左側結腸における大腸早期癌診断の実態―実地医家の立場から

Current Status in the Diagnosis of Left-sided Colorectal Tumors: From a practitioner's standpoint

要旨　1978年度以降1985年3月に至る7年間に名古屋市野垣病院で発見された大腸腺腫1,047症例1,272個，大腸癌669症例690個（うち早期癌208症例228個）の拾い上げ成績を分析した．早期癌は全大腸癌の約330％を占め，しかもその89％が下行結腸以下の左側結腸に見出された．早期癌の拾い上げ手段は肛門からの病変脱出，直腸指診，肛門鏡，直腸鏡検査またはsigmoidoscopyなど下部大腸検査法によるものが32％を占め，その中にはたまたま痔核などの肛門手術中に発見されたものも少数ながら散見された．しかしながら全大腸の網羅性を有するX線検査またはtotal colonofiberscopyによるものが全体の68％を占め，特に大腸の隆起性病変が強く疑われる患者，高齢者，遠方よりの来院患者には外来における注腸X線検査とtotal colonofiberscopyの同日併用による大腸癌精密スクリーニングが最も効率的と考えられた．

　The authors analysed 1,272 adenomas and 690 arcinomas of the colon and rectum including 228 early carcinomas detected during a seven-year period from 1978 to 1985 at the Nogaki Hospital, Nagoya and evaluated screening efficiency by the results obtained.

　Early carcinomas accounted for 33% among all colorectal carcinomas, and 89% of them were located in the rectum and left colon distal to the splenic fiexure.

　Diagnostic procedures such as optical examlnation of the anal region, digital rectal examination, anoscopy, proctoscopy or proctosigmoidoscopy were able to pick-up 32% of the early carcinomas.

　Some of them were found incidentally during surigcal operations for anal diseases such as hemorrhoids etc. 68% of them were detected by barium enema or colonoscopy capable of investigating the entire colon.

　The authors feel strongly that a detailed screening with sequential use of colonoscopy and barium enema on the same day at a clinic is especially efficient in patients suspected of having a protruded lesion, and in cases of elderly people, or of patients who live a long way from the clinic.