盲腸・上行結腸の癌診断

Diagnosis of Carcinoma in the Cecum and Ascending Colon

　Colonofiberscope^1)～7)の開発により，盲腸・上行結腸の内視鏡的観察が可能となり，この部の疾患の診断は飛躍的な進歩をとげた．換言すると，この部の診断のポイントは，いかにしてscopeを挿入させるかということにあるといっても過言ではなかろう．Colonofiberscopeの深部挿入法については，すでに多くの機会に述べてきたので省略するが，著者らの考案した逆「の」字法¹⁾と牧石らのsliding tube法⁸⁾を用いることにより，2，3の例外を除いて回盲部までの挿入は非常に容易であり，外来でもroutineに行ない得るということを強調したい．

　本稿では，盲腸・上行結腸の癌とその鑑別診断について，Colonofiberscopyによる診断を中心に論ずる．

　Diagnosis of affections involving the cecum or ascending colon has made rapid progress in accordance with the development of colonofiberscopy. In other words, it would be not too much to say that diagnostic point in these areas lies in how to insert the scope into the segment to be examined. And now the insertion is easily done by the “α”-loop method as devised by the author or by sliding tube method worked out by Makiishi et al.

　Patients with carcinoma in the cecum or ascending colon often complain of tenderness on palpation or even spontaneous pain over the afflicted area or of sensation of fullness of the abdomen. Not uncommonly would the patients visit the hospital because they have palpated a tumor.

　Roentgenography of carcinomas in these areas show shadow defect, mural irregularity, rigidity and narrowing of the lumen. Naturally these findings should be distinguished from strictures due to functional disorders. By roentgenology alone it is often difficult to diagnose early cancer.

　Diagnosis of advanced carcinoma is made with ease by colonofiberscopy, but in the terminal stage of cancer the scope is often hard to insert because of cancerous peritonitis. We would also come across cases in which biopsy was negative for malignancy. In minute focal carcinoma in polyps it is usually hard to confirm malignant findings. Endoscopic polypectomy thus becomes important in the sense of complete biopsy of the affected areas. As yet it is hard to tell benign polyp from malignant one by endoscopic features alone. Further progress in this field is thus eagerly awaited for.

　As the right-hand side of the colon, especially the cecum is a most favored site of inflammatory diseases, in this paper are illustrated cases of ulcerative colitis, fibrinous appendicitis, Crohn's disease and nonspecific ulcer of the cecum.