対策型検診のための胃内視鏡検診マニュアル2015 年度版

一般社団法人 日本消化器がん検診学会
対策型検診のための胃内視鏡検診マニュアル作成委員会 編集୍⯡♫ᅋἲே ᪥ᮏᾘ໬ჾࡀࢇ᳨デᏛ఍ᑐ⟇ᆺ᳨デࡢࡓࡵࡢ⫶ෆど㙾᳨デ࣐ࢽࣗ࢔ࣝసᡂጤဨ఍
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ᅜ❧኱Ꮫἲே ᒣᙧ኱Ꮫ⌮஦࣭๪Ꮫ㛗୍⯡♫ᅋἲே ᪥ᮏᾘ໬ჾࡀࢇ᳨デᏛ఍⌮஦㛗ጤဨ୍℩㞞ኵ ࿴ḷᒣ┴❧་⛉኱Ꮫᩍᤵ
ᩪ⸨༤ᅜ❧◊✲㛤Ⓨἲே ᅜ❧ࡀࢇ◊✲ࢭࣥࢱ࣮
♫఍࡜೺ᗣ◊✲ࢭࣥࢱ࣮㒊㛗῰㇂኱ຓ  බ┈㈈ᅋἲே ᐑᇛ┴ᑐࡀࢇ༠఍ࡀࢇ⥲ྜᨭ᥼ࢭࣥࢱ࣮ᡤ㛗ᡂ⃝ᯘኴ㑻 ᪂₲┴❧ࡀࢇࢭࣥࢱ࣮᪂₲⑓㝔⮫ᗋ㒊㛗℈ᓥࡕࡉ࡜ ᅜ❧◊✲㛤Ⓨἲே ᅜ❧ࡀࢇ◊✲ࢭࣥࢱ࣮
⣽ᕝ἞♫఍࡜೺ᗣ◊✲ࢭࣥࢱ࣮ᐊ㛗ᅜᐙබົဨඹ῭⤌ྜ㐃ྜ఍ ᶓ὾ᰤඹ῭⑓㝔㝔㛗ⰾ㔝⣧἞⸨⏣ಖ೺⾨⏕኱Ꮫྡ㄃ᩍᤵ㸦 㡢㡰㸧 ᮏ࣐ࢽࣗ࢔ࣝసᡂࡣࠊཌ⏕ປാ⛉Ꮫ≉ู◊✲஦ᴗ ᖹᡂ  ᖺᗘ 㺀ᑐ⟇ᆺ᳨デ࡜ࡋ࡚ࡢ⫶ෆど㙾᳨ᰝ➼ࡢᐇ᪋࡟࠿࠿ࡿయไᩚഛࡢࡓࡵࡢ◊✲㺁࡟ᇶ࡙ࡃႸᴾ ഏᴾᴾ
Ϩ. ┠ⓗBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBข‫ࢧރ‬ᴾ ᴾ 1ᴾ
ϩ.⫶ෆど㙾᳨デࡢ⛉Ꮫⓗ᰿ᣐBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBສ޽ẼẰểᴾ
1. ⫶ࡀࢇ᳨デ࢞࢖ࢻࣛ࢖ࣥBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB3
2. ⫶ࡀࢇṚஸ⋡ῶᑡຠᯝBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB5
3. ឤᗘ࣭≉␗ᗘBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB7
4. ⏕Ꮡ⋡BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB8Ϫ.
⫶ෆど㙾᳨デࡢ୙฼┈BBBBBBBBBBBBBBBBBBBBBBBBBBBBສ޽ẼẰểẆฑ᜿‫ٻ‬яᴾ 
1. ഇ㝧ᛶBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB ℈ᓥࡕࡉ࡜ 10
2.㐣๫デ᩿BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB ℈ᓥࡕࡉ࡜ 10
3.ឤᰁBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB ℈ᓥࡕࡉ࡜ 12
4.അⓎ⑕BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB ῰㇂኱ຓ 13

ϫ.
ᐇ᪋᪉ἲBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBສ޽ẼẰể
1.ᑐ㇟ᖺ㱋BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB18
2.᳨デ㛫㝸BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB20
3.ᑐ⟇ᆺ᳨デࡢᑐ㇟ᖺ㱋᳨࣭デ㛫㝸BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB20

Ϭ.
⢭ᗘ⟶⌮ࡢ⪃࠼᪉BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB૬ᕲҦᴾ
1.⢭ᗘ⟶⌮⥲ㄽBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB21
2.⫶ෆど㙾᳨デࡢࡓࡵࡢ⢭ᗘ⟶⌮BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB25ϭ.
⫶ෆど㙾᳨デᐇ᪋ࡢ᮲௳BBBBBBBBBBສ޽ẼẰểẆ঺ຓ௎‫ٽ‬ᢹẆฑ᜿‫ٻ‬яẆኬ߷඙ᴾ
1. ⫶ෆど㙾᳨デࡢฎ⌮⬟BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB℈ᓥࡕࡉ࡜ 26
2. ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB℈ᓥࡕࡉ࡜ 30
3. ᳨デཷデᑐ㇟BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB ᡂ⃝ᯘኴ㑻 32
4. ᳨ᰝ་࣭࣓ࢹ࢕࢝ࣝࢫࢱࢵࣇBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB ῰㇂኱ຓ 33
5. ᳨ᰝ㛵㐃ᶵჾBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB⣽ᕝ἞ 35
6. ㄞᙳయไBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB ᡂ⃝ᯘኴ㑻ࠊ⣽ᕝ἞ࠊ℈ᓥࡕࡉ࡜ 37
7. ⤖ᯝุᐃBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB ℈ᓥࡕࡉ࡜ 41
8. ᳨デࢹ࣮ࢱ࣮࣋ࢫBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB℈ᓥࡕࡉ࡜ 43
9. ⢭ᗘ⟶⌮ᣦᶆࡢ⟬ฟBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB℈ᓥࡕࡉ࡜ 46
10. ◊ಟ࣒࢝ࣜ࢟ࣗࣛBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB℈ᓥࡕࡉ࡜ 48

Ϯ.
᳨ᰝᡭ㡰BBBBBBBBBBBBBBBBBBBBBBBBBBBB঺ຓ௎‫ٽ‬ᢹẆᑷ᣼ኝ඙Ẇኬ߷඙Ẇສ޽ẼẰểᴾ
1. ᳨ᰝࡢ‽ഛBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB ᡂ⃝ᯘኴ㑻 49
2. ࢖ࣥࣇ࢛࣮࣒ࢻ࣭ࢥࣥࢭࣥࢺBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB ⰾ㔝⣧἞ 51
3. ๓ฎ⨨BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB ᡂ⃝ᯘኴ㑻 53

4. ⫶ෆど㙾᳨ᰝᡭ㡰BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB⣽ᕝ἞ 56
5. ᶵჾ⟶⌮BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB⣽ᕝ἞ 64
6. ⤖ᯝሗ࿌BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB ℈ᓥࡕࡉ࡜ 67

ϯ. ୙฼┈࡬ࡢᑐ⟇BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBສ޽ẼẰểẆฑ᜿‫ٻ‬яᴾ
1.ഇ㝧ᛶBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB ℈ᓥࡕࡉ࡜ 692.㐣๫デ᩿BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB ℈ᓥࡕࡉ࡜ 69
3.ឤᰁBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB ℈ᓥࡕࡉ࡜ 694.അⓎ⑕BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB ῰㇂኱ຓࠊ℈ᓥࡕࡉ࡜ 71

ϰ.
ࡲ࡜ࡵBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBສ޽ẼẰểᴾ 76
ϱ.
௒ᚋࡢㄢ㢟BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBɟແᨻ‫پ‬Ẇສ޽ẼẰể
1.ࣜࢫࢡᒙู໬BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB ୍℩㞞ኵ 79
2.⫶ෆど㙾࡟ࡼࡿ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁデ᩿BBBBBBBBBBBBBBBBB ୍℩㞞ኵ 88
3. ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜ㝖⳦BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB ℈ᓥࡕࡉ࡜ 96Q & ABBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBສ޽ẼẰểᴾ
ᕷ༊⏫ᮧ⦅ _______________________________________________________________________ 97
་⒪ᶵ㛵⦅ ________________________________________________________________________ 99

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,.┠ⓗࡀࢇ᳨デࡣࠊࢃࡀᅜࡢࡀࢇᑐ⟇ࡢ㔜せ࡞᪋⟇ࡢ୍ࡘ࡜ࡉࢀࠊ2012 ᖹᡂ 24 ᖺ 6 ᭶࡟ 㛶 ㆟ Ỵ ᐃ ࡉ ࢀࡓ ࡀ ࢇᑐ⟇᥎㐍ᇶᮏィ⏬࡛ࡣࠊࡍ࡭࡚ࡢᕷ༊⏫ᮧࡀ⢭ᗘ⟶⌮࣭஦ᴗホ౯ࢆᐇ᪋ࡍࡿ࡜࡜ࡶ࡟ࠊ⛉Ꮫⓗ᰿ᣐ࡟ᇶ࡙࠸ࡓࡀࢇ᳨デࢆᐇ᪋ࡍࡿࡇ࡜ࠊࡲࡓࠊཷデ⋡ࢆ 5 ᖺ௨ෆ࡟ 50% ⫶ࠊ⫵ࠊ኱⭠ࡣᙜ㠃 40%࡜ࡍࡿࡇ࡜ࢆ┠ᶆ࡜ࡋ࡚ᥖࡆ࡚࠸ࡿࠋࡲࡓࠊࡀࢇ᳨デࡣࠊ೺ᗣቑ㐍ἲ࡟ᇶ࡙࠸࡚ᕷ༊⏫ᮧࡀᐇ᪋ࡍࡿ
೺ᗣቑ㐍஦ᴗ࡜ࡋ࡚఩⨨࡙ࡅࡽࢀࠊࡑࡢᐇ᪋࡟࠶ࡓࡗ࡚ࡣࠊᅜ㝿ⓗ࡟ᶆ‽໬ࡉࢀࡓᡭ㡰࡛సᡂࡉࢀࡓ
ᅜ❧ࡀࢇ◊✲ࢭࣥࢱ࣮࡟ࡼࡿ࢞࢖ࢻࣛ࢖ࣥ 㺀᭷ຠᛶホ౯࡟ᇶ࡙ࡃࡀࢇ᳨デ࢞࢖ࢻࣛ࢖ࣥ㺁 ࡸࠊཌ⏕ປാ┬㺀ࡀࢇ᳨デࡢ࠶ࡾ᪉࡟㛵ࡍࡿ᳨ウ఍㺁࡛ࡢ᳨ウ➼ࢆ㋃ࡲ࠼࡚సᡂࡉࢀࡓ㺀ࡀࢇண㜵㔜Ⅼ೺ᗣᩍ⫱ཬࡧࡀࢇ᳨デᐇ᪋ࡢࡓࡵࡢᣦ㔪㺁 ᖹᡂ 20 ᖺ 3 ᭶ 31 ᪥௜ࡅ೺Ⓨ➨ 0331058 ྕཌ⏕ປാ┬೺ᗣᒁ㛗㏻▱ูῧ ࡟‽ᣐࡍࡿࡇ࡜ࡀồࡵࡽࢀ࡚࠸ࡿࠋ
⫶ࡀࢇ᳨デ࡟ࡘ࠸࡚ࡣࠊࡇࢀࡲ࡛ࠊ⫶ X ⥺᳨デࡀ⫶ࡀࢇṚஸ⋡ῶᑡຠᯝࢆ♧ࡍ┦ᛂࡢドᣐࡀ࠶ࡿࡇ
࡜࠿ࡽᑐ⟇ᆺ᳨デ࡜ࡋ࡚᥎ዡࡉࢀࠊୖグᣦ㔪࡛ࡶ⫶ࡀࢇ᳨デࡢ᳨ᰝ㡯┠ࡣၥデཬࡧ⫶ X ⥺᳨ᰝ࡜ࡋ࡚࠸ࡿ 1)ࠋ⫶ X ⥺᳨デࡣࠊ㏆ᖺ㧗⃰ᗘࣂ࣒ࣜ࢘ࡢᑟධࡸࢹࢪࢱࣝ໬࡞࡝࡟ࡼࡾ⢭ᗘࡢྥୖࡀ㐍ࡵࡽࢀ࡚࠸ࡿࡶࡢࡢࠊཷデ⋡ࡢఙࡧᝎࡳࡸㄞᙳ་ࡢ㧗㱋໬࡜⫱ᡂ୙㊊࡞࡝ࠊ௒ᚋࡢᬑཬᣑ኱ࢆ㜼ᐖࡍࡿၥ㢟Ⅼࡀ㢧ᅾ໬ࡋ࡚࠾ࡾࠊ᪂ࡓ࡞᳨デࢩࢫࢸ࣒ࡢᑟධࡀ᳨ウࡉࢀ࡚ࡁࡓࠋ
ࡑࡇ࡛ᑟධࡀᮇᚅࡉࢀ࡚࠸ࡿࡢࡀࠊࡶࡣࡸ⫶ X ⥺᳨ᰝ࡟௦ࢃࡗ࡚ୖ㒊ᾘ໬⟶ࡢ࣮ࣝࢸ࢕᳨ࣥᰝ࡟࡞
ࡗ࡚࠸ࡿ⫶ෆど㙾᳨ᰝࢆࢫࢡ࣮ࣜࢽࣥࢢ᳨ᰝ࡜ࡍࡿ⫶ࡀࢇ᳨デࢩࢫࢸ࣒࡛࠶ࡿࠋ⫶ෆど㙾᳨ᰝ࡟ࡼࡿ
⫶ࡀࢇ᳨デࡣࠊࡍ࡛࡟ᆅᇦࡢ་ᖌ఍ࡀ୰ᚰ࡜࡞ࡗ࡚࠸ࡃࡘ࠿ࡢᆅᇦ࡛ᐇ᪋ࡉࢀ࡚࠸ࡓࡀࠊ㺀᭷ຠᛶホ౯࡟ᇶ࡙ࡃ⫶ࡀࢇ᳨デ࢞࢖ࢻࣛ࢖ࣥ㺁2005 ᖺᗘ∧࡛ࡣࠊ⫶ࡀࢇṚஸ⋡ῶᑡຠᯝࡢ᭷↓ࢆุ᩿ࡍࡿドᣐࡀ୙༑ศ࡛࠶ࡿࡓࡵᑐ⟇ᆺ᳨デ࡜ࡋ࡚᥎ዡ࡛ࡁ࡞࠸࡜ุ᩿ࡉࢀ࡚࠸ࡓ 2)ࠋࡑࡢᚋࡶ⫶ෆど㙾᳨ᰝ࡟ࡼࡿ⫶ࡀࢇ᳨デࡣᐇ᪋௳ᩘࡢቑຍࢆࡳࡏࠊ෌ホ౯ࢆᮃࡴኌࡀ㧗ࡲࡗ࡚࠸ࡓ࡜ࡇࢁࠊࡇࡢࡓࡧୖ㏙ࡋࡓᅜ❧ࡀࢇ◊✲ࢭࣥࢱ࣮ࡢ࢞࢖ࢻࣛ࢖ࣥࡢ᭦᪂∧ࡀබ⾲ࡉࢀࠊ᪥㡑ࡢ⑕౛ᑐ↷◊✲ࡢ⤖ᯝ࡟ᇶ࡙࠸࡚ࠊ㺀⫶ࡀࢇṚஸ⋡ῶᑡຠᯝࢆ♧ࡍ┦ᛂࡢドᣐࡀ࠶ࡾࠊᑐ⟇ᆺ᳨デཬࡧ௵ពᆺ᳨デ࡟᥎ዡࡍࡿ㺁࡜ࡢุ᩿ࡀ♧ࡉࢀࡓࡢ࡛࠶ࡿ 3)ࠋࡇࡢ⤖ᯝ➼ࢆ㋃ࡲ࠼࡚ࠊཌ⏕ປാ┬ࡢ㺀ࡀࢇ᳨デࡢ࠶ࡾ᪉࡟㛵ࡍࡿ᳨ウ఍㺁࡛ࡶ᳨ウࡀ㐍ࡵࡽࢀࠊ2015 ᖺ 9 ᭶࡟࡜ࡾࡲ࡜ࡵࡽࢀࡓ୰㛫ሗ࿌᭩࡛⫶ࡀࢇ᳨デࡢ᳨デ㡯┠ࡣ㺀⫶㒊࢚ࢵࢡࢫ⥺᳨ᰝཪࡣ⫶ෆど㙾᳨ᰝ࡜ࡍࡿ㺁࡜ࡢᥦゝࡀ࡞ࡉࢀࠊࡇࡢᥦゝ࡟ᇶ࡙࠸࡚ࠊୖ㏙ࡋࡓ㺀ࡀࢇண㜵㔜Ⅼ೺ᗣᩍ⫱ཬࡧࡀࢇ᳨デᐇ᪋ࡢࡓࡵࡢᣦ㔪㺁ࡶᨵṇࡉࢀࡓ࡜ࡇࢁ࡛࠶ࡿࠋ
ࡶ࡜ࡼࡾ⫶ෆど㙾᳨ᰝࡣ་ᖌࡀ་⒪ࡢ⌧ሙ࡛ᐇ᪋ࡍࡿ་⒪⾜Ⅽ࡛࠶ࡾࠊࡑࢀࢆ⏝࠸ࡓࡀࢇ᳨デࡣࠊከࡃࡢሙྜࠊ᳨デᶵ㛵ࡀ㞟ᅋ᳨デࡢᙧែ࡛ᐇ᪋ࡋ࡚࠸ࡿ⫶ X ⥺᳨ᰝ࡟ࡼࡿ᳨デ࡜␗࡞ࡾࠊ⑓㝔ࡸデ⒪ᡤ࡞࡝ࡢ་⒪ᶵ㛵࡛་ᖌࡀᐇ᪋ࡍࡿಶ᳨ูデࡢᙧែࢆ࡜ࡿࡇ࡜࡟࡞ࡿࠋࡋ࠿ࡋࠊ᳨デࢆᥦ౪ࡍࡿሙࡣ
ྠ୍࡛࠶ࡗ࡚ࡶࠊ᳨デ࡜デ⒪࡛ࡣࡑࡢᑐ㇟⪅ࡀ␗࡞ࡿࠋࡇࡢᙧែ࡛ࡢ᳨デࢆᑐ⟇ᆺ᳨デ࡜ࡋ࡚ᐇ᪋ࡍ
ࡿࡓࡵ࡟ࡣࠊࡇࢀࡲ࡛ࡢ⫶ X ⥺᳨デࡢᘏ㛗࡜ࡋ࡚࡛ࡣ࡞ࡃࠊ඲ࡃ᪂ࡋ࠸ᐇ᪋యไࢆᵓ⠏ࡍࡿᚲせࡀ࠶ࡿࠋࡲࡓࠊࡑࡢᐇ᪋యไࡣࠊ⢭ᗘ⟶⌮ࠊ᳨ᰝᡭ㡰ࠊᏳ඲⟶⌮࡞࡝࡟ࡘ࠸୍࡚ᐃࡢᇶ‽ࢆᐃࡵࡓᶆ‽໬ࡉࢀࡓࡶࡢ࡛࡞ࡅࢀࡤ࡞ࡽ࡞࠸ࠋ≉࡟ࠊ↓⑕≧⪅ࢆᑐ㇟࡜ࡍࡿ᳨デ࡛ࡣᏳ඲⟶⌮ࡀࡼࡾ㔜せ࡛࠶ࡿࡇ࡜࠿ࡽࠊᮏ࣐ࢽࣗ࢔࡛ࣝࡣࠊ᥎ࡉࢀࡿഅⓎ⑕ࢆྍ⬟࡞㝈ࡾ㑊ࡅࡿࡓࡵࠊデ⒪௨ୖ࡟ៅ㔜࡞ᑐᛂ࡟୓

