食道鏡検査―食道ファイバースコープを中心として

EXAMINATION WITH ESOPHAGOSCOPES: Utilization of the Fiberscope

Ⅰ．はじめに

　従来，食道鏡による診断は硬性食道鏡にたより，耳鼻科医の手によって行なわれていた．最近，食道の微細な病変を問題にする様になり，癌の早期発見が叫ばれるようになって，実際診断にたずさわる内科，外科，放射線科の医師が比較的容易に操作することが出来る食道鏡の開発が望まれていたが，食道ファイバースコープの改良によって食道疾患の診断も新しい時代に入ったのではないかと思われる．胃癌の早期発見がレントゲン撮影診断技術と内視鏡の活用によって，いちじるしい向上を見た事が思い出されるのである．

　実際に現在までに報告された7例の早期食道癌のうち，そのほとんどが，食道鏡による生検によって確診が得られていることを思うと（第6表）食道ファイバースコープの普及は今後，益々，その重要性が認識されるものと思われる．

　われわれは第1表及び，第2表に示す如く，種種の疾患に各種の食道ファイバースコープを使用して来たが，その使用経験を中心に，従来の硬性鏡と対比しながら述べて見たいと思う．

　In the course of about two years running from 1964 through March 1967, we have utilized the fiberscope for the total of 585 cases, all of which involving esophageal ailments and post-excision developments. From this experience the merits of fiberscopes in comparison with the hard-type esophagoscopes, comparison of the features of various makes, the relation to the actual tissue diagnosis, and the positive rates of the biopsy are reported in this article.

　The fiberscope manufactured by American Cystoscope, Inc. lacks the angle adjustment device at the tip, which may partially contribute to the rather low positive rate. On the other hand the two Japanese-make types, Olympus (E. F.) and Machida (F. E. S.), incorporate the angle adjustment device, and both of them are superior to the American-make type on other accounts as well.

　Olympus Type E. F. attained the remarkable result in the positive rates of 92.3 and 75.0 per cents, for the cancers of esophagus and of cardic orifice respectively. Moreover, the brushing technique utilized in our surgical group in examining the cellular tissues resulted in the positive rates of 88.4% and 69.6%. for the cancers of esophagus and of cardiac orifice respectively. In view of this rather excellent showing we feel the brushing technique should be made the routine of every esophageal examination.

　The superior quality of fiberscopes were best exemplified in the diagnosis of esophageal varices, post-operative observation of intestine and the rest of the stomach, or the observation/examination inside the thorax in the case of esophageal hernia. None of these could be satisfactorily conducted when the only available tools were hardtype esophagoscopes.

　In this article various cases pertaining to the above are described, and the merit of utilizing the fiberscope is fully discussed.