亀田 徹, 高橋 功, 森下 由香, 吉田 哲, 大西 新介, 内藤 祐貴, 清水 隆文, 真鍋 春子, 岩崎 浩司, 本間 多恵子

Toru KAMEDA, Isao TAKAHASHI, Yuka MORISHITA, Akira YOSHIDA, Shinsuke ONISHI, Yuki NAITO, Takafumi SHIMIZU, Haruko MANABE, Koji IWASAKI, Taeko HONMA

手稲渓仁会病院救急部

Department of Emergency Medicine, Teine Keijinkai Hospital

キーワード : abdomen, emergency, hand-carried ultrasound, ultrasonography

目的：携帯型超音波装置の普及により，救急外来や一般診察室で超音波検査が手軽に利用出来るようになった．救急外来における携帯型装置を用いた腹部超音波検査の有用性について検討した．対象と方法：事前に診断されていない非外傷患者で，救急外来にて病歴・身体所見を取得された後，著者により2種類の携帯型装置のいずれかを用いて腹部超音波検査を施行され，さらに単純X線検査を除く画像診断，内視鏡，手術いずれかが施行された144例を抽出し，病変部位の特定に関し携帯型超音波装置の精度をretrospectiveに検討した．結果：116例（81％）の超音波所見は，原発・主病変の部位について最終診断と一致したが，28例（19％）は一致しなかった．28例中25例では原発・主病変を描出出来なかったが，そのうち4例は治療方針決定に寄与する重要な間接所見が得られた．一方，主病変の部位を誤って判断したのは28例中3例とわずかであった．結論：救急外来にて病歴と身体所見を取得後に施行した携帯型装置による腹部超音波検査は，病変部位を特定するのに有用である．

Purpose. To evaluate the utility of abdominal ultrasonography carried out using hand-carried devices in the emergency room. Materials and Methods. We reviewed records of abdominal ultrasonography using either of two different types of hand-carried devices by the first author in nontraumatic patients who presented to the emergency department. We chose 144 consecutive patients whose lesions had not been previously identified but were evaluated using imaging modalities other than plain radiography, endoscopy, or surgery after the ultrasonographic examination had been carried out. We retrospectively evaluated the accuracy of identifying abdominal lesions with the hand-carried devices. Results. The ultrasonographic findings of 116 (81%) cases agreed with the final diagnoses on the parts in which primary or main lesions were located; those of 28 (19%) cases did not. Twenty-five of the 28 examinations failed to detect the lesions, but 4 of the 25 examinations correctly detected significant indirect findings that contributed to the final diagnoses. Only 3 of the 28 examinations yielded incorrect results. Conclusion. Abdominal ultrasonography performed with the hand-carried devices after noting the patient′s history and carrying out a physical examination in the emergency room is useful in identifying the sites of primary or main lesions.