඲ࢆᮇࡍࡇ࡜࡜ࡋࡓࠋ̿  ̿

ᮏ࣐ࢽࣗ࢔࡛ࣝࡣࠊࡇࡢ⫶ෆど㙾᳨ᰝ࡟ࡼࡿᑐ⟇ᆺ᳨デࡢᶆ‽໬ࡉࢀࡓᐇ᪋యไࡢᵓ⠏ࢆ┠ⓗ࡜ࡋ࡚ࠊࡑࢀࢆᐇ᪋ࡍࡿࡓࡵ࡟ᚲせ࡞᮲௳ࢆᩚ⌮ࡋࠊࢫࢡ࣮ࣜࢽࣥࢢ᳨ᰝ࡜ࡋ࡚ࡢ⫶ෆど㙾᳨ᰝᡭ㡰ࠊࢲࣈࣝࢳ࢙ࢵࢡࡸࢹ࣮ࢱ⟶⌮࡞࡝ࡢ⢭ᗘ⟶⌮యไࠊഅⓎ⑕ᑐ⟇࡞࡝ࡢᏳ඲⟶⌮యไ࡞࡝ࠊᑐ⟇ᆺ᳨デ࡜ࡋ࡚ᩚഛࡍ࡭ࡁ஦㡯࡟ࡘ࠸࡚ᥦ♧ࡋࡓࠋ࡞࠾ࠊᮏᏛ఍࠿ࡽබ㛤ࡋࡓ 2010 ᖺࡢ㺀⫶ෆど㙾᳨デ࣐ࢽࣗ࢔ࣝ㺁ࠊ2014 ᖺࡢ㺀⤒㰯ෆど㙾࡟ࡼࡿ⫶ࡀࢇ᳨デ࣐ࢽࣗ࢔ࣝ㺁ࡣࠊ⫶ෆど㙾᳨デࡢ⫶ࡀࢇṚஸ⋡ῶᑡຠᯝࡀ
ᮍ☜ᐃࡢ᫬ᮇ࡛ࡢබ⾲࡛࠶ࡾࠊ௨㝆ࠊෆど㙾ཬࡧ㛵㐃ᶵჾࡢᨵၿࡶ㐍ࢇ࡛࠸ࡿࠋ௒ᅇࠊཌ⏕ປാ┬ࡢᣦ㔪࡟ᇶ࡙ࡁࠊ⫶ෆど㙾᳨ᰝࡢᑟධࡀ☜ᐃࡋࡓࡇ࡜ࢆዎᶵ࡟ࠊᮏ࣐ࢽࣗ࢔࡛ࣝࡣᑐ⟇ᆺ᳨デ࡟↔Ⅼࢆ⤠ࡾࠊࡉࡽ࡟᭱᪂ࡢ▱ぢࢆຍ࠼ࠊࡑࡢෆᐜࢆ᭦᪂ࡋࡓࠋ
ᮏ࣐ࢽࣗ࢔ࣝ⦅㞟࡟࠶ࡓࡾࠊ2015 ᖺ 12 ᭶ 22 ᪥࠿ࡽ 2016 ᖺ 1 ᭶ 11 ᪥࡟ࢃࡓࡗ࡚ᮏᏛ఍࣮࣒࣮࣍࣌
ࢪୖ࡟ࢻࣛࣇࢺࢆᥦ♧ࡋ࡚ࣃࣈࣜࢵࢡࢥ࣓ࣥࢺࢆເ㞟ࡋࡓ࡜ࡇࢁࠊྛ᪉㠃࠿ࡽண᝿ࢆ㉸࠼ࡿከࡃࡢ㈗㔜࡞ࡈពぢࢆ࠸ࡓࡔ࠸ࡓࠋࡈពぢࢆ࠸ࡓࡔ࠸ࡓⓙᵝ࡟ࡣࡇࡢሙࢆ೉ࡾ࡚ᚰ࠿ࡽឤㅰ⏦ࡋୖࡆࡿḟ➨࡛࠶ࡿࠋࡈពぢࢆ㏲᳨୍ウࡉࡏ࡚࠸ࡓࡔࡁࠊ࡛ࡁࡿࡔࡅࡑࢀࡽࢆ཯ᫎࡉࡏࡿᙧ࡛ಟṇࢆຍ࠼ࡓࡀࠊᚲࡎࡋࡶࡈពぢ࡟ἢࢃ࡞࠸グ㏙ࡶ࠶ࢁ࠺࠿࡜ᛮ࠺ࠋᮏ࣐ࢽࣗ࢔ࣝసᡂࡢᇶᮏጼໃࡣࠊ௒ᅇ᪂ࡓ࡟⫶ෆど㙾᳨デࢆᑟධࡍࡿ࡟࠶ࡓࡗ࡚ࠊ᳨デ࡟ཧຍࡍࡿ᳨ᰝ་ࡀᚲࡎࡋࡶ㇏ᐩ࡞⤒㦂ࢆ᭷ࡋ࡚࠸ࡿ࡜ࡣ㝈ࡽ࡞࠸ሙྜࡶ᝿ᐃࡋࠊ↓⑕≧⪅ࢆᑐ㇟࡜ࡍࡿ᳨デࡢ୙฼┈ࢆ᭱ᑠ㝈࡟࡜࡝ࡵࡿࡇ࡜ࢆ➨୍⩏࡜ࡋ࡚࠸ࡿࠋࡇ
ࡢࡓࡵࠊࢲࣈࣝࢳ࢙ࢵࢡࡸഅⓎ⑕ᑐ⟇࡞࡝ࡢᏳ඲⟶⌮࡟ࡘ࠸࡚ࡣៅ㔜࡟ࡳ࠼ࡿྍ⬟ᛶࡀྰࡵ࡞࠸ࡇ࡜
ࢆࡈ⌮ゎ㢪࠺ࡶࡢ࡛࠶ࡿࠋ࡞࠾ࠊ⫶ X ⥺᳨デࡢ⢭ᗘ⟶⌮࡟ࡘ࠸࡚ࡣࠊู㏵ᐃࡵ࡚࠸ࡿ㺀᪂࣭⫶ X ⥺᧜ᙳἲ࢞࢖ࢻࣛ࢖ࣥ㺁࡟ᚑ࠺ࡇ࡜ࢆཎ๎࡜ࡋ 4)ࠊᮏ࣐ࢽࣗ࢔࡛ࣝྲྀࡾᢅ࠺᳨デ᪉ἲࡣ⫶ෆど㙾᳨デ࡟㝈ᐃࡋࠊ⫶ X ⥺᳨デࡢ⢭ᗘ⟶⌮࡟ࡘ࠸࡚ࡣゝཬࡋ࡚࠸࡞࠸ࠋ
⌧ᅾࠊ⫶ෆど㙾᳨ᰝ࡟ࡼࡿ⫶ࡀࢇ᳨デࡢᑟධࢆ᳨ウࡋ࡚࠸ࡿᕷ༊⏫ᮧ࡟࠾࠸࡚ࡣࠊᮏ࣐ࢽࣗ࢔ࣝࢆ
ཧ⪃ࡢୖࠊᐇ᪋ࡢ᮲௳ࢆ‶ࡓࡋࠊᐇ᪋యไࡢᩚࡗࡓᆅᇦ࠿ࡽᮏ᱁ⓗ࡟ᑟධࡋ࡚࠸ࡓࡔࡁࡓ࠸ࠋ
㸦῝ᑿᙲ㸧

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ཧ⪃ᩥ⊩
1㸧ཌ⏕ປാ┬㸬ࡀࢇண㜵㔜Ⅼ೺ᗣᩍ⫱ཬࡧࡀࢇ᳨デᐇ᪋ࡢࡓࡵࡢᣦ㔪㸬ᖹᡂ 20 ᖺ 3 ᭶ 31 ᪥௜ࡅ೺➨0331058 ྕཌ⏕ປാ┬೺ᗣᒁ㛗㏻▱ูῧ㸬2008.
2㸧ᖹᡂ 17 ᖺᗘཌ⏕ປാ┬ࡀࢇ◊✲ຓᡂ㔠㺀ࡀࢇ᳨デࡢ㐺ษ࡞᪉ἲ࡜ࡑࡢホ౯ἲࡢ☜❧࡟㛵ࡍࡿ◊✲㺁⌜ ୺௵◊✲⪅♽∗Ụ཭Ꮥ 㸬᭷ຠᛶホ౯࡟ᇶ࡙ࡃ⫶ࡀࢇ᳨デ࢞࢖ࢻࣛ࢖ࣥ㸬ᮾி㸪2006㸬
3㸧ᅜ❧ࡀࢇ◊✲ࢭࣥࢱ࣮ ࡀࢇண㜵᳨࣭デ◊✲ࢭࣥࢱ࣮㸬᭷ຠᛶホ౯࡟ᇶ࡙ࡃ⫶ࡀࢇ᳨デ࢞࢖ࢻࣛ࢖
ࣥ 2014 ᖺᗘ∧㸬ᮾி㸪2015㸬
4㸧 ᪥ᮏᾘ໬ჾࡀࢇ᳨デᏛ఍⫶ࡀࢇ᳨デ⢭ᗘ⟶⌮ጤဨ఍⦅㸬᪂࣭⫶X⥺᧜ᙳἲ࢞࢖ࢻࣛ࢖ࣥᨵゞ∧ 2011
ᖺ 㸬་Ꮫ᭩㝔㸪ᮾி㸪2011㸬̿  ̿

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1.⫶ࡀࢇ᳨デ࢞࢖ࢻࣛ࢖ࣥ
2000 ᖺᗘ࠿ࡽࠊ㺀᭷ຠᛶホ౯࡟ᇶ࡙ࡃ⫶ࡀࢇ᳨デ࢞࢖ࢻࣛ࢖ࣥ㺁ࡣࠊᅜ㝿ᶆ‽࡟ᇶ࡙ࡁࠊࢃࡀᅜ⊂⮬ࡢࡀࢇ᳨デ࢞࢖ࢻࣛ࢖ࣥࡢసᡂᡭ㡰ࢆᐃᘧ໬ࡋࡓ᪉ἲ 1)ࢆ㋃ࡲ࠼࡚ࠊసᡂࡉࢀ࡚ࡁࡓࠋ࢞࢖ࢻࣛ࢖࡛ࣥ
ࡣ⫶ࡀࢇṚஸ⋡ῶᑡຠᯝ ฼┈ ࡜୙฼┈࡜ࡢࣂࣛࣥࢫࢆ⪃៖ࡋࠊࢃࡀᅜ࡟࠾ࡅࡿᑐ⟇ᆺ᳨デ࡜௵ពᆺ᳨デࡢᐇ᪋࡟ࡘ࠸࡚ࡢ᥎ዡࢆࡲ࡜ࡵ࡚࠸ࡿࠋ㺀᭷ຠᛶホ౯࡟ᇶ࡙ࡃ⫶ࡀࢇ᳨デ࢞࢖ࢻࣛ࢖ࣥ㺁2005 ᖺᗘ∧࡛ࡣࠊ୺࡜ࡋ࡚ᅜෆ࡛⾜ࢃࢀࡓ⑕౛ᑐ↷◊✲ࡢᡂᯝࢆࡶ࡜࡟⫶ X ⥺᳨デࡀ᥎ዡࡉࢀࡓ 2)ࠋ୍᪉ࠊ⫶ෆど㙾᳨デࠊ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜᢠయ
᳨ᰝ࡜࣌ࣉࢩࣀࢤ᳨ࣥᰝࡣ⫶ࡀࢇṚஸ⋡ῶᑡຠᯝࢆ᳨ウࡋࡓ◊✲ࡀ࡯࡜ࢇ࡝ㄆࡵࡽࢀ࡞࠸ࡇ࡜࠿ࡽࠊ
⛉Ꮫⓗ᰿ᣐࡣ୙༑ศ࡜ุ᩿ࡉࢀࡓࠋ
9 ᖺࡪࡾࡢ᭦᪂࡜࡞ࡗࡓ㺀᭷ຠᛶホ౯࡟ᇶ࡙ࡃ⫶ࡀࢇ᳨デ࢞࢖ࢻࣛ࢖ࣥ 2014 ᖺᗘ∧㺁࡛ࡣࠊ᪥㡑ࡢ⑕౛ᑐ↷◊✲࡟ࡼࡾ⫶ࡀࢇṚஸ⋡ῶᑡຠᯝࡀ☜ㄆࡉࢀࡓࡇ࡜࠿ࡽࠊ⫶ෆど㙾᳨デࡣࠊ⫶ X ⥺᳨デ࡜ඹ࡟ᑐ⟇ᆺ᳨デ࣭௵ពᆺ᳨デࡢ᪂ࡓ࡞᪉ἲ࡜ࡋ࡚᥎ዡࡉࢀࡓ ⾲ 1 3)ࠋ୍᪉ࠊ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜᢠయ
᳨ᰝ࡜࣌ࣉࢩࣀࢤ᳨ࣥᰝࡢే⏝ἲ ABC ᳨デ ࡣ⫶ࡀࢇṚஸ⋡ῶᑡຠᯝࢆ♧ࡍ᫂☜࡞ドᣐࡣ࡞ࡃࠊᑐ⟇ᆺ᳨デ࡜ࡋ࡚ࡣ᥎ዡࡉࢀ࡚࠸࡞࠸ࠋ⫶ෆど㙾᳨デࡣᑐ⟇ᆺ᳨デ࡜ࡋ࡚᥎ዡࡉࢀࡓࡀࠊయไࡀᩚഛࡉࢀ࡚࠸ࡿ⫶㹖⥺᳨デ࡜ࡣ␗࡞ࡾࠊࡑ
ࡢᐇ᪋࡟ࡣᵝࠎ࡞ၥ㢟ࡀᥦ㉳ࡉࢀ࡚࠸ࡿࠋࡇࡢࡓࡵࠊ࢞࢖ࢻࣛ࢖࡛ࣥࡣࠊ㺀㔜⠜࡞അⓎ⑕࡟㎿㏿࠿ࡘ㐺ษ࡟ᑐᛂ࡛ࡁࡿయไࡢᩚഛࡀ࡛ࡁ࡞࠸࠺ࡕࡣᐇ᪋ࡍ࡭ࡁ࡛ࡣ࡞࠸㺁࡜ࡢ᮲௳ࡀ௜グࡉࢀ࡚࠸ࡿࠋ

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ཧ⪃ᩥ⊩
1㸧 ᖹᡂ 16 ᖺᗘཌ⏕ປാ┬ࡀࢇ◊✲ຓᡂ㔠㺀ࡀࢇ᳨デࡢ㐺ษ࡞᪉ἲ࡜ࡑࡢホ౯ἲࡢ☜❧࡟㛵ࡍࡿ◊✲ࠖ⌜ ୺௵◊✲⪅♽∗Ụ཭Ꮥ 㸬᭷ຠᛶホ౯࡟ᇶ࡙ࡃࡀࢇ᳨デ࢞࢖ࢻࣛ࢖ࣥసᡂᡭ㡰㸬ᮾி㸪2005㸬2㸧 ᖹᡂ 17 ᖺᗘཌ⏕ປാ┬ࡀࢇ◊✲ຓᡂ㔠㺀ࡀࢇ᳨デࡢ㐺ษ࡞᪉ἲ࡜ࡑࡢホ౯ἲࡢ☜❧࡟㛵ࡍࡿ◊✲㺁⌜ ୺௵◊✲⪅♽∗Ụ཭Ꮥ 㸬᭷ຠᛶホ౯࡟ᇶ࡙ࡃ⫶ࡀࢇ᳨デ࢞࢖ࢻࣛ࢖ࣥ㸬ᮾி㸪2006㸬3㸧 ᅜ❧ࡀࢇ◊✲ࢭࣥࢱ࣮ ࡀࢇண㜵᳨࣭デ◊✲ࢭࣥࢱ࣮㸬᭷ຠᛶホ౯࡟ᇶ࡙ࡃ⫶ࡀࢇ᳨デ࢞࢖ࢻࣛ࢖
ࣥ 2014 ᖺᗘ∧㸬ᮾி㸪2015㸬㸦℈ᓥࡕࡉ࡜㸧̿  ̿

