内視鏡によるスクリーニング

Mass Survey of the Stomach with the Gastrocamera

はじめに

　早期発見のいかんが胃癌の永久治癒率を大きく左右する現状において，そのための有力な手段の一つとして胃集検が行なわれ，その成果は目覚ましいものがあるといえども，なお検討を要すべき点が少なくない．

　胃癌は初期には一般的に自覚症状が軽微であるか，殆んど無症状であるため，一般に健康と信じる人々の中から胃癌，とくに粘膜癌のごとき早期胃癌を見つけ出さなければならない．早期胃癌の発見が集団検診の目的であり，使命であるが，第一次スクリーニングの方法いかんによっては，その成績に重大なる影響があり，見逃し→手遅れ→すなわち死に直結する問題に対し，筆者らは極力見逃し例の防止と，進んで精密度の高いスクリーニング法の必要性を痛感する．間接X線のみによるスクリーニング法は，客観的に病巣，をとらえ得る優れた方法として，広く一般に行なわれており，さらに最近テレビカメラの開発撮影技術の進歩などにより，早期胃癌を始め，微細病変の発見は大きな進歩を示しつつあるが，なお検討を要すべき点も少なくない．

　筆者らは集検の場における，第一次スクリーニング法として，従来の間接X線スクリーニングに，集検用胃カメラを併用して10数年来，胃集団検診を行なってきているが，内視鏡スクリーニングの意義方法，成績およびいくつかの問題点について述べる．

　The earliest possible diagnosis of stomach cancer is essential for obtaining better therapeutic results. In this respect, the conventional minute Photofluo-rographic mass survey is still unsatisfactory. The authors have performed mass survey with the gastrocarnera in K-city for more than 10 years on 6967 cases in total, among which 38 cases of stomach cancer, including 19 cases in early stages, or 0.5% of the total number of the examinees, were found; of which 25 cases were diagnosed as cancer at the screening only with the gastrocamera type P. The P-type gastrocamera used by the authors for more than one decade has been playing an important role in the mass survey of the stomach, being favored for its easy manipulation without any discomfort or side effect suffered by the examined, and constantly proving the excellent diagnostic capability, consequently minimizing the number of those cases referred for further diagnostic measures. On the other hand, the popularity among the examinees who once experienced the gastrocamera examination increased the number of the examinees year by year and also facilitated the necessary follow-up of the eases in question, which consequently solicited many interesting research proolems thereof concerned and greatly animated the cooperative works among the local medical units.

　The PA type gastrocamera newly exploited by Sakita et al. is more convenient to photograph the entire area of the stomach and now intensifying the diagnostic capability in the mass survey by endoscopy.