S状結腸癌のMass Screening―近接X線テレビ装置によるルーチンX線検査

Mass Screening for Carcinoma of the Sigmoid Colon: Routine radiographic examination by close-up television apparatus

　わが国における大腸のX線診断は，胃のX線診断の目覚しい進歩の蔭に長い間おきざりにされ，検査法もほとんど改良をみなかった．しかし，狩谷・西沢らの研究が報告されたのを機に，この数年の間に急速に進歩し診断能も著しく向上してきた．また，わが国で開発されたジャイロに関しても丸山（癌研）らによって検査理論もでき，優れた成績が報告されている．

　このような短期間におけるレベルの向上も，すでに胃において微細病変描写の検査理論ができ上がっているわが国においては，当然のことといえよう．しかし，この胃における検査理論がそのまま大腸にあてはまるものではなかった．腸の解剖学的，生理学的な特異性，病変の特徴など胃との相違点に対して，どのように対処していくかが大きな課題であったが，これらもほぼ解決されたとみてよいであろう．

　For routine radiographic examination of the colon, we have adopted four standard positions of the patient on the basis of slightly modified one-stage method used by Kariya and Nishizawa. For preparation of the patient, a modified Brown's procedure has been adopted. Evaluation of the efficacy of our method for routine X-ray examination of the colon has given us the following results:

　1. In 28 per cent of the patients the time for examination in each individual wias withn 10 minutes. Less than 14 minutes were necessary for the remainder. Radiation time per person was under four minutes; on an average it was three.

　2. For exposures of the sigmoid colon we have used four films as regular positions: supine frontal, supine first oblique, supine second oblique and prone frontal positions. We have studied how well protruding lesions might be delineated. If the four different positions were adopted in routine examinations, one or two films at least would include positive results, either (+) or (++).

　3. No close correlation was seen between the positive results and the size (height, greatest diameter) of the tumors. However, those of low stature were liable to be overlooked even when they were large in diameter.

　4. Such factors as anatomic and physiologic conditions, the nature of the lesions or poor coating of the contrast medium to the mucosal surface account for the difficulty in detecting lesions. In particular, there is still much room for improvement in coating.

　5. Study of the relationship between coating and network patterns showed that a requisite for obtaining good coating did not coincide with that of getting satisfactory network patterns. At times they could conflict with each other. A great deal of technical skill is necessary to satisfy both conditions.