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2+

2+

B

B

⫶ X ⥺᳨ᰝ⫶ෆど㙾᳨ᰝ

I

I

࣊ࣜࢥࣂࢡࢱ
࣮࣭ࣆࣟࣜᢠయ᳨ᰝ ༢⊂
ἲ࣌ࣉࢩࣀࢤࣥ
᳨ᰝ࡜࣊ࣜࢥ
ࣂࢡࢱ࣮࣭ࣆ
ࣟࣜᢠయ᳨ᰝࡢే⏝ἲ33ᑐ⟇ᆺ᳨デ࡜ࡋ࡚ࡢᐇ᪋ࢆ᥎
ዡࡍࡿࠋ᳨デᑐ㇟ࡣ 50 ṓ௨ୖࡀᮃࡲࡋࡃࠊ᳨デ㛫㝸ࡣ 2㹼3ᖺ࡜ࡍࡿࡇ࡜ࡀྍ⬟࡛࠶ࡿࠋࡓࡔࡋࠊ㔜⠜࡞അⓎ⑕࡟㎿㏿࠿ࡘ㐺ษ࡟ᑐᛂ࡛ࡁࡿయไࡀᩚ
ഛ࡛ࡁ࡞࠸࠺ࡕࡣᐇ᪋ࡍ࡭ࡁ
࡛࡞࠸ࠋࡉࡽ࡟ࠊ⢭ᗘ⟶⌮యไࡢᩚഛ࡜ඹ࡟ࠊ୙฼┈࡟ࡘ࠸࡚㐺ษ࡞ㄝ᫂ࢆ⾜࠺࡭ࡁ࡛࠶ࡿࠋ
ᑐ⟇ᆺ᳨デ࡜ࡋ࡚ࡢᐇ᪋ࢆ᥎
ዡࡋ࡞࠸ࠋ」ᩘࡢほᐹ◊✲࡟࠾࠸࡚Ṛஸ⋡ῶᑡຠᯝࢆ♧ࡍ┦ᛂ࡞ドᣐࡀ࠶ࡿࠋ
୙฼┈࡟ࡘ࠸࡚ࡣഇ㝧ᛶࠊ㐣๫デ᩿ࡢ௚ࠊ๓ฎ⨨ࡢဗ㢌㯞㓉࡟ࡼࡿࢩࣙ
ࢵࢡࡸ✸Ꮝ࣭ฟ⾑࡞࡝ࡢഅⓎ⑕ࡀ࠶ࡾࠊ㔜⠜࡞ሙྜࡣ⥭ᛴᛶࢆ᭷ࡍࠋ」ᩘࡢほᐹ◊✲࡟࠾࠸࡚Ṛஸ⋡ῶᑡຠᯝࡀ♧၀ࡉࢀࡓࡀࠊ◊✲ࡢ㉁ࡀప
࠸ࡓࡵࠊ☜ᐃⓗ࡞ุ᩿ࡣᚓࡽࢀ࡞࠿
ࡗࡓࠋ୙฼┈࡟ࡘ࠸࡚ࡣഇ㝜ᛶࠊഇ㝧ᛶࠊ㐣๫デ᩿ࡢྍ⬟ᛶࡀ࠶ࡿࠋ

Ṛஸ⋡ῶᑡຠᯝࢆ᳨ウࡋࡓ◊✲ࡣ࡞࠿ࡗࡓࠋ୙฼┈࡟ࡘ࠸࡚ࡣഇ㝜ᛶࠊഇ㝧ᛶࠊ㐣๫デ᩿ࡢྍ⬟ᛶࡀ࠶ࡿࠋ

ᑐ⟇ᆺ᳨デ࡜ࡋ࡚ࡢᐇ᪋ࢆ᥎
ዡࡋ࡞࠸ࠋᑐ⟇ᆺ᳨デ࡜ࡋ࡚ࡢᐇ᪋ࢆ᥎
ዡࡋ࡞࠸ࠋᑐ⟇ᆺ᳨デ࡜ࡋ࡚ࡢᐇ᪋ࢆ᥎
ዡࡍࡿࠋ᳨デᑐ㇟ࡣ 50 ṓ௨ୖࡀᮃࡲࡋ࠸ࠋ
୙฼┈࡟ࡘ࠸࡚㐺ษ࡞ㄝ᫂ࢆ
⾜࠺࡭ࡁ࡛࠶ࡿࠋ」ᩘࡢほᐹ◊✲࡟࠾࠸࡚Ṛஸ⋡ῶᑡຠᯝࢆ♧ࡍ┦ᛂ࡞ドᣐࡀ࠶ࡾࠊࡑࡢ
⤖ᯝ࡟ࡣ୍㈏ᛶࡀ࠶ࡿࠋ
୙฼┈࡟ࡘ࠸࡚ࡣࠊ㧗⃰ᗘࣂ࣒ࣜ࢘
ࡢᬑཬᚋࠊㄗᄟࡢሗ࿌ࡀቑຍࡋ࡚࠸
ࡿࠋࡑࡢ௚ࡢ୙฼┈࡟ࡣࠊഇ㝧ᛶࠊ㐣๫デ᩿ࠊᨺᑕ⥺⿕ࡤࡃࡀ࠶ࡿࠋ

Ṛஸ⋡ῶᑡຠᯝࢆ᳨ウࡋࡓ◊✲ࡣ࡞࠿ࡗࡓࠋ୙฼┈࡟ࡘ࠸࡚ࡣഇ㝜ᛶࠊഇ㝧ᛶࠊ㐣๫デ᩿ࡢྍ⬟ᛶࡀ࠶ࡿࠋ

ᑐ⟇ᆺ᳨デ

᥎ዡࡢෆᐜ

௵ពᆺ᳨デ࡜ࡋ࡚ᐇ᪋ࡍࡿሙྜ
࡟ࡣࠊṚஸ⋡ῶᑡຠᯝࡀ୙࡛᫂࠶
ࡿࡇ࡜࡜୙฼┈ཬࡧ௒ᚋࡢ᳨デࡢᚲせᛶ࡟ࡘ࠸࡚㐺ษ࡞ㄝ᫂ࢆ
⾜࠺࡭ࡁ࡛࠶ࡿࠋ㐺ษ࡞ㄝ᫂࡟ᇶ
࡙ࡃಶேࡢཷデࡣጉࡆ࡞࠸ࠋ

௵ពᆺ᳨デ࡜ࡋ࡚ᐇ᪋ࡍࡿሙྜ
࡟ࡣࠊṚஸ⋡ῶᑡຠᯝࡀ୙࡛᫂࠶
ࡿࡇ࡜࡜୙฼┈ཬࡧ௒ᚋࡢ᳨デࡢᚲせᛶ࡟ࡘ࠸࡚㐺ษ࡞ㄝ᫂ࢆ
⾜࠺࡭ࡁ࡛࠶ࡿࠋ㐺ษ࡞ㄝ᫂࡟ᇶ
࡙ࡃಶேࡢཷデࡣጉࡆ࡞࠸ࠋ

௵ពᆺ᳨デ࡜ࡋ࡚ᐇ᪋ࡍࡿሙྜ
࡟ࡣࠊṚஸ⋡ῶᑡຠᯝࡀ୙࡛᫂࠶
ࡿࡇ࡜࡜୙฼┈ཬࡧ௒ᚋࡢ᳨デࡢᚲせᛶ࡟ࡘ࠸࡚㐺ษ࡞ㄝ᫂ࢆ
⾜࠺࡭ࡁ࡛࠶ࡿࠋ㐺ษ࡞ㄝ᫂࡟ᇶ
࡙ࡃಶேࡢཷデࡣጉࡆ࡞࠸ࠋ

௵ពᆺ᳨デ࡜ࡋ࡚ᐇ᪋ࢆ᥎ዡࡍ
ࡿࠋ᳨デᑐ㇟ࡣ 50 ṓ௨ୖࡀᮃࡲ
ࡋࡃࠊ᳨デ㛫㝸ࡣ 2㹼3 ᖺ࡜ࡍࡿࡇ࡜ࡀྍ⬟࡛࠶ࡿࠋ
ࡓࡔࡋࠊ㔜⠜࡞അⓎ⑕࡟㎿㏿࠿ࡘ
㐺ษ࡟ᑐᛂ࡛ࡁࡿయไࡀᩚഛ࡛
ࡁ࡞࠸࠺ࡕࡣᐇ᪋ࡍ࡭ࡁ࡛࡞࠸ࠋ
ࡉࡽ࡟ࠊ⢭ᗘ⟶⌮యไࡢᩚഛ࡜ඹ
࡟୙฼┈࡟ࡘ࠸࡚㐺ษ࡞ㄝ᫂ࢆ
⾜࠺࡭ࡁ࡛࠶ࡿࠋ

௵ពᆺ᳨デ࡜ࡋ࡚ࡢᐇ᪋ࢆ᥎ዡ
ࡍࡿࠋ᳨デᑐ㇟ࡣ 50 ṓ௨ୖࡀᮃࡲࡋ࠸ࠋ୙฼┈࡟ࡘ࠸࡚㐺ษ࡞ㄝ᫂ࢆ⾜࠺࡭ࡁ࡛࠶ࡿࠋ

௵ពᆺ᳨デࣜࢫࢡᒙู໬࡜ෆど㙾࠶ࡿ࠸ࡣ X ⥺ࢆ⤌ࡳྜࢃࡏࡓ᳨デࡢṚஸ⋡ῶᑡຠᯝ࡟㛵ࡍࡿホ౯◊✲ࡀᚲせ࡛࠶ࡿࠋࡲࡓࠊࣜࢫࢡᒙู໬ࠊෆど㙾᳨デࠊ㝖⳦ࢆ⤌ࡳྜࢃࡏࡓண㜵᪉ἲ࡟ࡘ࠸
࡚ࠊ㛗ᮇ㏣㊧࡟ᇶ࡙ࡃホ౯◊✲ࡀᚲせ࡛࠶ࡿࠋࣜࢫࢡᒙู໬࡜ෆど㙾࠶ࡿ࠸ࡣ X ⥺ࢆ⤌ࡳྜࢃࡏࡓ᳨デࡢṚஸ⋡ῶᑡຠᯝ࡟㛵ࡍࡿホ౯◊✲ࡀᚲせ࡛࠶ࡿࠋࡲࡓࠊࣜࢫࢡᒙู໬ࠊෆ
ど㙾᳨デࠊ㝖⳦ࢆ⤌ࡳྜࢃࡏࡓண㜵᪉ἲ࡟ࡘ࠸࡚ࠊ㛗ᮇ㏣㊧࡟ᇶ࡙ࡃホ౯◊✲ࡀᚲせ࡛࠶ࡿࠋࣜࢫࢡᒙู໬࡜ෆど㙾࠶ࡿ࠸ࡣ X ⥺ࢆ⤌ࡳྜࢃࡏࡓ᳨デࡢṚஸ⋡ῶᑡຠᯝ࡟㛵ࡍࡿホ౯◊✲ࡀᚲせ࡛࠶ࡿࠋ

ᅜෆ࣭ᅜእ࡛ࡢ◊✲ࡀ㐍ࡳࡘࡘ࠶ࡿࡀ༑඲࡛
ࡣ࡞࠸ࡇ࡜࠿ࡽࠊṚஸ⋡ῶᑡຠᯝ࡟ࡘ࠸࡚ホ౯◊✲ࢆࡉࡽ࡟㐍ࡵࡿᚲせࡀ࠶ࡿࠋࡲࡓࠊ㡑ᅜࡢ⑕౛ᑐ↷◊✲ࡣሗ࿌᭩࡛ࡢබ⾲࡟␃ࡲࡗ࡚࠾ࡾࠊࣆ࢔࣭ࣞࣅ࣮ࣗࢆ⤒ࡓㄽᩥࡢබ⾲ᚋࠊ෌ᗘ⢭ᰝࡍࡿࠋഇ㝧ᛶࠊ㐣๫デ᩿ࠊ๓ฎ⨨ࡸ᳨ᰝ࡟ࡼࡿഅⓎ⑕࡞࡝ࡢ୙฼┈࡟㛵ࡍࡿ᳨ウࡀᚲせ࡛࠶ࡿࠋ40 ṓ௦࡟ᑐࡍࡿ᥎ዡ࡟
ࡘ࠸࡚ࠊࣆࣟࣜ⳦ឤᰁ⋡ࢆࡶ࡜࡟෌᳨ウࡍࡿࡓࡵࡢᇶ♏㈨ᩱࢆ⵳✚ࡍ࡭ࡁ࡛࠶ࡿࠋ

௒ᚋࡢ⥅⥆࡟ࡣࠊṚஸ⋡ῶᑡຠᯝࡢ኱ࡁࡉࢆ෌᳨ドࡍ࡭ࡁ࡛࠶ࡿࠋഅⓎ⑕࡟㛵ࡍࡿ㛵㐃Ꮫ఍ࡢㄪᰝࡀ⾜ࢃࢀ࡚࠸ࡿࡀࠊ㐣๫デ᩿ࡸᨺᑕ⥺⿕ࡤࡃ࡞࡝ࡢ୙฼┈࡟ࡘ࠸࡚ࡢ᳨ウࡀᚲせ࡛࠶ࡿࠋ40 ṓ௦࡟ᑐࡍࡿ᥎ዡ࡟ࡘ࠸࡚ࠊࣆ
ࣟࣜ⳦ឤᰁ⋡ࢆࡶ࡜࡟෌᳨ウࡍࡿࡓࡵࡢᇶ♏㈨ᩱࢆ⵳✚ࡍ࡭ࡁ࡛࠶ࡿࠋ

◊✲࡬ࡢᥦゝ㸦ᅜ❧ࡀࢇ◊✲ࢭࣥࢱ࣮ࡀࢇண㜵᳨࣭デ◊✲ࢭࣥࢱ࣮㸬᭷ຠᛶホ౯࡟ᇶ࡙ࡃ⫶ࡀࢇ᳨デ࢞࢖ࢻࣛ࢖ࣥ 2014 ᖺᗘ∧㸬2015, P.4㸧

1㸧ྛ᪉ἲࢆ⫶ࡀࢇ᳨デࡢ 1 ḟࢫࢡ࣮ࣜࢽࣥࢢ᪉ἲ࡜ࡋ࡚ᐇ᪋ࡋࡓሙྜࡢホ౯࡛࠶ࡿࠋ
2㸧ドᣐࡢࣞ࣋ࣝࠊ᥎ዡࢢ࣮ࣞࢻࡣ㺀᭷ຠᛶホ౯࡟ᇶ࡙ࡃ⫶ࡀࢇ᳨デ࢞࢖ࢻࣛ࢖ࣥ 2014 ᖺᗘ∧㺁ࢆཧ↷ࠋ
3㸧᥎ዡࢢ࣮ࣞࢻ I ࡣࠊ⌧ẁ㝵࡟࠾࠸࡚ࡀࢇ᳨デ࡜ࡋ࡚ᐇ᪋ࡍࡿࡓࡵࡢドᣐࡀ୙༑ศ࡛࠶ࡿࡇ࡜ࢆព࿡ࡍࡿࡀࠊ௒ᚋࡢ◊✲ᡂᯝ࡟ࡼࡗ࡚ᑗ᮶ⓗ࡟ุᐃࢆኚ᭦ࡍࡿྍ⬟ᛶࡀ࠶ࡿࠋ

I࣌ࣉࢩࣀࢤ᳨ࣥᰝ ༢⊂ἲ

2Ѹ

ドᣐࡢ
ࣞ࣋ࣝ
(Ṛஸ⋡
ῶᑡຠᯝ)

᪉ἲ

᥎ዡ
ࢢ࣮ࣞࢻ

⾲ 1. ᭷ຠᛶホ౯࡟ᇶ࡙ࡃ⫶ࡀࢇ᳨デ࢞࢖ࢻࣛ࢖ࣥ 2014 ᖺᗘ∧ࡢ᥎ዡࢢ࣮ࣞࢻ

2.⫶ࡀࢇṚஸ⋡ῶᑡຠᯝ⫶ෆど㙾᳨デ࡟ࡼࡿ⫶ࡀࢇṚஸ⋡ῶᑡຠᯝࢆ᳨ウࡋࡓ↓సⅭ໬ẚ㍑ᑐ↷ヨ㦂ࡢሗ࿌ࡣ࡞࠸ࠋࡋ࠿ࡋࠊḟၿࡢ᪉ἲ࡜ࡋ࡚ࠊࢥ࣮࣍ࢺ◊✲ࠊ⑕౛ᑐ↷◊✲ࡀ⾜ࢃࢀ࡚࠸ࡿࠋ
㫽ྲྀ┴ 4 ᕷ 㫽ྲྀࠊ⡿Ꮚࠊ಴ྜྷࠊቃ

࡜᪂₲ᕷ࡟࠾࠸࡚ࠊ⑕౛ᑐ↷◊✲ࡀ⾜ࢃࢀࡓ 1)ࠋ⫶ࡀࢇṚஸ⪅ࢆ⑕౛⩌࡜ࡋࠊ⑕౛⩌ࡢ⫶ࡀࢇデ᩿᪥࡟⏕Ꮡࡋ࡚࠸ࡿ↓⑕≧⪅ࡢ⏕ᖺ᭶᪥ࠊᛶูࠊᒃఫᆅࢆ࣐ࢵࢳࡉࡏࡓᑐ↷⩌ࢆ 1㸸6 ࡛ᢳฟࡋࡓࠋ⑕౛⩌ࡣࠊ⏨ᛶ 288 ேࠊዪᛶ 122 ே࡛࠶ࡾࠊᑐ↷⩌ࡣ 2,292 ே࡛࠶ࡗࡓࠋ3 ᖺ௨ෆ࡟ᑡ
࡞ࡃ࡜ࡶ 1 ᗘ࡛ࡶ⫶ෆど㙾᳨デࢆཷデࡋࡓሙྜࠊ30%ࡢ⫶ࡀࢇṚஸ⋡ῶᑡຠᯝࢆㄆࡵࡓ ࢜ࢵࢬẚ 0.695ࠊ
95%CI: 0.489–0.986 ⾲ 2 ࠋ୍᪉ࠊ⫶ X ⥺᳨デ࡟ࡘ࠸࡚ࡣࠊ᭷ព࡞⫶ࡀࢇṚஸ⋡ῶᑡຠᯝࡣㄆࡵࡽࢀ࡞࠿ࡗࡓ ࢜ࢵࢬẚ 0.865ࠊ95%CI: 0.631–1.185 ࠋ

