大腸癌と内視鏡検査 : 12年間の臨床統計

過去12年間に当科に入院した大腸癌患者を集計し,大腸癌の現状と内視鏡施行状況について検討を加え,以下の結論を得た.(1)大腸癌患者は174名で,女性42.0%,男性58.0%であり,年齢は17歳より84歳におよび平均年齢は60.1歳で50歳代,60歳代に多かった.(2)多発例は8%に認められ,発生部位では,直腸・S状結腸の病変で過半数を占めていた.(3)臨床症状は,下血,腹痛,下痢,便秘が多く認められた.(4)形態は,限局潰瘍型・浸潤潰瘍型が多く,大きさは3cm以上の例が多く,深達度では,201病変のうち47病変が早期癌であった.治療は,外科的治療が85.6%を占め,内視鏡的ポリペクトミーを受けた例は12例であった.(5)内視鏡検査は140例に施行され,病変の存在診断は93.4%で可能であり,そのうち93.5%で癌と診断可能であった.大きさ1cm未満の病変では,内視鏡検査は注腸造影検査よりも診断能力が優れていた.From 1973 to 1985, 174 patients with cancer of the colon and rectum were admitted to the Division of Gastroenterology, Kawasaki Medical School. Various kinds of clinical analyses were performed on these patients, including colonoscopy. The following results were obtained. (1) The distribution by sex was 42.0% women and 58.0% men. The patients ranged in age from 17 to 84 years. The mean age was 60.1 years old and the peak occurred in the 50-60 year age group. (2) Multiple lesions occurred in 8% of all cases. More than half of the lesions occurred in the rectum and sigmoid colon. (3) The symptoms of melena, abdominal pain, diarrhea, and constipation were often recognized in these patients. (4) Localized or invasive ulceration types of the colorectal cancer were common and the lesions were usually more than 3cm in diameter. Forty-seven lesions were classified as early cancer. Almost all of patients received surgical treatment and an endoscopical polypectomy was performed on 12 patients. (5) Colonoscopic examinations of 140 patients were performed. Of the total 93.4% of the lesions could be detected and 93.5% of those, which were detected by colonofiberscopy, could be diagnosed as cancer. Especially in the case of lesions of less than 1cm in diameter, colonofiberscopic diagnosis proved more effective than a barium enema

転移性十二指腸癌と内視鏡検査 : 15症例の検討

転移性十二指腸悪性腫瘍について7年間の自験例に検討を加え,以下の結論を得た.(1)転移性十二指腸悪性腫瘍は15例で,膵癌11例,胆嚢癌4例であった.(2)いずれも粘膜下腫瘍の所見を有しているが,膵癌では,病変は下行部,水平部で内側を中心とし,胆嚢癌では下行部で全周性病変であることが特徴である.(3)紫がかった色調変化は,転移性十二指腸悪性腫瘍の診断根拠のひとつと考えられた.From 1979 to 1985, 15 patients with metastatic cancer of the duodenum were admitted to the division of gastroenterology, Kawasaki Medical School. Various kinds of clinical analyses were performed on these patients, including endoscopy, and the following results were obtained. (1) Fifteen cases of metastatic malignant tumor of the duodenum were collected. Of these, 11 cases involved carcinoma of the pancreas and 4 cases involved carcinoma of the gall-bladder. (2) These metastatic cancers were submucosal tumors. Carcinoma of the pancreas usually invades the inside of the second or third portion of the duodenum and carcinoma of gall-bladder usually invades the second portion of the duodenum all round. (3) Purple mucosa is one sign of a metastatic malignant tumor of the duodenum

内視鏡的に虫体を摘出しえた胃アニサキス症と回虫症 : 7症例の検討

川崎医科大学附属病院開設以来12年間に7例の胃内寄生虫を経験した.6例はアニサキスで,穿刺部位は胃体部大彎でびらんを伴っていた.全員鯖を摂取しており11月に多発していた.内視鏡的に虫体を摘出した.1例は回虫で,胃体部大彎で観察され,内視鏡的に摘出した.胃内で回虫を観察することはまれである.From 1973 to 1985, 7 cases of parasites were experienced in our department. In 6 cases of anisakiasis, the worms caused inflammation and erosion of the greater curvature of body of the stomach. All patients had eaten Mackerel. Gastric anisakiasis were frequently encountered in November. In all cases, the worms were removed by endoscopy. In 1 case of ascariasis, the worm was observed in the greater curvature of body of the stomach and was removed by endoscopy. It is rare that the worm of ascariasis is observed in the stomach

バルーンカテーテルによる拡張術が有効であった先天的食道狭窄の1例

症例は,70歳女性で嚥下障害を主訴として当科に入院した.食道造影では,食道入口部に高度の狭窄を認めた.内視鏡検査では,狭窄部の内腔は平滑であったが,肛門側へ挿入できなかった.先天的食道狭窄と診断し,バルーンカテーテルによる拡張術を施行したところ著しい症状の改善を認めた.バルーンカテーテルを用いた拡張療法は,食道狭窄に対し有用であり安全に施行できる.A 70 year-old female was admitted to our division complaining of difficulty in swallowing solid foods. A barium meal examination of the esophagus showed severe stenosis at the entrance of the esophagus. Endoscopical examination showed the mucosa of the stenosis to be smooth but the endoscope was not passed through the stenosis to the anal side. The stenosis was diagnosed to be congenital stenosis. Balloon catheter dilatation was performed and the symptom was remarkably removed. Dilatation therapy by a balloon catheter is effective and safe for a patient with stenosis of the esophagus