山内 理海¹, 濱田 敏秀²

Masami YAMAUCHI¹, Toshihide HAMADA²

¹廿日市市吉和診療所（現：県立広島病院臨床腫瘍科）, ²市立三次中央病院消化器科

¹Hatsukaichi-Yoshiwa Municipal Clinic, ²Department of Gastroenterology, Miyoshi Central Hospital

キーワード : ultrasonography, primary care, gastrointestinal disease

目的：プライマリ・ケア診療における消化管超音波検査の有用性を評価する．対象と方法：へき地診療所で2年間に267例の体外式超音波検査を施行した．全例で実質臓器に引き続き消化管を観察した．腹部症状を有する患者が183例，検査値異常の精査が31例，ルーチン検査が53例含まれる．消化管の異常所見の描出率，診断の妥当性，診断後の経過などを検討した．結果：有症状患者183例中，58例（32％）に消化管の所見を認めた．診断の内訳は，感染性腸炎38例，胃潰瘍4例，腸閉塞4例，虚血性大腸炎3例，便秘3例，急性虫垂炎2例，および十二指腸潰瘍，腸間膜リンパ節炎，上行結腸憩室炎，S状結腸癌が1例ずつであった．検査値異常の精査とルーチン検査では消化管の異常を指摘出来なかった．手術や内視鏡所見と比較出来た27症例から算出した消化管超音波検査の感度，特異度は，それぞれ85％，86％であった．US所見は治療方針の決定や紹介の必要性の判断の際に重要な情報となった．結論：消化管超音波検査は疾患の所見を高い確率で拾い上げることが出来るため，プライマリ・ケアの現場できわめて有用である．

Purpose: To evaluate the usefulness of ultrasonography for the diagnosis of gastrointestinal disease in a rural primary care setting. Subjects and Methods: Over a 24-month period, 267 consecutive patients were examined using transabdominal ultrasound (US), of whom 183 had clinical abdominal symptoms, 31 had abnormalities on blood test, and 53 had neither of them. Results: In 58 (32%) of 183 patients with abdominal symptoms, US detected gastrointestinal disorders (38 infectious enterocolitis, four gastric ulcer, four bowel obstruction, three ischemic colitis, three constipation, two appendicitis, one duodenal ulcer, one mesenteric lymphadenitis, one colonic diverticulitis, and one sigmoid colon cancer). The sensitivity and specificity of US were 85% and 86%, respectively. US often yielded important information about the urgency of diseases and let us know the necessity of referral. Conclusion: Ultrasonography plays an important role in establishing a correct diagnosis of gastrointestinal disease in primary care.