⾲ 2. 㫽ྲྀ࣭᪂₲⑕౛ᑐ↷◊✲࡟࠾ࡅࡿṚஸῶᑡຠᯝ
ᑐ㇟ᩘデ᩿᪥ࡲ࡛ࡢཷデほᐹᮇ㛫 ⑕౛⩌ ᑐ↷⩌

⫶ෆ
ෆど㙾᳨デ
⑕౛⩌(%)

ᑐ↷⩌(%)

࢜ࢵࢬẚ
(95%CI)⫶ X ⥺᳨デ⑕౛⩌(%)

ᑐ↷⩌(%)

࢜ࢵࢬẚ
(95%CI)

12 ࠿᭶

410

2,292

38 (9.3)

207 (9.0)

0.964(0.660–1.407)

35 (8.5)

219 (9.6)

0.837(0.565–1.240)

24 ࠿᭶

410

2,292

41 (10.0)301 (13.1)

0.702(0.490–1.006)

50 (12.2)

312 (13.6)

0.843(0.601–1.182)

36 ࠿᭶

407

2,275

44 (10.8)326 (14.3)

0.695(0.489–0.986)

60 (14.7)363 (16.0)

0.865(0.631–1.185)

48 ࠿᭶

387

2,167

46 (11.9)332 (15.3)

0.714(0.507–1.007)

64 (16.5)

398 (18.4)

0.843(0.621–1.146)

Hamashima C, et al. PLoS ONE. 2013, e79088 ᩥ⊩  ᨵኚ㡑ᅜ࠿ࡽࡣࠊᅜᐙࡀࢇ᳨デࢹ࣮ࢱ࣮࣋ࢫ࡟ᇶ࡙ࡃ⫶ෆど㙾᳨デ࡜ࠊ⫶ X ⥺᳨デࡢࢥ࣮࣍ࢺෆ⑕౛ᑐ↷◊✲ࡢ⤖ᯝࡀሗ࿌ࡉࢀ࡚࠸ࡿࠋ㡑ᅜࡢ◊✲࡛ࡣࠊ2002㹼2003 ᖺࡢᅜᐙࡀࢇ᳨デࡢᑐ㇟⪅ 16,902,631 ே࠿ࡽࠊ⫶ࡀࢇ࡜デ᩿ࡉࢀṚஸࡋࡓ⪅ 35,457 ேࢆ⑕౛⩌࡜ࡋࠊྠ᫬ᮇࡢࡀࢇ᳨デཷデ⪅࠿ࡽ 1㸸4 ࡛ᑐ↷⩌ 141,828 ேࢆᢳฟࡋࡓࠋࡇࡢ⤖ᯝࠊ⫶ෆど㙾᳨デ࡟ࡼࡾ 57%ࡢ⫶ࡀࢇṚஸ⋡ῶᑡຠᯝࢆㄆࡵࡓ ࢜ࢵࢬẚ 0.43ࠊ95%CI: 0.40–
0.46㸧ࠋࡉࡽ࡟ᖺ㱋ู࡟ࡳࡿ࡜ࠊ40㹼79 ṓ࡛ 1㹼3 ᖺ௨ෆࡢཷデṔࡀ࠶ࡗࡓሙྜࡢ⫶ࡀࢇṚஸ⋡ῶᑡຠᯝࡣ 50
㹼70%࡛࠶ࡗࡓ 2)ࠋ୍᪉ࠊ⫶ X ⥺᳨デࡢ⫶ࡀࢇṚஸ⋡ῶᑡຠᯝࡣ 7 %࡟␃ࡲࡗ࡚࠸ࡓ ࢜ࢵࢬẚ 0.93ࠊ95%CI:
0.80–0.96㸧ࠋࡇࡢ࡯࠿ࠊᴟࡵ࡚ᑠつᶍ࡞◊✲࡛ࡣ࠶ࡿࡀࠊ㛗ᓮ┴ୖ஬ᓥ⏫࡛⾜ࢃࢀࡓ◊✲࡛ࡣࠊ⫶ෆど㙾᳨デཷデ࡟ࡼࡾ 80%ࡢ⫶ࡀࢇṚஸ⋡ῶᑡຠᯝࡀㄆࡵࡽࢀࡓ ࢜ࢵࢬẚ 0.206ࠊ95%CI: 0.044–0.965 3)ࠋ
ୖグࡢ᪂₲ᕷ࣭㫽ྲྀ┴ࡢ⑕౛ᑐ↷◊✲࡜ࢹ࣮ࢱࡀ㔜」ࡋ࡚࠸ࡿࡀࠊ5 ᖺ㛫ࡢ㏣㊧ㄪᰝ࡟ᇶ࡙ࡃࢥ࣮࣍ࢺ◊✲ࡀ᪂₲ᕷ࠿ࡽሗ࿌ࡉࢀ࡚࠸ࡿ 4)ࠋ᪂₲ᕷẸࢆẚ㍑ᑐ↷࡜ࡋࡓᶆ‽໬Ṛஸẚ SMR: standard mortality ratio ࡣࠊ⫶ෆど㙾᳨デ⩌ 0.43 95%CI: 0.30–0.57㸧
ࠊ┤᥋ X ⥺⩌ 0.68 95%CI: 0.55–0.79㸧
ࠊ㛫᥋ X ⥺⩌ 0.85 95%CI: 0.71–
0.94 ࡛࠶ࡗࡓ ⾲ 3 ࠋࡋ࠿ࡋࠊẚ㍑ᑐ↷ࢆᕷẸ඲య࡜ࡋࡓሙྜࠊࡑࡢ୰࡟ࡣ᭷⑓⪅࡞࡝ࡀྵࡲࢀࡿࡓࡵࠊ᳨
デࡢ᭷ຠᛶࡣ㐣኱ホ౯ࡉࢀࡀࡕ࡛࠶ࡾࠊៅ㔜࡞ゎ㔘ࢆせࡍࡿࠋ̿  ̿

⾲ 3. ᪂₲ࢥ࣮࣍ࢺ◊✲࡟࠾ࡅࡿᶆ‽໬Ṛஸẚ
ཧ↷ேཱྀ

᳨デ⩌









ෆど㙾




ィ
⏨ᛶ
ዪᛶ

ほᐹ್
24
18
6

ᮇᚅ್
56
37
20

SMR 95%CI
0.43 (0.30–0.57)
0.49 (0.32–0.66)
0.31 (0.12–0.54)






ほᐹ್
216
154
62

ᮇᚅ್
349
220
129

SMR 95%CI
0.62 (0.57–0.67)
0.70 (0.64–0.76)
0.48 (0.39–0.57)

┤᥋ X ⥺



ィ
⏨ᛶ
ዪᛶ

43
29
14

63
40
23

0.68 (0.55–0.79)
0.72 (0.56–0.85)
0.62 (0.39–0.80)





266
173
93

393
244
149

0.68 (0.63–0.73)
0.71 (0.65–0.77)
0.62 (0.53–0.70)㛫᥋ X ⥺



ィ
⏨ᛶ
ዪᛶ

38
31
7

45
27
17

0.85 (0.71–0.94)
1.13 (1.04–1.43)
0.41 (0.18–0.67)





208
130
78

281
169
112

0.74 (0.68–0.79)
0.77 (0.70–0.83)
0.69 (0.59–0.77)

᪂₲ᕷ

⫶ࡀࢇṚஸ



⫶ࡀࢇṚஸࢆ㝖ࡃ඲ࡀࢇṚஸ

Hamashima C, et al. World J Gastroenterol. 2015, P.2464 ᩥ⊩ 4 ᨵኚ㫽ྲྀ┴࡛⾜ࢃࢀࡓ᪂ࡓ࡞ࢥ࣮࣍ࢺ◊✲࡛ࡣࠊ6 ᖺ㛫ࡢ㏣㊧ࡢ⤖ᯝࠊ⫶ X ⥺᳨デཷデ⩌࡟ẚࡋࠊ⫶ෆど㙾᳨
デཷデ⩌ࡢ⫶ࡀࢇṚஸ⋡ࡣ 67%పୗࡋࡓ ┦ᑐࣜࢫࢡ 0.327ࠊ95%CI: 0.118–0.908 5)ࠋ⫶ X ⥺᳨デ࡜⫶ෆど㙾᳨デ࡜ࡢ⫶ࡀࢇṚஸࣜࢫࢡࡣཷデ㛤ጞ᪥࠿ࡽ 4 ᖺ┠ࡲ࡛ࡣ࡯ࡰྠࡌ࡛࠶ࡗࡓࡀࠊ௨㝆ࠊࡑࡢᕪࡣᣑ኱ࡋ࡚࠸ࡓ
ᅗ 1㸧ࠋHamashima C, et al. Cancer Sci. 2015, P.1747 ᩥ⊩ 5 ᨵኚ

ᅗ 1. ⫶ࡀࢇṚஸࡢ⣼✚ࣜࢫࢡ̿  ̿



3.ឤᗘ࣭≉␗ᗘࡇࢀࡲ࡛⫶ෆど㙾᳨デࡢឤᗘ࣭≉␗ᗘࡢ⟬ฟ᪉ἲࡣࠊᅜ㝿ᶆ‽࡟‽ࡌࡓ᪉ἲ࡛ࡣ⤫୍ࡉࢀ࡚࠾ࡽࡎࠊ᜛ព
ⓗ࡟᳨デ㛫㝸ࢆ 3 ᖺ࡞࡝௵ពࡢᮇ㛫࡟タᐃࡋࡓሗ࿌࡟␃ࡲࡗ࡚࠸ࡓࠋࡲࡓࠊ㏣㊧ㄪᰝࡶ⥅⥆ཷデ࡟ࡼࡿᢕᥱ
ࡸ♫ဨࢩࢫࢸ࣒ࡢ↷ྜࢆ⏝࠸࡚࠾ࡾࠊࡑࡢಙ㢗ᛶࡣᚲࡎࡋࡶ㧗ࡃ࡞࠿ࡗࡓࠋ
ᅜ㝿ⓗ࡞ᇶ‽࡛ࡣࠊ୰㛫ᮇࡀࢇࡣࠊ᳨デཷデ᫬࡟㺀ࡀࢇ࡞ࡋ ᳨ᰝ㝜ᛶ 㺁࡜ุ᩿ࡉࢀࠊḟᅇ᳨デࡲ࡛࡟デ᩿ࡉࢀࡓࡀࢇ࡜ᐃ⩏ࡉࢀࡿ6)ࠋឤᗘࡢ⟬ฟ᪉ἲ࡟ࡣࠊデ᩿ἲ࡜Ⓨ⏕⋡ἲࡀ࠶ࡿࠋⓎ⏕⋡ἲ࡜ࡣࠊ㐣๫デ᩿ࡢᙳ㡪ࢆ㝖እࡋ࡚ࠊ᳨デࡢឤᗘࢆ ᐃࡍࡿ᪉ἲ࡛࠶ࡿࠋデ᩿ἲ࡟ࡼࡿឤᗘࡢ⟬ฟ᪉ἲࡣࠊᚋ㏙グ㍕ࢆཧ↷ࡍࡿ P.46 ࠋ㫽ྲྀ┴⡿Ꮚᕷ࡛ࡣࠊ⫶ X ⥺᳨デ࡜ྠᵝ࡟ 1 ᖺ㛫㝸࡛⫶ෆど㙾᳨デࡀᐇ᪋ࡉࢀ࡚࠾ࡾࠊ㫽ྲྀ┴ࡀࢇⓏ㘓࡟ᇶ࡙ࡁࠊ୰㛫ᮇࡀࢇࢆᢕᥱࡋࠊデ᩿ἲ࡜Ⓨ⏕⋡ἲࡢ୧⪅ࢆ⏝࠸ࠊึᅇ᳨デ࡜⥅⥆᳨デࡢឤᗘࢆ⟬ฟࡋ࡚࠸ࡿ 7)ࠋ
᳨デᚋ 1 ᖺ௨ෆࡢⓎぢ⫶ࡀࢇࢆ୰㛫ᮇࡀࢇ࡜ࡋࡓሙྜࠊデ᩿ἲ࡟ࡼࡿึᅇ᳨デࡢឤᗘࡣ 95.5%ࠊ≉␗ᗘࡣ 85.1%ࠊ
⥅⥆᳨デࡢឤᗘࡣ 97.7%ࠊ≉␗ᗘࡣ 88.8%࡛࠶ࡗࡓ ⾲ 4 ࠋ୍᪉ࠊⓎ⏕⋡ἲ࡟ࡼࡿࠊึᅇ᳨デࡢឤᗘࡣ 88.6%ࠊ
⥅⥆᳨デࡢឤᗘࡣ 95.4%࡛࠶ࡗࡓࠋ࠸ࡎࢀࡢ᪉ἲࢆ⏝࠸ࡓሙྜ࡛ࡶࠊึᅇ࣭⥅⥆᳨デඹ࡟ࠊ⫶ X ⥺᳨デ࡟ẚ࡭࡚ࠊ⫶ෆど㙾᳨デࡢឤᗘࡣ㧗࠿ࡗࡓࠋ ྠᵝ࡟㏲ᖺ᳨デࢆ⾜ࡗ࡚࠸ࡿ᪂₲ᕷࡢሗ࿌࡛ࡶࠊデ᩿ἲ࡟ࡼࡿ⫶ෆど㙾᳨デࡢឤᗘࡣ 96.8%ࠊ⫶ X ⥺᳨デࡢឤᗘࡣ 81.8%࡜ሗ࿌ࡉࢀ࡚࠸ࡿ 8)ࠋ

⾲ 4. ⫶ෆど㙾᳨デ࡜⫶ X ⥺᳨デ㸸ឤᗘ࣭≉␗ᗘࡢẚ㍑
⟬ฟ᪉ἲ

᳨デ᪉ἲ





デ᩿ἲ

ෆど㙾


Ⓨ⏕⋡ἲ

X⥺

ෆど㙾



X⥺


ឤᗘ 95%CI ≉␗ᗘ 95%CI 



ึᅇ᳨デ



⥅⥆᳨デ



ึᅇ᳨デ



⥅⥆᳨デ

0.955
(0.875–0.991)
0.893(0.718–0.977)
0.886(0.698–0.976)
0.831(0.586–0.964)



0.977
(0.919–0.997)
0.885(0.664–0.972)
0.954(0.842–0.994)
0.855(0.637–0.970)







0.851
(0.843–0.859)
0.856(0.846–0.865)
–




0.888
(0.883–0.892)
0.891(0.885–0.896)
–



–




–









㸦Hamashima C, et al. Int J Cancer. 2013, P.658㸧ᩥ⊩ 7 ᨵኚ̿  ̿



4.⏕Ꮡ⋡⫶ෆど㙾᳨デࡀ⾜ࢃࢀ࡚࠸ࡿ㫽ྲྀ┴ 4 ᕷࡢ⫶ෆど㙾᳨デⓎぢ⫶ࡀࢇࡢ 5 ᖺ⏕Ꮡ⋡ࡣ 91.9 s 1.6%(95%CI:
87.5–93.8)ࠊ⫶ X ⥺᳨デⓎぢࡀࢇࡢ 5 ᖺ⏕Ꮡ⋡ࡣ 86.8s 2.9%(95%CI: 79.9–91.5)࡛࠶ࡾࠊ⫶ෆど㙾᳨デⓎぢࡀࢇࡢ 5 ᖺ⏕Ꮡ⋡ࡀ㧗࠸ ᅗ 2 ࠋࡲࡓࠊ㏲ᖺ᳨デࡢ୰㛫ᮇࡀࢇࡢ 5 ᖺ⏕Ꮡ⋡ࡣࠊ⫶ෆど㙾᳨デ 91.3s 5.9% 95%CI:
69.5–97.8 ࠊ⫶ X ⥺᳨デ 68.7s 2.9% 95%CI: 45.2–83.7 ࡛࠶ࡗࡓࠋ⫶ X ⥺᳨デࡢ୰㛫ᮇࡀࢇࡢ 5 ᖺ⏕Ꮡ⋡ࡣࠊእ᮶Ⓨぢࡀࢇࡢ 5 ᖺ⏕Ꮡ⋡࡜࡯ࡰྠ➼࡛࠶ࡗࡓࠋ ୍᪉ࠊ ⫶ෆど㙾᳨デ࡛ࡣࠊ ᳨デⓎぢࡀࢇ࡜୰㛫ᮇࡀࢇࡢ
5 ᖺ⏕Ꮡ⋡ࡣ࡯ࡰྠ➼࡛࠶ࡗࡓ ᅗ 3 9)ࠋ

Hamashima C, et al. PLoS ONE. 2015, e0126796 ᩥ⊩ 9 ᨵኚ

ᅗ 2. Ⓨぢ⤒⦋ู⏕Ꮡ⋡ࡢẚ㍑

Hamashima C, et al. PLoS ONE. 2015, e0126796 ᩥ⊩ 9 ᨵኚ

ᅗ 3. ᳨デⓎぢࡀࢇ࡜୰㛫ᮇࡀࢇࡢ⏕Ꮡ⋡̿  ̿

ཧ⪃ᩥ⊩
1㸧 Hamashima C, Ogoshi K, Okamoto M, et al. A community-based, case-control study evaluatingmortality reduction from gastric cancer by endoscopic screening in Japan. PLoS ONE 2013; 8:e79088.
2㸧 Cho B. Evaluation of the validity of current national health screening programs and plans to improve
the system. (in Korean) Seoul University, Seoul, 2013, 741–758.
3㸧 Matsumoto S, Yoshida Y. Efficacy of endoscopic screening in an isolated island: a case-control study.
Indian J Gastroenterol 2014; 33:46–49.
4㸧 Hamashima C, Ogoshi K, Narisawa R, et al. Impact of endoscopic screening on mortality reduction
from gastric cancer. World J Gastroenterol 2015; 21:2460–2466.
5㸧 Hamashima C, Shabana M, Okada K, et al. Mortality reduction from gastric cancer by endoscopic andradiographic screening. Cancer Sci 2015; 106: 1744–1749.
6㸧 Perry N, Broeders M, de Wolf C, et al. European guidelines for quality assurance in breast cancer
screening and diagnosis. Fourth ed, European Commission, Luxemburg, 2006.
7㸧 Hamashima C, Okamoto M, Shabana M, et al. Sensitivity of endoscopic screening for gastric cancer
by the incidence method. Int J Cancer 2013; 133:653–659.
8㸧 ᑠ㉺࿴ᰤ, ᡂ⃝ᯘኴ㑻, ຍ⸨ಇᖾ, ௚㸬᪂₲ᕷఫẸ࡟ᑐࡍࡿ⫶ࡀࢇෆど㙾᳨デ㸬ENDOSCOPIC
FORUM for digestive disease 2010; 26(1):5–16.
9㸧 Hamashima C, Shabana M, Okamoto M, et al. Survival analysis of patients with interval cancer
undergoing gastric cancer screening by endoscopy. PLoS ONE 2015; 10:e0126796.

