| 特集名 | CT colonography 2019―今日までの進歩と現状，そして大腸がん検診への展開 | |
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| 題名 | CT colonographyの有用性を巡って (2) 地域医療の立場から―高齢者に対する精密検査法としてのCT colonographyの有用性 | |
| 発刊年月 | 2019年 03月 | |
| 著者 | 八坂 貴宏 | 長崎県上五島病院外科 |
| 著者 | 安田 貴明 | 長崎県上五島病院放射線科 |
| 著者 | 山口 将太 | 長崎県上五島病院内科 |
| 著者 | 本田 徹郎 | 長崎みなとメディカルセンター消化器内科 |
| 【 要旨 】 | 大腸癌の精密検査法は全大腸内視鏡（total colonoscopy；TCS）であるが，高齢者は全身状態の低下や併存症により，内視鏡検査を容易に実施できないケースも少なくない．高齢者の多い離島病院においてCT colonography（CTC）を導入したが，6mm以上の病変の発見精度は，TCSと比較して感度94％，特異度92％であり，偶発症は0％であった．CTCは，高齢者に対しても，安全にそして有効に活用できる検査法であると考えられた． 85歳以上の超高齢者に対するTCS精密検査後の評価では大腸癌関連死はわずか7％であった．CTCは内視鏡検査より検査時間が短く，消化管前処置の負担が少なく，高齢者にも行いやすい．高齢者の大腸癌の予後や身体状況を考慮すると，精密検査として受容性の高いCTCを先行し，トリアージの後，TCSに移行する方法もありうると考えられた． |
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| Theme | CT Colonography 2019 -- Recent Advances, Current Status and Its Evaluation as a Modality for Organized Cancer Screening | |
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| Title | Usefulness of CT Colonography as a Detailed Examination for the Elderly | |
| Author | Takahiro Yasaka | Department of Surgery, Nagasaki Kamigoto Hospital |
| Author | Takaaki Yasuda | Radiology Section, Nagasaki Kamigoto Hospital |
| Author | Shota Yamaguchi | Department of Gastroenterology, Nagasaki Kamigoto Hospital |
| Author | Tetsuro Honda | Department of Gastroenterology, Nagasaki Harbor Medical Center |
| [ Summary ] | Total colonoscopy (TCS) is first choice for a detailed examination of a person with colon cancer. Because the elderly have decreased functions of the body and have many complications, there are a lot of cases where TCS cannot be performed easily. We introduced CT colonography (CTC) in a remote island hospital for many of the elderly. The discovery of colon lesions more than 6 mm with CTC was 94 % of sensitivity, and 92 % of specificity. The occurrence of accidents using CTC was 0 %. It is thought that CTC is a detailed examination procedure that can be performed effectively and safely for the elderly. The colon cancer-related death rate was 7 % as determined by an evaluation of TCS for the super elderly over 85 years of age. CTC has a shorter inspection time than endoscopy, and there are fewer intestinal pre-treatment burdens, so CTC is easy to perform on the elderly. When we consider the outcome of colon cancer and the physical condition of the elderly, we perform the receptive CTC first. And after triage, it is thought that shifting to TCS is better. |
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