3)体外式消化管超音波検査

Clinical Evaluation of Transabdominal Ultrasound for Patients with Gastrointestinal Bleeding

要旨　消化管の各種出血性疾患に対する体外式超音波法（以下US法）の診断的意義について述べた．近年の内視鏡機器の発達により以前に比べ緊急内視鏡検査は安全に行え，また各種の局注療法，熱凝固療法，クリッピングなどの内視鏡的止血操作も確立されてきており，それぞれ良好な成績が得られている．しかしながら，消化管出血時には条件が不良なことも多く，十分な検査や止血処置ができないことも少なくない．消化管領域における各種出血性疾患には悪性腫瘍をはじめ炎症性疾患や循環障害に伴う疾患があり多岐に及ぶ．US法では直接病変を描出することのみならず，消化管以外の他臓器の検索から原因疾患を絞り込むことも可能であり，更に非侵襲的で安全な検査であることを考慮すると，内視鏡検査に先立って行われるべき検査法である．内視鏡やX線診断等の従来の診断法にこれらのUS法を加えることでより効率的に治療方針を決定でき，また病態生理の把握にも役立つ．

　We report the diagnostic usefulness of transabdominal ultrasound in cases of gastrointestinal bleeding. The development of endoscopy and various endoscopic hemostasis methods such as clipping and thermocoagulation has enabled us to perform emergency endoscopy with greater safety than before. Advances in these technologies have produced good treatment results in cases of gastrointestinal bleeding stemming from a variety of causes. According to our experience, it is often impossible to perform endoscopy and hemostatic treatment successfully because of the severity of the bleeding and related conditions. Gastrointestinal bleeding can result from many conditions including malignant tumor, inflammation, and circulatory disorders. Pretreatment transabdominal ultrasound examination allows us not only to detect the source of the bleeding in the gastrointestinal tract but also to make a preliminary diagnosis of the primary disease on the basis of findings in the gastrointestinal tract and surrounding internal organs. With this in mind, it can be said that transabdominal ultrasound is a useful non-invasive method of obtaining needed information before endoscopic examinations. The adding of transabdominal ultrasound to conventional diagnostic methods including endoscopic and radiological studies may be useful for determining more appropriate treatment strategies and for advancing our understanding of the underlying pathophysiology.