㸦℈ᓥࡕࡉ࡜㸧̿  ̿ Ϫ⫶ෆど㙾᳨デࡢ୙฼┈ ⫶ෆど㙾᳨デࡢ୺ࡓࡿ୙฼┈࡟ࡣࠊഇ㝧ᛶࠊ㐣๫デ᩿ࠊឤᰁࠊഅⓎ⑕ࡀ࠶ࡿࠋ
1.ഇ㝧ᛶ⫶ෆど㙾᳨デ࡟࠾ࡅࡿ㺀ഇ㝧ᛶ㺁࡜ࡣࠊ⫶ࡀࢇ࡛ࡣ࡞࠸⑓ኚ࡟㺀⫶ࡀࢇ࠶ࡿ࠸ࡣࡑࡢ␲࠸㺁࡜࠸࠺ุ᩿ࢆࡍࡿࡇ࡜࡛࠶ࡿࠋ㫽ྲྀ┴⡿Ꮚᕷ࡛ࡢ⫶ෆど㙾᳨デࡢഇ㝧ᛶ⋡ࡣࠊึᅇ᳨デ 14.9%ࠊ⥅⥆᳨デ
11.2%࡛࠶ࡗࡓ 1)ࠋ
⫶ෆど㙾᳨デ࡛ࡣࠊഇ㝧ᛶࡢ௦᭰ᣦᶆ࡜ࡋ࡚㺀⏕᳨⋡㺁ࢆ⏝࠸ࡿሙྜࡀ࠶ࡿࠋ⫶ෆど㙾᳨デ࡛ࡣࠊ㺀⫶ࡀࢇ㺁࠶ࡿ࠸ࡣ㺀⫶ࡀࢇ␲࠸㺁ࡢ⑓ኚ࡟⏕᳨ࢆ⾜࠺ࠋ⤖ᯝⓗ࡟⫶ࡀࢇ࡛ࡣ࡞࠿ࡗࡓሙྜࡣࠊ⏕᳨ࡣ୙せ࡞᳨ᰝ࡜࠸࠺ࡇ࡜࡟࡞ࡿࠋ⫶ࡀࢇࡢྍ⬟ᛶࡀ࡯࡜ࢇ࡝࡞࠸඾ᆺⓗ࡞⫶ᗏ⭢࣏࣮ࣜࣉࡣࠊほᐹࡀ༑ศ⾜ࢃࢀ࡚࠸ࢀࡤ⏕᳨ࡣ୙せ࡛࠶ࡾࠊࡴࡋࢁࠊ⏕᳨ࢆ⾜࠺࡜ฟ⾑ࡢࣜࢫࢡࢆᣍࡃྍ⬟ᛶࡀ࠶ࡿࠋ⫶ෆど㙾᳨デ࡛ࡣࠊ୎ᑀ࡞ほᐹࢆ⾜࠸ࠊ⏕᳨ࡣ᭱ᑠ㝈࡟␃ࡵࡿᚲせࡀ࠶ࡿࠋ
2.㐣๫デ᩿㐣๫デ᩿࡜ࡣࠊࡀࢇ᳨デࢆ⾜࠺ࡇ࡜࡛ࠊᮏ᮶ࡣ⏕࿨ணᚋ࡟ࡣᙳ㡪ࡋ࡞࠸ࡀࢇࢆⓎぢࡍࡿࡇ࡜ࢆ
ព࿡ࡍࡿ 2)ࠋࡇࢀ࡟ࡼࡾࠊᮏ᮶ࡣ୙ᚲせ࡞⢭ᐦ᳨ᰝࡸ἞⒪ࡢቑຍࢆᣍࡃྍ⬟ᛶࡀ࠶ࡿ 3)ࠋࡍ࡭࡚ࡢ
ࡀࢇ᳨デ࡛㐣๫デ᩿ࡣᏑᅾࡍࡿࡀࠊࡑࡢ๭ྜࡣ␗࡞ࡿࠋ
⡿ᅜ࡛ࡣࠊ࣐ࣥࣔࢢࣛࣇ࢕ᑟධᚋ࡟ほᐹࡉࢀ࡚࠸ࡿஙࡀࢇ⨯ᝈᩘࡢ⇿Ⓨⓗ࡞ቑຍ࡟ẚ࡭࡚ࠊஙࡀࢇṚஸ⋡ࡢῶᑡࡀᑠࡉ࠸ࡇ࡜ࡀሗ࿌ࡉࢀࠊ㐣๫デ᩿ࡀ↓ど࡛ࡁ࡞࠸࡜ࡉࢀ࡚࠸ࡿ 4)ࠋᅜ㝿ⓗ࡟ࡣࠊஙࡀࢇ᳨デࡸ๓❧⭢ࡀࢇ᳨デࡢ㐣๫デ᩿࡟㛵ࡍࡿᩘከࡃࡢሗ࿌ࡀ࠶ࡿࠋࡓࡔࡋࠊ㐣๫デ᩿ࡢ⟬ฟ᪉ἲ࡟ࡘ࠸࡚ࡣ⤫୍ࡋࡓぢゎࡀᚓࡽࢀ࡚࠸࡞࠸ 5)ࠋ
ࢃࡀᅜ࡛ࡣࠊ⫶ෆど㙾᳨デࡢ㐣๫デ᩿࡟㛵ࡍࡿ◊✲ࡣ࡯࡜ࢇ࡝⾜ࢃࢀ࡚࠸࡞࠸ࠋᅜ❧ࡀࢇ◊✲ࢭࣥࢱ࣮ࡢ⥲ྜࡀࢇ᳨デཷデ⪅ࢆᑐ㇟࡟ࠊᐇ

⨯ᝈᩘ࡜ཷデ⪅㞟ᅋࡢᖺ㱋ᵓᡂ࠿ࡽồࡵࡓᮇᚅ⨯ᝈᩘ࡜ࡢẚ࡛࠶ࡿ O /E ẚ ほᐹ್ண ್ ࢆồࡵࡓ⤖ᯝࠊ⣙ 2ಸ࡜࡞ࡾ⨯ᝈ㉸㐣ࢆሗ࿌ࡋ࡚࠸ࡿ6)ࠋ
ࡓࡔࡋࠊࡇࡢ⨯ᝈ㉸㐣ࡣࠊᑗ᮶Ṛஸࡢཎᅉ࡜࡞ࡿ⫶ࡀࢇࢆඛ⾜ࡋ࡚Ⓨぢࡋࡓࡶࡢ࡜㐣๫デ᩿ࡢ୧⪅ࢆྵࡴࡓࡵࠊࡍ࡭࡚㐣๫デ᩿࡜࡞ࡿࢃࡅ࡛ࡣ࡞࠸ࡇ࡜࡟␃ពࡀᚲせ࡛࠶ࡿࠋཧ⪃ᩥ⊩1㸧 Hamashima C, Okamoto M, Shabana M, et al. Sensitivity of endoscopic screening for gastric cancer
by the incidence method. Int J Cancer 2013; 133:653–659.
2㸧 Vainio H, Bianchini F, eds. IARC Handbooks of cancer preventation. Volume 7. Breast cancer
screening. IARC Press, Lyon, 2002; 144–147.
3㸧 Harris RP, Wilt TJ, Qaseem A. A value framework for cancer screening: advice for high-value carefrom the American College of Physicians. Ann Intern Med 2015; 162:712–717.
4㸧 Bleyer A, Welch HG. Effect of three decades of screening mammography on breast-cancer incidence.
N Engl J Med 2012; 367:1998–2005.
̿  ̿



5㸧 Marmot MG, Altman DG, Cameron DA, et al. The benefits and harms of breast cancer screening: an
independent review. Br J Cancer 2013; 108:2205–2240.
6㸧 Hamashima C, Sobue T, Muramatsu Y, et al. Comparison of observed and expected numbers ofdetected cancers in the research center for cancer prevension and screening program. Jpn J Clin Oncol
2006; 36:301–308.

㸦℈ᓥࡕࡉ࡜㸧̿  ̿



3.ឤᰁ ᾘ໬ჾෆど㙾ࢆ௓ࡍࡿឤᰁ࡟ࡣࠊ⣽⳦ࠊ┿⳦ࠊ࢘࢖ࣝࢫឤᰁࡢሗ࿌ࡀ࠶ࡿࠋ1985 ᖺ࡟᪥ᮏᾘ໬ჾෆど㙾Ꮫ఍ᾘẘጤဨ఍ࡼࡾࠊ⫶ෆど㙾᳨ᰝࢆཷࡅࡓᝈ⪅ࡢ 8.5%࡟ B ᆺ⫢⅖࣐࣮࣮࢝ࡢ㝧ᛶࡀㄆࡵࡽࢀࡓࡇ࡜ࡀሗ࿌ࡉࢀࡓ 1, 2)ࠋࡲࡓࠊ1990 ᖺ௦࡟ࡣࠊ⫶ෆど㙾᳨ᰝᚋࡢᛴᛶ⫶⢓⭷⑓ኚࡢཎᅉࡀࠊෆど㙾ࢆ௓ࡋࡓ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ࡟ࡼࡿࡇ࡜ࡀุ᫂ࡋ࡚࠸ࡿ 3, 4)ࠋ1995 ᖺ௨㝆ࡣࠊ᪥ᮏ
ᾘ໬ჾෆど㙾Ꮫ఍ࢆ୰ᚰ࡟ࠊෆど㙾ᶵჾࡢὙί࣭ᾘẘ࡟㛵ࡍࡿ࢞࢖ࢻࣛ࢖ࣥࡸ࣐ࢽࣗ࢔ࣝ࡞࡝ࡀస
ᡂࡉࢀ 5-8)ࠊࡑࡢᑐ⟇ࡣᾐ㏱ࡋࡘࡘ࠶ࡾࠊṇࡋࡃ⾜࠼ࡤឤᰁᣑ኱ࢆ㜵ࡄࡇ࡜ࡀ࡛ࡁࡿࠋ⫶ෆど㙾᳨デࡢ㛤ጞ࡟ࡼࡾࠊ⫶ෆど㙾᳨ᰝ௳ᩘࡣቑຍࡍࡿࡇ࡜ࡀண

ࡉࢀࡿࡀࠊᶵჾࡢὙί࣭ᾘẘࡀ㐺ษ࡛࡞ࡅࢀࡤࠊឤᰁᣑ኱ࢆᣍࡃྍ⬟ᛶࡀ࠶ࡿࠋཧ⪃ᩥ⊩1㸧 ᪥ᮏᾘ໬ჾෆど㙾Ꮫ఍ᾘẘጤဨ఍㸬ᾘ໬ჾෆど㙾᳨ᰝ࡜ B ᆺ⫢⅖࢘࢖ࣝࢫ HBV ឤᰁࡢ㛵㐃࡟ࡘ࠸࡚ ➨ 1 ሗ 㸬Gastroenterol Endsc 1985; 27:2727–2733.
2㸧 ᪥ᮏᾘ໬ჾෆど㙾Ꮫ఍ᾘẘጤဨ఍㸬ᾘ໬ჾෆど㙾᳨ᰝ࡜ B ᆺ⫢⅖࢘࢖ࣝࢫ HBV ឤᰁࡢ㛵㐃࡟ࡘ࠸࡚ ➨ 2 ሗ 㸬Gastroenterol Endsc 1985; 27:2734–2738.
3㸧 Sugiyama T, Naka H, Yabana T, et al. Is Helicobacter pylori infection responsible for postendoscopic
acute gastric mucosal lesions? Europ J Gastroenterol and Hepatol 1992; 4:S93–96.
4㸧 బ⸨බ㸪⸨㔝㞞அ㸪㣤⏣㱟୍㸬ෆど㙾ᚋᛴᛶ⫶⢓⭷⑓ኚࡣ Helicobacter pylori ࡢึឤᰁ࠿㸬
ENDOSC FORUM Digest Dis 1933; 9:7–11
5㸧 ㉥ᯇὈḟ, ▼ཎ❧, బ⸨බ, ௚㸬ᾘ໬ჾෆど㙾ࡢឤᰁไᚚ࡟㛵ࡍࡿ࣐ࣝࢳࢯࢧ࢚ࢸ࢕ᐇ㊶࢞࢖
ࢻ㸬Gastroenterol Endosc 2014; 56:89–104㸬
6㸧 ᪥ᮏᾘ໬ჾෆど㙾Ꮫ఍⏥ಙ㉺ᨭ㒊ឤᰁᑐ⟇ጤဨ఍㸬ෆど㙾ᾘẘἲ࢞࢖ࢻࣛ࢖ࣥ㸬ENDOSCFORUM Digest Dis 1995; 11:18–23.
7㸧 ᪥ᮏᾘ໬ჾෆど㙾Ꮫ఍ᾘẘጤဨ఍㸬ᾘ໬ჾෆど㙾ᶵჾὙί࣭ᾘẘἲ࢞࢖ࢻࣛ࢖ࣥ㸬Gastroenterol
Endosc 1998; 40:2022–2034㸬
8㸧 ᪥ᮏᾘ໬ჾෆど㙾ᢏᖌ఍ᾘẘጤဨ఍㸬ෆど㙾ࡢὙί࣭ᾘẘ࡟㛵ࡍࡿ࢞࢖ࢻࣛ࢖ࣥ㸬᪥ᾘෆど㙾఍ᢏሗ 1996; 16:57–63㸬㸦℈ᓥࡕࡉ࡜㸧̿  ̿



4.അⓎ⑕അⓎ⑕࡜ࡣࠊ᳨ᰝ࡟క࠸ேⅭⓗ࡟㞀ᐖࢆ㉳ࡇࡍࡇ࡜࡛࠶ࡾࠊ㍍ᚤ࡞౛࠿ࡽṚ࡟⮳ࡿ㔜⠜࡞౛ࡲ࡛࠶ࡿࠋ⫶ X ⥺᳨ᰝ࡟ẚ࡭⫶ෆど㙾᳨ᰝ࡛ࡣࠊഅⓎ⑕ࢆᣍࡃྍ⬟ᛶࡣ㧗࠸ 1, 3-5)ࠋ ⾲ 1 
⾲ 1. അⓎ⑕ࡢẚ㍑
᪥ᮏᾘ໬ჾࡀࢇ᳨デᏛ఍ 

