the right colon, however, is thought to be the main reason. It is possible to say colonofiberscopy is a more reliable procedure in finding out early carcinoma in the right colon. It should be noted, however, that there was a lesion that was completely missed even by this reliable diagnostic method.