大腸腫瘍診断における注腸X線検査のポイント―sm massive癌の精密検査

Scrutinized Examination of Colonic Cancer Massively Invading the Submucosa―An Important Point in the Diagnosis of Colonic Neoplasia Using Barium Enema Examination

要旨　大腸癌の深達度診断の指標となる所見を，主要な文献からまとめると，大きさ，肉眼形態，表面構造の“腫瘍正面像の所見”，側面変形，画然とした硬化像の“腫瘍側面像の所見”，ひだ集中像と周囲の透亮像の“腫瘍周囲の所見”の3所見に大別された．最近は，sm massive癌を治療前に適確に診断することが求められている．したがって，精密検査においてsm massive癌を診断するための3所見を確実に描出する検査(二重造影法，薄層法，圧迫法)のポイントを解説した．特に，二重造影法では，空気量に変化を加えた正面像と側面像を中心とした多方向からの撮影が必要であることを強調した．

　According to the medical literature, findings helpful for diagnosis of the depth of invasion of colonic cancer were grossly classified under three headings. They were (1) findings of the en face view such as size, morphologic features and surface structure, (2) findings of the lateral view such as lateral deformity and distinct rigidity, and (3) findings of the surrounding area such as convergency of folds and translucency around the tumor. Recently, it has been required to appropriately diagnose cancer massively invading the submucosa (sm massive cancer). For this purpose, methods of scrutinized examination to correctly diagnose sm massive cancer such as double contrast study, thin barium coating method, and compression study were described. Above all, it was emphasized that, during double contrast study, observaton of the lesion from various directions including the en face and lateral view with varying amounts of air is necessary.