᪥ᮏᾘ໬ჾෆど㙾Ꮫ఍
㸧
㸧

᳨ᰝ᪉ἲ

⫶㹖⥺᳨ᰝ⫶ෆど㙾᳨ᰝ

⏕᳨ࢆྵࡴほᐹࡢୖ㒊ᾘ໬⟶ෆど㙾᳨ᰝᑐ㇟⪅᳨デཷデ⪅

᳨デཷデ⪅

ᝈ⪅᳨࣭デཷデ⪅ཷデ⪅ᩘ ே 

3,130,477

244,899

7,408,688

അⓎ⑕ ே 

1,325

214

372

୺ࡓࡿഅⓎ⑕

⭠㛢ሰࠊ⭠⟶✸Ꮝ㐣ᩄ⑕࢔ࢼࣇ࢕ࣛ࢟ࢩ࣮ࢩࣙࢵࢡṚஸ ே 

1

0

14

അⓎ⑕⋡
㸦/100,000㸧

42.3

87.4

5.0

Ṛஸ⋡

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0.19

⢓⭷⿣๰ࠊ㰯⭍ฟ⾑ヲ⣽୙᫂㙠㟼⸆࡟ࡼࡿ࿧྾ᢚไ

1㸧デ⒪࡟࠾ࡅࡿෆど㙾᳨ᰝࡢഅⓎ⑕ㄪᰝ ᪥ᮏᾘ໬ჾෆど㙾Ꮫ఍࡛ࡣ 1983 ᖺ࠿ࡽ 5 ᖺࡈ࡜࡟Ꮫ఍ホ㆟ဨࠊᑓ㛛་ࡢᡤᒓࡍࡿ᪋タ࡟ᑐࡋ࡚അⓎ⑕ࡢ࢔ࣥࢣ࣮ࢺㄪᰝࢆ⾜ࡗ࡚࠸ࡿ 1, 2)ࠋ᭱᪂ࡢ➨ 5 ᅇㄪᰝ 2003ࠥ2007 ᖺ ࡟࠾ࡅࡿᅇ཰⋡ࡣ
44%࡛࠶ࡿ 1)ࠋ᪥ᮏᾘ໬ჾෆど㙾Ꮫ఍ࡢഅⓎ⑕ㄪᰝࡣࠊデ᩿ࡢࡓࡵࡢෆど㙾᳨ᰝࡔࡅ࡛ࡣ࡞ࡃࠊෆ
ど㙾἞⒪࡟࠾ࡅࡿഅⓎ⑕ࡶྵࡲࢀ࡚࠸ࡿࡇ࡜࡜ࠊ⤒㰯ෆど㙾࡟ࡼࡿ㰯ฟ⾑࡞࡝ࡢ㍍ᚤ࡞അⓎ⑕ࡣྵࡲࢀ࡚࠸࡞࠸ࡇ࡜ࠊୖ㒊ᾘ໬⟶ෆど㙾᳨ᰝࡔࡅ࡛ࡣ࡞ࡃࠊୗ㒊ᾘ໬⟶ෆど㙾᳨ᰝࠊ⫹⮅ෆど㙾᳨ᰝ࡞࡝ࡍ࡭࡚ࡢᾘ໬ჾෆど㙾᳨ᰝࡀྵࡲࢀࡿࡇ࡜࡟␃ពࡍࡿᚲせࡀ࠶ࡿࠋ ⾲ 2 ࡣ➨ 1 ᅇㄪᰝ࠿ࡽ➨ 5 ᅇㄪᰝࡲ࡛ࡢഅⓎ⑕Ⓨ⏕⋡ࡣ 22ࠥ65 /10୓ ࡛࠶ࡾࠊ≉࡟పୗഴྥࡣ
ㄆࡵ࡚࠸࡞࠸ࠋ⾲ 3 ࡣ➨ 1 ᅇㄪᰝ࠿ࡽ➨ 5 ᅇㄪᰝࡲ࡛ࡢ๓ฎ⨨࡟㛵ࡍࡿഅⓎ⑕Ⓨ⏕⋡࡜അⓎ⑕Ṛஸ⋡ࢆ♧ࡋ࡚࠸ࡿࡀࠊ➨ 2 ᅇㄪᰝࡲ࡛ࡢഅⓎ⑕Ṛஸ⋡ࡣ 1.22ࠥ1.62 /10୓ ࡜㢖ᗘࡀ㧗࠿ࡗࡓࡀࠊ
᭱㏆ࡣ 0.01ࠥ0.1 /10୓ ࡜ 1 /10 ௨ୗ࡟࡞ࡗ࡚࠸ࡿࠋ➨ 4 ᅇㄪᰝ࡛ࡣࠊ๓ฎ⨨࡟ࡼࡿṚஸ౛ 14 ௳୰
8 ௳ 57% ࡜㙠㟼⸆࡟ࡼࡿṚஸࡀከ࠿ࡗࡓࡀ 2)ࠊ➨ 5 ᅇㄪᰝ࡛ࡣࠊୗ㒊ᾘ໬⟶ෆど㙾᳨ᰝ࡟క࠺⭠⟶Ὑίᾮ࡟ࡼࡿṚஸࡀ 11 ௳୰ 8 ௳ 73% ࡜ከᩘࢆ༨ࡵ࡚࠸ࡓ ⾲ 4 ࠋ⫶ෆど㙾᳨デࡢഅⓎ⑕ࡢᐇែ࡟᭱ࡶ㏆࠸㈨ᩱࡣ⾲ 5 ࡟♧ࡍࡈ࡜ࡃࠊ⏕᳨ࢆྵࡴほᐹࡢࡳࡢ᳨ᰝ࡟࠾ࡅࡿഅⓎ⑕㢖ᗘ࡛࠶ࢁ࠺ࠋ
ࡇࢀ࡟ࡼࡿ࡜ࠊഅⓎ⑕Ⓨ⏕⋡ࡣ 5 /10୓ ࡛࠶ࡾࠊഅⓎ⑕Ṛஸ⋡ࡣ 0.19 /10୓ ࡜࡞ࡗ࡚࠸ࡿ 1)ࠋ

̿  ̿

⾲ 2. ྛㄪᰝᮇ㛫࡟⾜ࢃࢀࡓ᳨ᰝ⥲ᩘ࡜അⓎ⑕Ⓨ⏕⋡      㸦ᖺ㸧᳨ᰝ⥲ᩘ➨ 1 ᅇㄪᰝ 1983–1987➨ 2 ᅇㄪᰝ 1988–1992➨ 3 ᅇㄪᰝ 1993–1997➨ 4 ᅇㄪᰝ 1998–2002➨ 5 ᅇㄪᰝ 2003–2007
ィ

4,425,654
8,068,439
12,131,194
12,844,551
12,563,287
50,033,125

അⓎ⑕ᩘ

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୓

1,188
5,205
2,609
4,152
7,242
20,396

27
65
22
32
57
40.8

㸦ⰾ㔝⣧἞㸪௚㸬Gastroenterol Endosc. 2010, P.96㸧ᩥ⊩ 1 ᨵኚ

➨ 1 ᅇㄪᰝ࠿ࡽ➨ 5 ᅇㄪᰝࡲ࡛ࡢഅⓎ⑕Ⓨ⏕⋡⾲ 3. ๓ฎ⨨࡟㛵ࡍࡿഅⓎ⑕
അⓎ⑕ᩘ /10୓
୓➨ 1 ᅇㄪᰝ
➨ 2 ᅇㄪᰝ
➨ 3 ᅇㄪᰝ
➨ 4 ᅇㄪᰝ
➨ 5 ᅇㄪᰝ

443
1,663
169
754
466

Ṛஸᩘ /10୓
୓

10.0
25.2
1.4
5.9
3.7

54
129
6
14
11

1.22
1.62
0.01
0.10
0.09

㸦ⰾ㔝⣧἞㸪௚㸬Gastroenterol Endosc. 2010, P.96㸧ᩥ⊩ 1 ᨵኚ

➨ 1 ᅇㄪᰝ࠿ࡽ➨ 5 ᅇㄪᰝࡲ࡛ࡢ๓ฎ⨨࡟㛵ࡍࡿഅⓎ⑕Ⓨ⏕⋡࡜Ṛஸ⋡

⾲ 4. ๓ฎ⨨࡟㛵ࡍࡿഅⓎ⑕㸦➨ 5 ᅇㄪᰝ㸧

ဗ㢌㯞㓉
㰯⭍㯞㓉
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㙠㟼⸆
㙠③⸆
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ᢠจᅛ⸆㺃ᢠ⾑ᑠᯈ⸆ࡑࡢ௚     ィ

അⓎ⑕ᩘ

Ṛஸᩘ

38
8
37
167
11
114
67
24
466

0
0
0
3
0
8
0
0
11

㸦ⰾ㔝⣧἞㸪௚㸬Gastroenterol Endosc. 2010, P.96㸧ᩥ⊩ 1 ᨵኚ

➨ 5 ᅇㄪᰝ࡟࠾ࡅࡿ๓ฎ⨨࡟㛵ࡍࡿഅⓎ⑕ࡢヲ⣽

⾲ 5. ⏕᳨ࢆྵࡴほᐹࡢࡳࡢ᳨ᰝ࡟࠾ࡅࡿഅⓎ⑕

ୖ㒊ᾘ໬⟶
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኱⭠
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ィ

᳨ᰝ௳ᩘ
7,408,688
13,0722,548,400
43,14945,593
10,058,902

അⓎ⑕ᩘ

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୓

Ṛஸᩘ

372
5
45 344
313
12
14
32
0

744
7

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14 0.190
21 0.8200 
35 0.35㸦ⰾ㔝⣧἞㸪௚㸬Gastroenterol Endosc. 2010, P.98㸧ᩥ⊩ 1 ᨵኚ

➨ 5 ᅇㄪᰝ࡟࠾ࡅࡿ⏕᳨ࢆྵࡴほᐹࡢࡳࡢ᳨ᰝ࡟࠾ࡅࡿഅⓎ⑕ᩘ࡜Ṛஸᩘ̿  ̿



2㸧᳨デ࡟࠾ࡅࡿ⫶ෆど㙾᳨ᰝࡢഅⓎ⑕ㄪᰝ ᪥ᮏᾘ໬ჾࡀࢇ᳨デᏛ఍࡛ࡣ 2010 ᖹᡂ 22 ᖺᗘࡢ඲ᅜ㞟ィ࠿ࡽ⫶ෆど㙾᳨デࡢഅⓎ⑕ㄪᰝࢆ⾜ࡗ࡚࠾ࡾࠊ2012 ᖹᡂ 24 ᖺᗘࡢഅⓎ⑕ㄪᰝࡀ᭱᪂ࡢࡶࡢ࡛࠶ࡿࠋ⾲ 6 ࡟ 2010 ᖹᡂ 22 ᖺᗘ࠿ࡽ2012 ᖹᡂ 24 ᖺᗘࡲ࡛ࡢ 3 ᖺศࡢഅⓎ⑕ㄪᰝࢆ㞟ィࡋࡓࡶࡢࢆ♧ࡋ࡚࠸ࡿ 3-5)ࠋ3 ᖺ㛫ࡢ㞟ィ࡛ࡣ࢔ࣥࢣ࣮ࢺࡢᅇ཰⋡ࡣ 49.3%࡛࠶ࡾࠊ⫶ෆど㙾᳨ᰝ⥲ᩘࡣ 740,245 ௳࡛࠶ࡗࡓࠋ౑⏝ᶵ✀࡛⤒ཱྀෆど㙾࡜⤒㰯ෆど㙾ࡢ༊ูࡀࢃ࠿ࡗ࡚࠸ࡿࡶࡢࡔࡅ࡛ẚ㍑ࡍࡿ࡜⤒ཱྀ㸸⤒㰯㸻5.7㸸1 ࡢ๭ྜ࡟࡞ࡿࠋ
അⓎ⑕Ⓨ⏕௳ᩘࡣ 574 ௳ 78 /10 ୓ ࡛࠶ࡗࡓࠋෆど㙾἞⒪ࢆྵࡲࡎࠊ᳨デࡔࡅ࡟ࡶ࠿࠿ࢃࡽࡎ᪥ᮏᾘ໬ჾෆど㙾Ꮫ఍ࡢㄪᰝࡢഅⓎ⑕㢖ᗘࡀ㧗࠸ࡢࡣࠊ⤒㰯ෆど㙾࡟ࡼࡿ᧿㐣യ 㰯ฟ⾑ࢆྵࡴ ࡶࠊ
അⓎ⑕࡜ࡋ࡚㞟ィࡋ࡚࠸ࡿ࠿ࡽ࡛࠶ࡿࠋ⾲ 7 ࡟⑕౛ࡢෆヂࢆ♧ࡍࠋ
അⓎ⑕ㄪᰝ࡛ࡣṚஸ౛ࡣሗ࿌ࡉࢀ࡚࠸࡞࠸ࡀࠊ௒ᚋᮏ᱁ⓗ࡟⫶ෆど㙾᳨デࡀᐇ᪋ࡉࢀࢀࡤࠊ㔜⠜࡞അⓎ⑕ࡶⓎ⏕ࡍࡿ࡜ண᝿ࡉࢀࡿࠋࡇࡢࡓࡵࠊ༑ศ࡞അⓎ⑕ᑐ⟇ࡀᚲせ࡛࠶ࡿࠋ㸦1㸧⢓⭷⿣๰ࠊ᧿㐣യ᭱ࡶከ࠸㒊఩ࡣ㰯⭍࡛࠶ࡾࠊᛶูࡀࢃ࠿ࡗ࡚࠸ࡿ⑕౛᳨࡛ウࡍࡿ࡜ 91% 457ே/503ே ࢆ༨ࡵࡿࠋ⫶ෆど㙾ᶵ✀ูࡢⓎ⏕௳ᩘ࠿ࡽ᥎

ࡍࡿ࡜ࠊ⤒㰯ෆど㙾࡟ࡼࡿ㰯ฟ⾑ࡀ᭱ࡶከ࠸ࠋ἞⒪⤒㐣࡛ࡣධ㝔ࢆせࡍࡿࡶࡢࡀ 1 ௳࠶ࡿࡀࠊࡇࢀࡣ⫶⢓⭷ࡢ⿣๰࠿ࡽࡢฟ⾑ࡢࡓࡵ࡛࠶ࡾࠊ72% 361 ே /503
ே ࡢ⑕౛ࡣࡑࡢࡲࡲᖐᏯ࡛ࡁࡿ⛬ᗘࡢ㍍ᚤ࡞ฟ⾑࡛࠶ࡗࡓࠋ
㸦2㸧⏕᳨㒊఩࠿ࡽࡢฟ⾑ฟ⾑ࡢ㔞ࡀከ࠸⑕౛ࡢࡳሗ࿌ࡉࢀ࡚࠸ࡿ࡜ᛮࢃࢀࡿࡀࠊ21 ௳࡜ᑡ࡞࠸ࡶࡢࡢධ㝔ࢆせࡋࡓ⑕౛ࡀ 4 ௳ࡶ࠶ࡿࠋࡓࡔࡋࠊᢠ⾑ᰦ⸆ ᐃ⩏ࡣᚋ㏙ࠊP.32 ࢆཧ↷ ࡜ࡢ㛵㐃ࡣ᫂ࡽ࠿࡛ࡣ࡞࠸ࠋ
ᅜෆ◊✲࡛ࡣࠊ࢔ࢫࣆࣜࣥࢆྵࡴᢠ⾑ᰦ⸆ࢆ᭹⏝ࡋ࡚ࡶ⏕᳨ᚋฟ⾑ࡣቑຍࡋ࡞࠸࡜࠸࠺ሗ࿌ࡀ
࠶ࡿ 6, 7)ࠋࡋ࠿ࡋࠊ᳨デཷデ⪅ࡢ㧗㱋໬࡟ࡼࡾࠊᢠ⾑ᰦ⸆ࡢ᭹⏝⪅ࡀቑຍࡍࡿࡇ࡜ࢆ⪃࠼ࡿ࡜ࠊ⫶ෆど㙾᳨デ࡛ࡢᏳ᫆࡞⏕᳨ࡢᐇ᪋࡟ࡣὀពࡀᚲせ࡜࡞ࡿࠋ㸦3㸧࢔ࢼࣇ࢕ࣛ࢟ࢩ࣮ࢩࣙࢵࢡ
๓ฎ⨨⸆࡟ࡼࡿ࢔ࢼࣇ࢕ࣛ࢟ࢩ࣮ࢩࣙࢵࢡࡢሗ࿌౛ࡣ 7 ௳ 0.9510୓ ࡜㢖ᗘࡣᑡ࡞ࡃࠊධ㝔ࢆせࡍࡿࡼ࠺࡞㔜⑕౛ࡣㄆࡵࡽࢀ࡞࠿ࡗࡓࠋ౑⏝⸆๣࡟ࡣဗ㢌㯞㓉࡟౑⏝ࡍࡿᒁᡤ㯞㓉⸆࡜⭠⟶ࡢ㐠ືࢆᢚไࡍࡿ㙠②⸆࡟ࡼࡿࡶࡢࠊ࡝ࡕࡽ࠿ࢃ࠿ࡽ࡞࠸ࡶࡢ࡜ࡀ࠶ࡿࠋ
㸦4㸧࿧྾ᢚไ
㙠③⸆࣭㙠㟼⸆࡟ࡼࡿ࿧྾ᢚไࡣࠊṚஸ࡟⧅ࡀࡿྍ⬟ᛶࡀ࠶ࡿࠋഅⓎ⑕ㄪᰝ࡛ࡣ 8 ௳ 1.110 ୓ࡢሗ࿌ࡣ࠶ࡗࡓࡀࠊṚஸ౛ࡣㄆࡵࡽࢀ࡞࠿ࡗࡓࠋ
㸦5㸧ࡑࡢ௚
ୖグࡢሗ࿌࡛ࡣ ⓶ୗẼ⭘ࡣ ㄆࡵࡽࢀ࡞࠿ࡗࡓࡶࡢࡢࠊ⫶ෆど㙾࡟ࡼࡿᾘ໬⟶✸Ꮝࡀ ဗ㢌࡜⫶
࡟ 1 ௳ࡎࡘィ 2 ௳ㄆࡵࡽࢀࡓࠋࡑࡢ࡯࠿࡟ࠊὀᑕ㒊఩ࡢ⑊③࡞࡝ࡀሗ࿌ࡉࢀ࡚࠸ࡿࠋ ᮏㄪᰝ࡛ࡣሗ࿌ࡉࢀ࡚࠸࡞࠸ࡀࠊᢠ⾑ᰦ⸆ࡢఇ⸆࡟ࡼࡿ⾑ᰦሰᰦ⑕Ⓨ⑕ࡢࣜࢫࢡ 8-10)ࡸఇ⸆෌
㛤ᚋࡢฟ⾑ࡢྍ⬟ᛶ 11, 12)ࡶ࠶ࡿࠋ

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⾲ 6. ᪥ᮏᾘ໬ჾࡀࢇ᳨デᏛ఍ ᖹᡂ 22ࠊ23ࠊ24 ᖺᗘ ෆど㙾⫶ࡀࢇ᳨デഅⓎ⑕࡟㛵ࡍࡿ࢔ࣥࢣ࣮ࢺㄪᰝ
ᅇ཰⋡ 365 ᪋タ㸭741 ᪋タ୰㸻49.3% 㔜」࠶ࡾෆど㙾⫶ࡀࢇ᳨デ᳨ᰝᩘ
᳨ᰝ⥲ᩘ

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3-5)

ᨵኚ

᪥ᮏᾘ໬ჾࡀࢇ᳨デᏛ఍㸸ᖹᡂ 22, 23, 24 ᖺᗘ ෆど㙾⫶ࡀࢇ᳨デഅⓎ⑕࡟㛵ࡍࡿ࢔ࣥࢣ࣮ࢺㄪᰝࡢᴫせ⾲ 7. ྛ⑕౛ࡢヲ⣽
㸦1㸧⢓⭷⿣๰ࠊ᧿㐣യ㒊  ఩㸦」ᩘᅇ⟅᭷㸧἞  ⒪

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㸦᪥ᮏᾘ໬ჾࡀࢇ᳨デᏛ఍അⓎ⑕࢔ࣥࢣ࣮ࢺㄪᰝሗ࿌ 3-5)㸧ᨵኚ᪥ᮏᾘ໬ჾࡀࢇ᳨デᏛ఍㸸ᖹᡂ 22, 23, 24 ᖺᗘෆど㙾⫶ࡀࢇ᳨デഅⓎ⑕࡟㛵ࡍࡿ࢔ࣥࢣ࣮ࢺㄪᰝ࡟࠾ࡅࡿྛ⑕౛ࡢヲ⣽̿  ̿

