小松 篤史

Atsushi KOMATSU

東京大学医学部附属病院女性診療科・産科

Department of Obstetrics & Gynecology, The University of Tokyo Hospital

キーワード : obstetrics & gynecology, transvaginal ultrasound, uterine fibroids, ovarian tumor, pregnancy

腹部領域には消化管疾患のみならず泌尿器科疾患および産婦人科疾患も含まれ，指導検査士（腹部領域）には当然ながらそれらの臨床の知識と高度な超音波検査技術が求められる．産婦人科は産科と婦人科に分けられ，産科に関するものは指導検査士（腹部領域）には必要ないと考えがちであるが，全く妊娠に気が付かず腹部膨隆で内科を受診する患者もおり，やはり産婦人科全体の知識が必要であると考えられる．産婦人科で扱う臓器は子宮および子宮付属器（卵巣・卵管）であり，頻度として高いものは子宮筋腫および卵巣腫瘍である．いずれも時に臍上まで大きくなっていることがあり，腹部超音波検査で偶然にみつかることもある．子宮筋腫は一般に充実性の硬い腫瘤で正常筋層よりもやや低輝度で円形もしくは卵円形を呈する．卵巣腫瘍は多くは嚢胞性腫瘤としてみとめられ，内部に充実部分を有する場合には境界悪性もしくは悪性の可能性を考慮する必要がある．卵巣腫瘍には良性，悪性，境界悪性含めて多くの組織型があり，全てを記憶する必要はないが，頻度の高い子宮内膜症性嚢胞，成熟嚢胞性奇形腫の超音波所見や，悪性を疑う所見に関しては理解していただきたい．妊娠中の超音波は胎児が正常に発育しているかをみるものである．全身臓器の細かいスクリーニングに関しては割愛するが，胎児推定体重や羊水量評価，well-beingに関する知識は修得してもらいたい．

Abdominal ultrasound examinations can include investigation of not only the digestive organs but also the urinary and reproductive organs. As such, Senior Medical Sonographers must have clinical knowledge of both urology and obstetrics/gynecology as well as advanced examination skills. People tend to think that Senior Medical Sonographers do not need to have any knowledge of obstetrics, but there are patients with an abdominal bulge who visit internists without knowing that they are pregnant, suggesting that an overall knowledge of obstetrics and gynecology may be necessary. The relevant organs of obstetrics and gynecology are mainly the uterus and adnexa (ovaries, fallopian tubes). The most frequently encountered diseases in obstetrics and gynecology are uterine fibroids and ovarian cysts. Both diseases may sometimes grow to navel height, in which case they may be incidentally detected by abdominal ultrasound. Uterine fibroids generally present as a circle or egg-shaped solid mass with lower echogenicity than normal uterine myometrium. Most ovarian tumors are recognized as a cystic mass, and the possibility of malignancy needs to be investigated when a solid part is observed inside a cystic mass. The histopathology of ovarian tumors includes benign, borderline malignant, and malignant. Senior Medical Sonographers need to have knowledge of ultrasonographic findings of common ovarian tumors such as endometrial cyst, mature cystic teratoma, and suspected malignant ovarian tumor. The purpose of obstetrics ultrasound is to investigate fetal growth and fetal well-being. Sonographers need to be able to measure the estimated fetal body weight and the amniotic fluid volume. Knowledge of detailed screening of the fetus is not necessary for Senior Medical Sonographers.