上腹部腫瘤診断―胃を除く触診可能例の分析

Diagnosis of Masses in the Upper Part of the Abdomen: Analysis of palpable tumor cases other than those of the stomach

　ある種の腹部愁訴，特に上腹部のそれをもって患者が来院した場合，まず胃のX線検査は欠くことのできない検査法であることはいまさら言うまでもない．何らかの局在病変が胃に存在する場合は，少くとも本邦においては，胃X線，内視鏡，さらに，必要に応じて直視下生検と，そのsystem化がほぼ完成し，かつきわめて進歩した診断技術により，その病変の発見および性状診断が多くの専門家により，広く日常の診療として行なわれているのが現状である．直径10mm前後の悪性病変でさえ，そう稀でなく発見され，かつ正確な直視下生検によって術前の組織診断が可能な時代となっている．

　しかし一方，悪性腫瘍が胃以外の臓器から発生した場合，ほとんどその早期発見は不可能なのが又一面の現状であり，根治手術可能な時期に発見されてさらに術前の性状診断が確実になされる症例はまことに寥々たるものである．肝，胆道をはじめ膵臓，さらに大腸など近年必らずしも少なくない悪性腫瘍はそのほとんどが既に触診可能，ないし根治不能となって医師の診断を請うものが大多数を占めるのが現状であり，いかにしてこれら臓器悪性腫瘍の早期発見を行なうべきかが今後の大きな問題である．

　As compared with far advanced diagnostic efficiency in identifying gastric neoplasms, improvement of diagnosis of other abdominal tumors, especially of early diagnosis of malignant growths, is one of our most important objectives at the present time. The present paper does not aim to embrace all the aspects of diagnostic efficiency regarding individual examination method of these tumors, which in recent years has been greatly improved, nor does it attempt to explore the utmost diagnostic limitations. Our purpose here is to introduce to the readers how accurate can be the preoperative diagnosis of abdominal tumors that are already palpated, especially those of the digestive tract, encountered in an affiliated hospital, where various examination methods in different branches of medicine are comprehensively utilized. It is also reconsideration of our efforts in this field, expecting criticism and advice from all of the readers concerned.

　It is of course a matter of common knowledge that malignant tumors of the abdomen when already palpable are lesions beyond radical cure. We should therefore direct all our efforts toward early and definitive diagnosis of malignant tumors lurking deeply in the abdominal cavity by combining the most effective diagnostic procedures and selecting the most pertinent sequences in their practice.