臓器別からみた形態診断学―大腸疾患

Morphological Diagnosis of the Specific Organ, Colon Disease

要旨　大腸疾患の形態診断のための検査法は，20世紀後半から著しい進歩，慌しい動きがみられている．20世紀におけるこれらの診断法の歩みを総括するとともに，新しい方向を模索してみた．前処置法や注腸X線検査については大きい進歩がみられず，内視鏡を始めとする他の方法に遅れをとる傾向にある．しかし大腸疾患の診断理論の確立にはX線検査が大きい貢献を果たし，欧米とは異なる微細診断学が確立され，多くの炎症性疾患の病態が明らかになった，21世紀の大腸形態診断学への残された課題として，①X線検査の低迷をどう解決するか，②病理組織診断と肉眼分類の統一，③苦痛なき内視鏡挿入法の開発，などが挙げられるが，④わが国の大腸形態診断学を世界に向けて発信することも要求されている．

　The morphological diagnostic procedures of the colon diseases have been much progressed in the last half of the 20th century. The progress of the diagnostic procedures in the 20th century was summarized and the prospect of diagnostic procedures for the future was discussed. There has been not so much progress in the preparation before a diagnostic procedure and barium enema radiologic examination compared with endoscopic examination and other diagnostic procedures. But the radiologic examination has contributed the establishment of diagnostic theory of the colon diseases and Japan original minute diagnostic system which is not exist in the Western countries, and has disclosed pathophysiology of many inflammatory bowel diseases. The remaining problems of morphological examination of the colon for the 21st century are regarded as follows : ① how to manage the slump of the radiologic examination, ② consistency of pathologic diagnosis with its macroscopic classification, and ③ development of painless endoscopic insertion techniques. The Japanese morphological diagnostic procedures of the colon should be sent out to the world.