ཧ⪃ᩥ⊩ 1㸧 ⰾ㔝⣧἞㸪஬༑ᔒⰋ඾㸪኱ཎᘯ㝯㸪௚㸬ᾘ໬ჾෆど㙾㛵㐃ࡢഅⓎ⑕࡟㛵ࡍࡿ➨ 5 ᅇ඲ᅜㄪᰝ
ሗ࿌ؐ2003 ᖺࡼࡾ 2007 ᖺࡲ࡛ࡢ 5 ᖺ㛫ؐ㸬Gastroenterol Endosc 2010; 52:95–103.
2㸧 㔠Ꮚᴿ⸝㸪ཎ⏣ⱥ㞝㸪᫓᪥஭㐩ⶶ㸪௚㸬ᾘ໬ჾෆど㙾㛵㐃ࡢഅⓎ⑕࡟㛵ࡍࡿ➨ 4 ᅇ඲ᅜㄪᰝ
ሗ࿌ؐ1998 ᖺࡼࡾ 2002 ᖺࡲ࡛ࡢ 5 ᖺ㛫ؐ㸬Gastroenterol Endosc 2004; 46:54–61.
3㸧 ῰㇂኱ຓ㸪▼ᕝຮ㸪୍℩㞞ኵ㸪௚㸬ᖹᡂ 22 ᖺᗘ⫶ࡀࢇ᳨デഅⓎ⑕࢔ࣥࢣ࣮ࢺㄪᰝሗ࿌㸬᪥ᾘࡀࢇ᳨デㄅ 2013; 51:250–255㸬
4㸧 ῰㇂኱ຓ㸪▼ᕝຮ㸪୍℩㞞ኵ㸪௚㸬ᖹᡂ 23 ᖺᗘ⫶ࡀࢇ᳨デഅⓎ⑕࢔ࣥࢣ࣮ࢺㄪᰝሗ࿌㸬᪥ᾘࡀࢇ᳨デㄅ 2014; 52:253–258㸬
5㸧 ῰㇂኱ຓ㸪▼ᕝຮ㸪୍℩㞞ኵ㸪௚㸬ᖹᡂ 24 ᖺᗘ⫶ࡀࢇ᳨デഅⓎ⑕࢔ࣥࢣ࣮ࢺㄪᰝሗ࿌㸬᪥ᾘࡀࢇ᳨デㄅ 2015; 53:233–238㸬
6㸧 ᮾ⣡㔜㝯㸪᳃⏣㟹㸬ప⏝㔞࢔ࢫࣆࣜࣥ⥅⥆ୗ࡛ࡢ⫶࣭༑஧ᣦ⭠ ESD ࡢᏳ඲ᛶࡢ᳨ウ㸬
Gastroenterol Endosc 2011; 53:3326–3335㸬
7㸧 Goto O, Fujishiro M, Kodashima S, et al. A second-look endoscopy after endoscopic submucosal
dissection for gastric epithelial neoplasm may be unnecessary: a retrospective analysis ofpostendoscopic submucosal dissection bleeding. Gastrointest Endosc 2010; 71:241–248㸬
8㸧 Sibon I, Orgogozo JM. Antiplatelet drug discontinuation is a risk factor for ischemic stroke. Neurology
2004; 62:1187–1189㸬
9㸧 Maulaz AB, Bezerra DC, Michel P, et al. Effect of discontinuing aspirin therapy on the risk of brainischemic stroke. Arch Neurol 2005; 62:1217–1220㸬
10㸧Wahl MJ. Dental surgery in anticoagulated patients. Arch Intern Med 1998; 158:1610–1616㸬
11㸧 Blacker DJ, Wijdicks EF, McClelland RL. Stroke risk in anticoagulated patients with atrial fibrillation
undergoing endoscopy. Neurology 2003; 61:964–968㸬
12㸧Palareti G, Legnani C, Guazzaloca G, et al. Activation of blood coagulation after abrupt or stepwise
withdrawal of oral anticoagulantsʊa prospective study. Thromb Haemost 1994; 72:222–226㸬㸦῰㇂኱ຓ㸧̿  ̿

ϫᐇ᪋᪉ἲ

1.ᑐ㇟ᖺ㱋2010 ᖺࡢ⫶ࡀࢇ⨯ᝈ⋡ࡣࠊ1975 ᖺ࡟ẚ࡭ 40㹼49 ṓ࡛ࡣ⏨ዪඹ࡟ 1 / 3 ࠿ࡽ 1 / 2 ࡟ῶᑡࡋࡓ ᅗ 1 1)ࠋ
50 ṓ௨ୖ࡛ࡶ⏨ዪඹ࡟⫶ࡀࢇ⨯ᝈ⋡ࡣῶᑡഴྥ࡟࠶ࡾࠊ ຍ㱋࡟క࠸ῶᑡ๭ྜࡣ⦰ᑠࡋ࡚࠸ࡿࠋ
1975 ᖺᙜ᫬ࡢ 40 ṓ௦๓༙ࡢ⫶ࡀࢇ⨯ᝈ⋡ࢆୖᅇࡿࡢࡣࠊ⏨ᛶ࡛ࡣ 50 ṓ௦๓༙ࠊዪᛶ࡛ࡣ 50 ṓ௦ᚋ༙࡛࠶ࡿࠋ

900.0
800.0
700.0
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300.0
200.0
100.0
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40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+ṓ

1975ᖺ

48.9

97.5

151.1

231.5

356.4

512.3

673.4

735.3

762.3

565.0

1990ᖺ

43.9

71.8

131.3

211.0

321.0

444.9

556.2

669.1

721.4

707.5

2010ᖺ

14.6

34.2

75.1

147.5

236.0

332.6

487.7

605.3

676.4

708.3

ᅗ 1. ᖺ㱋ู⫶ࡀࢇ⨯ᝈ⋡ ⏨ᛶ ⫶ࡀࢇṚஸ⋡ࡢῶᑡࡣ㢧ⴭ࡛࠶ࡾࠊ2010 ᖺࡢ⫶ࡀࢇṚஸ⋡ࡣࠊ40㹼49 ṓ࡛ࡣ⏨ዪඹ࡟ 1 / 6 ࠿ࡽ
1 / 7 ࡟ῶᑡࡋࡓࠋ⫶ࡀࢇṚஸ⋡ࡢపୗࡣຍ㱋࡟క࠸ῶᑡࡋ࡚࠸ࡿࡀࠊ75㹼79 ṓ࡛࠶ࡗ࡚ࡶ⏨ᛶ࡛
1 / 3ࠊዪᛶ࡛ 1 / 2 ࡟ῶᑡࡋ࡚࠸ࡿ ᅗ 2 1)ࠋ
㺀᭷ຠᛶホ౯࡟ᇶ࡙ࡃ⫶ࡀࢇ᳨デ࢞࢖ࢻࣛ࢖ࣥ 2014 ᖺᗘ∧㺁࡛ࡣࠊ⫶ࡀࢇ⨯ᝈ⋡࣭Ṛஸ⋡ࡢ᥎⛣࡜฼┈࣭୙฼┈ࡢࣂࣛࣥࢫࡢほⅬ࠿ࡽࠊ⫶ෆど㙾᳨デࡢᑐ㇟ᖺ㱋࡜ࡋ࡚ 50 ṓ௨ୖࡀᮃࡲࡋ࠸࡜ࡋ
࡚࠸ࡿࠋ40 ṓ௦࡟ࡘ࠸࡚ࡣ⫶ࡀࢇ⨯ᝈ⋡࣭Ṛஸ⋡ࡢపୗࡀⴭࡋ࠸ࡇ࡜࡟ຍ࠼ࠊ⫶ෆど㙾᳨デ࡛ࡣ
50 ṓ௨ୖ࡟ẚ࡭࡚☜ᐇ࡟୙฼┈ࡀ኱ࡁࡃ࡞ࡿࡇ࡜ࡀᣦ᦬ࡉࢀ࡚࠸ࡿ 2)ࠋ
̿  ̿

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50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+ṓ

1975ᖺ

24.4

45.0

74.0

139.5

218.3

341.1

489.1

602.0

650.8

499.1

1990ᖺ

12.1

24.6

44.4

79.1

131.8

186.4

273.5

385.5

517.5

611.7

2010ᖺ

3.8

7.6

18.3

39.3

66.3

107.1

163.1

236.7

329.8

512.9

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ᅗ 2. ⫶ࡀࢇṚஸ⋡ ⏨ᛶ ̿  ̿

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2.᳨デ㛫㝸ᅜෆࡢ⑕౛ᑐ↷◊✲࡛ࡣࠊ2㹼4 ᖺ௨ෆࡢ⫶ෆど㙾᳨デཷデ࡟ࡼࡾ 30%ࡢ⫶ࡀࢇṚஸ⋡ῶᑡຠᯝࢆㄆࡵࡓࡀࠊ⑕౛⩌ࡢ⫶ࡀࢇデ᩿᪥௨๓ 3 ᖺ௨ෆࡢཷデࡢࡳ᭷ព࡛࠶ࡗࡓ 3)ࠋ୍᪉ࠊ㡑ᅜࡢ◊✲࡛
ࡣࠊ40㹼79 ṓࢆᑐ㇟࡜ࡋࡓሙྜࠊ1㹼3 ᖺ௨ෆࡢ⫶ෆど㙾᳨デཷデ࡛ 50㹼70%ࡢṚஸ⋡ῶᑡຠᯝࢆ
ㄆࡵࡓ 4)ࠋ
ࡇࢀࡽࡢ◊✲ᡂᯝࢆ㋃ࡲ࠼ࠊ㺀᭷ຠᛶホ౯࡟ᇶ࡙ࡃ⫶ࡀࢇ᳨デ࢞࢖ࢻࣛ࢖ࣥ 2014 ᖺᗘ∧㺁࡛ࡣࠊ⫶ෆど㙾᳨デ࡛ࡣ᳨デ㛫㝸ࢆ 2㹼3 ᖺ࡟ᘏ㛗ࡋࡓሙྜ࡛ࡶ⫶ࡀࢇṚஸ⋡ῶᑡຠᯝࡀᮇᚅ࡛ࡁࡿ࡜ࡋ
࡚࠸ࡿ 2 ) ࠋ୍᪉ࠊ⫶ෆど㙾᳨ᰝ࡟ࡼࡿഅⓎ⑕㢖ᗘࡣ⫶ X ⥺᳨ᰝ࡟ẚ࡭࡚኱ࡁ࠸ അⓎ⑕ࡢヲ⣽࡟ࡘ࠸࡚ࡣࠊ
๓㏙ P.13 ࢆཧ↷㸧ࠋഅⓎ⑕ࡢ☜⋡ࢆ୍ᐃ࡜ࡍࡿ࡜ࠊ᳨ᰝ௳ᩘࡢቑຍ࡟క࠸ࠊഅⓎ⑕௳ᩘࡶቑຍࡍࡿࠋ
ᚑࡗ࡚ࠊ㏲ᖺ᳨デࢆᐇ᪋ࡍࡿࡇ࡜࡛ࠊഅⓎ⑕ࡀቑຍࡍࡿྍ⬟ᛶࡀ㧗ࡃ࡞ࡿࠋẖᖺ᳨デࢆᐇ᪋ࡍࡿ
ࡇ࡜࡛ࠊ⣼✚ഇ㝧ᛶ⋡ࡀቑຍࡍࡿࡤ࠿ࡾ࡛࡞ࡃࠊ⏕᳨ࡢቑຍ࡟క࠸അⓎ⑕ࡶቑຍࡍࡿࠋࡲࡓࠊᚲ
せ௨ୖ࡟㢖ᅇࡢ᳨デࢆ⾜࠺ࡇ࡜ࡣࠊ㐣๫デ᩿࣭㐣๫἞⒪ࢆㄏⓎࡍࡿ 5)ࠋ3.ᑐ⟇ᆺ᳨デࡢᑐ㇟ᖺ㱋᳨࣭デ㛫㝸ᮏ࣐ࢽࣗ࢔࡛ࣝࡣࠊ㺀᭷ຠᛶホ౯࡟ᇶ࡙ࡃ⫶ࡀࢇ᳨デ࢞࢖ࢻࣛ࢖ࣥ 2014 ᖺᗘ∧㺁࡟ᇶ࡙ࡁࠊ⫶ෆど㙾᳨デࡢᑐ㇟ࡣ 50 ṓ௨ୖࠊ᳨デ㛫㝸ࡣ㝸ᖺ 2 ᖺ࡟ 1 ᅇ ࡢ᪉ἲࢆ᥎ዡࡍࡿࠋ⌧ẁ㝵࡛ࡣࠊᑐ㇟
ᖺ㱋࡟ୖ㝈ࢆタᐃࡋ࡚࠸࡞࠸ࡀࠊ௒ᚋࡣ᳨ウࡍࡿᚲせࡀ࠶ࡿࠋ

ཧ⪃ᩥ⊩
1㸧

ᅜ❧ࡀࢇ◊✲ࢭࣥࢱ࣮ ࡀࢇᑐ⟇᝟ሗࢭࣥࢱ࣮㸬ࡀࢇ᝟ሗࢧ࣮ࣅࢫ㺀ࡀࢇⓏ㘓࣭⤫ィ㺁㸬
http://ganjoho.jp/reg_stat/statistics/dl/index.html㹙2015.12.25㹛

2㸧 ᅜ❧ࡀࢇ◊✲ࢭࣥࢱ࣮ ࡀࢇண㜵᳨࣭デ◊✲ࢭࣥࢱ࣮㸬᭷ຠᛶホ౯࡟ᇶ࡙ࡃ⫶ࡀࢇ᳨デ࢞࢖ࢻ
ࣛ࢖ࣥ 2014 ᖺᗘ∧㸬ᮾி㸪2015㸬
3㸧 Hamashima C, Ogoshi K, Okamoto M, et al. A community-based, case-control study evaluatingmortality reduction from gastric cancer by endoscopic screening in Japan. PLoS ONE 2013; 8: e79088.
4㸧 Cho B, ௚㸬Ꮫ⾡◊✲ࢧ࣮ࣅࢫㄢ㢟 ᭱⤊⤖ᯝሗ࿌᭩㺀⌧⾜ࡢᅜᐙ೺ᗣ᳨デࣉࣟࢢ࣒ࣛ඲⯡࡟ᑐࡍࡿጇᙜᛶࡢホ౯ཬࡧไᗘᨵၿ᪉᱌ࡢᥦ♧᳨̿デᑐ㇟, ᳨デ㛫㝸, ᶆⓗ⑌ᝈ㸪᳨ᰝ㡯┠㸪㈝⏝ຠᯝ࡞࡝ࢆ୰ᚰ࡟̿㺁. ࢯ࢘ࣝ኱Ꮫᰯ་⛉኱Ꮫ㸪2013.
5㸧 Harris RP, Wilt TJ, Qaseem A. A value framework for cancer screening: advice for high-value carefrom the American College of Physicians. Ann Intern Med 2015; 162:712–717.

㸦℈ᓥࡕࡉ࡜㸧̿  ̿

Ϭ.⢭ᗘ⟶⌮ࡢ⪃࠼᪉
1.⢭ᗘ⟶⌮⥲ㄽ1㸧ࡀࢇ᳨デࡢᑟධ᮲௳
ࡀࢇ᳨デࡢ┠ⓗ࡛࠶ࡿṚஸ⋡ῶᑡࡢᡂᯝࢆ࠶ࡆࡿࡓࡵ࡟ࡣ ࠊ ᭷ຠ࡞ࡀࢇ᳨デࢆṇࡋࡃᐇ᪋ࡍࡿ
ࡇ࡜ࡀᚲせ࡛࠶ࡿࠋ ୧⪅ࡀᩚ࠸ࠊࡣࡌࡵ࡚㉁ࡢ㧗࠸᳨デࡢᥦ౪ࡀྍ⬟࡜࡞ࡿࠋࡉࡽ࡟ ࠊཷデ⋡ࡀྥୖࡍࡿࡇ࡜࡟ࡼࡾ᭱⤊┠ⓗ࡛࠶ࡿṚஸ⋡ῶᑡࡀ㐩ᡂࡉࢀࡿ㸦ᅗ 1㸧ࠋ
ᅗ 1.ࡀࢇ᳨デࡢᑟධ᮲௳

2㸧ᑐ⟇ᆺ᳨デ࡜௵ពᆺ᳨デࢃࡀᅜ࡟࠾ࡅࡿࡀࢇ᳨デ࡟ࡣࠊᕷ⏫ᮧ࡞࡝ࡢఫẸ᳨デ࡟௦⾲ࡉࢀࡿ㺀ᑐ⟇ᆺ᳨デ㺁࡜ࠊே㛫ࢻࢵࢡ࡞࡝ࡢ㺀௵ពᆺ᳨デ㺁ࡀ࠶ࡿ ⾲ 1 ࠋᑐ⟇ᆺ᳨デࡣࠊᆅᇦ࡞࡝࡟࠾ࡅࡿࡀࢇṚஸ⋡ࡢῶᑡࢆ┠ⓗ࡜ࡋ࡚ᑟධࡉࢀࡿࠋᑐ㇟࡜࡞ࡿேࠎࡀ☜ᐇ࡟฼┈ࢆཷࡅࡿࡓࡵ࡟ࠊ᭷ຠᛶࡢ☜❧ࡋࡓࡀࢇ᳨デࢆ㑅ᢥࡍࡿࡇ࡜ࡀᚲ㡲࡛࠶ࡿࠋࡉࡽ࡟୙฼┈ࢆ᭱ᑠ໬ࡋࠊ฼┈ࡀ୙฼┈ࢆୖᅇࡿࡇ࡜ࡀ᮲௳࡜࡞ࡿࠋ
ࠋ୍᪉ࠊ௵ពᆺ᳨デࡣࠊᑐ⟇ᆺ᳨デ௨እࡢ᳨デᙧែ࡛ࠊ་⒪ᶵ㛵࡞࡝ࡀ௵ព࡛ᥦ౪ࡍࡿ᳨デࢧ࣮ࣅࢫ࡛࠶ࡿࠋࡇࡢࡓࡵࠊᵝࠎ࡞᳨デ᪉ἲࡀ࠶ࡿࡀࠊࡑࡢ୰࡟ࡣࠊࡀࢇ᳨デ࡜ࡋ࡚᭷ຠᛶࡢ☜❧ࡋ࡚࠸࡞࠸᳨ᰝ᪉ἲࡀྵࡲࢀࡿሙྜࡶ࠶ࡿࠋࡋ࠿ࡋࠊಶேࡀ⮬ศࡢ┠ⓗࡸዲࡳ࡟ྜࢃࡏ᳨࡚デࢆ㑅ᢥ࡛ࡁࡿ࡜࠸࠺฼Ⅼࡀ࠶ࡿࠋᑐ⟇ᆺ᳨デࡢ⌮᝿ᆺࡀ⤌⧊ᆺ᳨デ࡛࠶ࡿࠋ⤌⧊ᆺ᳨デ࡛ࡣ᭷ຠᛶࡢ☜❧ࡋࡓࡀࢇ᳨デࢆṇࡋࡃ⾜࠺ࡓࡵࡢࢩࢫࢸ࣒ࡀᩚഛࡉࢀ࡚࠸ࡿࠋࡑࡢ᮲௳ࡣࠊ 1 ᑐ㇟㞟ᅋࡢ᫂☜໬ࠊ 2 ᑐ㇟࡜࡞ࡿಶே
ࡀ≉ᐃࡉࢀ࡚࠸ࡿࡇ࡜ࠊ 3 㧗࠸ཷデ⋡ࢆ☜ಖ࡛ࡁࡿయไࠊ 4 ⢭ᗘ⟶⌮యไࡢᩚഛࠊ 5 デ᩿࣭἞⒪యไࡢᩚഛࠊ 6 ᳨デཷデ⪅ࡢࣔࢽࢱࣜࣥࢢࠊ 7 ホ౯యไࡢ☜❧࡛࠶ࡿ 1)ࠋ᳨デࡢຠᯝࡣࠊࡇࢀ
ࡽࡀ࡝ࡢ⛬ᗘ㐩ᡂࡉࢀࡿ࠿࡟ࡼࡾỴᐃࡉࢀࡿࠋⱥᅜࡸ໭Ḣ࡛ࡣࠊ⤌⧊ᆺ᳨デࡢᐇ᪋ࡀᡂᯝࢆ࠶ࡆࠊ
ஙࡀࢇࠊᏊᐑ㢕ࡀࢇࡢṚஸ⋡ῶᑡࢆᐇ⌧ࡋࡓࠋ̿  ̿

⾲ 1. ᑐ⟇ᆺ᳨デ࡜௵ពᆺ᳨デ᳨デ᪉ἲᑐ⟇ᆺ᳨デ

௵ពᆺ᳨デ

ఫẸ᳨デᆺ㸧㸦ே㛫ࢻࢵࢡᆺ㸧┠ⓗᑐ㇟㞟ᅋ඲యࡢṚஸ⋡ࢆୗࡆࡿࡇ࡜ࢆ
┠ⓗ࡜ࡋࡓබඹᨻ⟇ᑐ⟇ᆺ᳨デ௨እࡢࡶࡢᴫせண㜵ᑐ⟇࡜ࡋ࡚⾜ࢃࢀࡿබඹⓗ࡞་⒪ࢧ࣮ࣅࢫ་⒪ᶵ㛵᳨࣭デᶵ㛵➼ࡀ௵ព࡟ᥦ౪ࡍࡿ
་⒪ࢧ࣮ࣅࢫ᳨デ᪉ἲṚஸ⋡ῶᑡຠᯝࡀド᫂ࡉࢀ࡚࠸ࡿ᪉ἲ
ࡀ㑅ᢥࡉࢀࡿ

Ṛஸ⋡ῶᑡຠᯝࡀド᫂ࡉࢀ࡚࠸ࡿ᪉ἲ
ࡀ㑅ᢥࡉࢀࡿࡇ࡜ࡀᮃࡲࡋ࠸

฼┈࡜୙฼┈㝈ࡽࢀࡓ㈨※ࡢ࡞࠿࡛ࠊ฼┈࡜୙฼┈ࡢࣂࣛࣥࢫࢆ⪃៖ࡋࠊ㞟ᅋ࡟࡜ࡗ࡚ࡢ฼┈ ಶேࡢุ࡛᩿ࣞ࣋ࣝࡍࡿ
ࢆ᭱኱໬ࡍࡿ

ලయ౛೺ᗣቑ㐍஦ᴗ࡟ࡼࡿᕷ⏫ᮧࡢఫẸ᳨デ㞟ᅋ᪉ᘧ࡜ࠊಶู᪉ᘧ       ᳨デᶵ㛵ࡸ་⒪ᶵ㛵࡛⾜࠺ே㛫ࢻࢵࢡࡸ⥲ྜ೺デ            ಖ㝤⪅ࡀ⚟฼ཌ⏕ࢆ┠ⓗ࡜ࡋ࡚ᥦ౪ࡍ
ࡿே㛫ࢻࢵࢡ 

3㸧ࡀࢇ᳨デࡢ⢭ᗘ⟶⌮ࡢᇶᮏⓗ⪃࠼᪉
㸦1㸧฼┈࣭୙฼┈ࣂࣛࣥࢫ᭷ຠᛶࡢ⛉Ꮫⓗ᰿ᣐࡀ☜❧ࡋ࡚࠸ࡿ᳨デ࡛࠶ࡗ࡚ࡶࠊ⢭ᗘ⟶⌮ࢆṇࡋࡃ⾜ࢃ࡞ࡅࢀࡤṚஸ⋡ῶᑡ࡟ࡣ฿㐩ࡋ࡞࠸ࠋࡀࢇ᳨デࡢ✀㢮࡟࠿࠿ࢃࡽࡎࠊ୙฼┈ࡣᚲⓎ࡛࠶ࡿࠋឤᗘ࣭≉␗ᗘࡀ 100%ࡢ᳨デἲࡣᏑᅾࡏࡎࠊഇ㝧ᛶࡸഇ㝜ᛶࡀᚲࡎⓎ⏕ࡍࡿࠋࡉࡽ࡟ࠊ⢭ᐦ᳨ᰝ࡟క࠺അⓎ⑕ࡶ୍ᐃ๭ྜ
࡛Ⓨ⏕ࡍࡿࠋ⢭ᗘ⟶⌮ࢆ⾜ࢃ࡞ࡅࢀࡤ୙฼┈ࡀ฼┈ࢆୖᅇࡗ࡚ࡋࡲ࠺ྍ⬟ᛶࡶ࠶ࡿࠋ฼┈ࢆ᭱኱໬ࡋࠊ୙฼┈ࢆ᭱ᑠ໬ࡍࡿࡇ࡜࡛ࡣࡌࡵ࡚ࡀࢇ᳨デࡢຠᯝࡀᚓࡽࢀࡿࡢ࡛ࠊ⢭ᗘ⟶⌮ࡢ௙⤌ࡳࡀ୙ྍḞ࡛࠶ࡿࠋ
㸦2㸧᳨デ࡜デ⒪ࡢ┦㐪Ⅼ    デ⒪࡜᳨デࡣࡋࡤࡋࡤΰྠࡉࢀࡿࡀࠊࡑࡢ㐪࠸ࢆ᫂☜࡟⌮ゎࡍࡿᚲせࡀ࠶ࡿ ⾲ 2 ࠋデ⒪࡛⾜ࢃࢀࡿ᳨ᰝࢆࡑࡢࡲࡲࡢᙧᘧ᳨࡛デ࡛⾜࠺ࡇ࡜ࡣࠊ୙฼┈ࡢࡳࡀቑ኱ࡍࡿ⤖ᯝ࡟࡞ࡾ࠿ࡡ࡞࠸ࠋձ ᑐ㇟ࡢ┦㐪Ⅼ↓⑕≧⪅ࡀᑐ㇟ࡢ᳨デࡣࠊᝈ⪅ࢆᑐ㇟࡜ࡍࡿデ⒪࡜ࡣ␗࡞ࡿ≉ᛶࢆᣢࡘࠋ᳨デࡢᑐ㇟ࡣ୍⯡㞟ᅋ࡛࠶ࡾࠊ࣏ࣆ࣮ࣗࣞࢩ࣭ࣙࣥ࢔ࣉ࣮ࣟࢳࡢᴫᛕ࡟ᇶ࡙ࡁ⾜࠺࡭ࡁ࡛࠶ࡿࠋ᳨デࡀᡂᯝࢆ࠶ࡆࡿ
࡟ࡣࠊୗグࡢᇶᮏⓗ᮲௳࡟ᑐᛂ࡛ࡁࡿ⢭ᗘ⟶⌮ࡢᇶ┙ᩚഛࡀᚲせ࡛࠶ࡿࠋa㸧᳨デࡢᡂᯝࢆ࠶ࡆࡿ࡟ࡣ୍ᐃࡢ᮲௳࡟㐺࠺඲ఫẸ࡟✚ᴟⓗ࡟࢔ࢡࢭࢫࡋࠊࡑࡢከࡃࡢᑐ㇟⪅࡟ཷデࡋ࡚ࡶࡽ࠺ᚲせࡀ࠶ࡿࠋᝈ⪅ࡣ⮬ࡽデ⒪࡟࢔ࢡࢭࢫࡍࡿࡀࠊ᳨デཷデ⪅ࡣᚲࡎࡋࡶ⮬ࡽࡢពᚿࡢࡳ࡛ཷデࡍࡿࢃࡅ࡛ࡣ࡞࠸ࠋࡇࡢࡓࡵࠊ⭾኱࡞ᩘࡢ᳨デᑐ㇟⪅ࢆ≉ᐃࡋࡓྡ⡙ࢆసᡂࡋࠊ
ཷデ່ዡࡋ࡞ࡃ࡚ࡣ࡞ࡽ࡞࠸ࠋb㸧ྛ᳨デࡢྛᣦᶆ࡟㛵ࡍࡿࢹ࣮ࢱࢆ⥙⨶ⓗ࡟ᢕᥱ㞟ィࡍࡿ௙⤌ࡳࡀ᪂ࡓ࡟ᚲせ࡜࡞ࡿࠋྠ᫬࡟
᳨デཷデᚋࡢཷデ⪅ࡢ᝟ሗࢆࠊ᳨デࢹ࣮ࢱ࣮࣋ࢫ࡟⥙⨶ⓗ࡟཯࡛ᫎࡁࡿ௙⤌ࡳࢆᵓ⠏ࡋ࡞ࡃ࡚ࡣ
࡞ࡽ࡞࠸ࠋc㸧↓⑕≧⪅ࡣᝈ⪅࡜ࡣ␗࡞ࡾࠊࣜࢫࢡࡶᑠࡉࡃࠊ᳨ᰝཷデࡢᚲ↛ᛶࡀప࠸ࠋࡇࡢࡓࡵࠊࡀࢇ᳨
デ࡟࠾࠸࡚ࡣࠊ฼┈࣭୙฼┈࡟ࡘ࠸࡚ṇࡋ࠸᝟ሗࢆᥦ౪ࡋࠊ⥅⥆ⓗ࡞ཷデࢆᨭ᥼ࡍࡿᚲせࡀ࠶ࡿࠋ̿  ̿ղ ᳨デࡢࣉࣟࢭࢫ ̿ ᳨デࡣከẁ㝵ࡢ⥲ྜⓗࣉࣟࢭࢫ࡛࠶ࡿ
᳨デ࡟ࡼࡾ⤠ࡾ㎸ࡲࢀࡓᑐ㇟࡟㐺ษ࡟デ᩿࣭἞⒪ࢆᥦ౪ࡋࠊ᭱⤊┠ⓗࡢṚஸ⋡ῶᑡ࡟⤖ࡧࡘࡅࡿࡲ࡛ࡀ᳨デࡢ඲ࣉࣟࢭࢫ࡜࡞ࡿࠋ᳨デࠊデ᩿ࠊ἞⒪ࠊࣔࢽࢱࣜࣥࢢࡢྛẁ㝵࡛ከᵝ࡞ᑓ㛛ศ㔝ࡀ㛵୚ࡍࡿࠋ᳨デࣉࣟࢢ࣒ࣛࡣᵓᡂࡍࡿྛẁ㝵ࡀྜ⌮ⓗ࡟ᶵ⬟ࡋ࡚ึࡵ࡚ᡂᯝࡀ࠶ࡀࡿࠋࡑࡢຠ
ᯝࢆ☜ㄆࡍࡿࡓࡵ࡟⢭ᗘ⟶⌮ᣦᶆࢆ⏝࠸ࡿࠋ
⾲ 2. ᳨デ࡜デ⒪ࡢ┦㐪Ⅼ
᳨ デ

ẚ ㍑

デ ⒪

ࡀࢇࢆ᪩ᮇⓎぢࡍࡿ࡜࡜ࡶ࡟ࠊ೺ᗣ࡞ே
࡟⑓Ẽ࡛࠶ࡿ࡜࠸࠺ㄗࡗࡓุᐃࢆࡋ࡞࠸

≉ᚩ⑓Ẽࢆṇࡋࡃデ᩿ࡍࡿ⑕≧ࡀ࡞࠸೺ᗣ࡞ே

య࡟㈇ᢸࡢ࡞࠸ࠊᏳ౯࡞᳨ᰝ᪉ἲ

་⒪ಖ㝤ࡣ㐺⏝እ⮬ᕫ㈇ᢸ㢠ࡣ᳨デࡢ✀㢮࡟ࡼࡾ␗࡞ࡿ
ᑡ࡞࠸

ཷࡅࡿே

⑕≧ࡸఱࡽ࠿ࡢ୙Ᏻࡀ࠶ࡿே

᳨ᰝ᪉ἲ⑓Ẽࡢཎᅉࢆ☜࠿ࡵࡿࡓࡵ࡟ᚲせ࡞᳨ᰝ᪉ἲయ࡬ࡢ㈇ᢸࡀ኱ࡁ࠿ࡗࡓࡾࠊ㧗౯࡞᳨ᰝࡢሙྜࡶ࠶ࡿ ㈝⏝་⒪ಖ㝤ࡀ㐺⏝ࡉࢀࡿ⑓Ẽࡀ࠶ࡿே

ከ࠸

4㸧ࡀࢇ᳨デࡢ⢭ᗘ⟶⌮ࡢ᪉ἲ㸦1㸧⢭ᗘ⟶⌮ᣦᶆࡀࢇ᳨デࡢ⢭ᗘ⟶⌮ࢆ⾜࠺ࡓࡵࡢᣦᶆࡣࠊ௨ୗࡢ 3 ࡘ࡟ศ㢮ࡉࢀࡿ ᅗ 2㸧ࠋձ ᢏ⾡࣭యไᣦᶆ
᳨デࡢ㉁ࢆᢸಖࡍࡿࡢ࡟ᚲせ࡞᪋タࡸタഛࠊேᮦ㓄⨨࡞࡝ࠊᐇ᪋యไࡸᢏ⾡Ỉ‽ࠊᩚഛ≧ἣࢆ☜ㄆࡋࠊ᳨デࡢ㉁ࡀᢸಖ࡛ࡁࡿయไࡀᩚࡗ࡚࠸ࡿ࠿ࢆࡳࡿᣦᶆ࡛࠶ࡿࠋࡇࡢᣦᶆ࡛ࡣࠊᶵჾ
⟶⌮ࠊయไᩚഛࠊᏳ඲ᛶࡢᢸಖࢆ☜ㄆࡍࡿࡇ࡜ࡀ┠ⓗ࡛࠶ࡿࠋղ ࣉࣟࢭࢫᣦᶆ
᳨デࣉࣟࢢ࣒ࣛࡀ┠ᶆ࡟ྥ࠿ࡗ࡚ṇࡋࡃ⾜ࢃࢀ࡚࠸ࡿ࠿ࡢ㐩ᡂᗘࢆࣜ࢔ࣝࢱ࢖࣒࡛ࡳࡿᣦ
ᶆ࡛࠶ࡾࠊࡀࢇ᳨デࢹ࣮ࢱ࡜ࡋ࡚ࣔࢽࢱࣜࣥࢢࡉࢀࡿཷデ⋡ࠊせ⢭᳨⋡ࠊࡀࢇⓎぢ⋡ࠊ㝧ᛶ཯ᛂ㐺୰ᗘ࡞࡝࡛࠶ࡿࠋճ ࢔࢘ࢺ࣒࢝ᣦᶆ
᭱⤊┠ⓗࡀ㐩ᡂࡉࢀࡓ࠿ࢆ☜ㄆࡍࡿࡓࡵࠊࡀࢇࡢ⨯ᝈ⋡࣭Ṛஸ⋡ࡀᣦᶆ࡜࡞ࡿࠋղ ࡣ▷ᮇⓗ࡞ᣦᶆ࡜ࡋ࡚⏝࠸ࡽࢀࠊ㛗ᮇⓗ࡟ ࡣ ճ࡛᭱⤊ⓗ࡞ᡂᯝࢆุᐃࡍࡿࡶࡢ࡛࠶ࡿࠋ ᮏ࣐ࢽࣗ࢔࡛ࣝࡣࠊձ ࡢ ᇶ‽ࢆ᭱ప㝈㑂Ᏺࡍ࡭ࡁ㡯┠࡜ࡋ࡚♧ࡋࠊղ ࡟ࡘ࠸࡚ࡣ⢭ᗘ⟶⌮ᣦᶆࡢ⟬ฟ᪉ἲࡸ⟬ฟࡢᇶᮏ࡜࡞ࡿࢹ࣮ࢱ࣮࣋ࢫᵓ⠏ࢆᥦ♧ࡋ࡚࠸ࡿ P.43 ཧ↷㸧ࠋ⌧ᅾࠊ⫶ X ⥺᳨ᰝ࡟ࡼࡿ⫶ࡀࢇ᳨デ࡟ࡣ ձ ࡜ࡋ࡚ࠊࡀࢇ᳨デࢳ࢙ࢵࢡࣜࢫࢺࡀ⏝࠸ࡽࢀ࡚࠸ࡿࠋࡲࡓ ղ ࡟ࡘ࠸࡚ࡣᩘ್┠ᶆࡀタᐃࡉࢀࠊ᭱ప㝈㐩ᡂࡍ࡭ࡁチᐜ್࡜ࡑࡢୖࡢẁ㝵࡛࠶ࡿ┠ᶆ್ࡀタᐃࡉࢀ࡚࠸ࡿࠋ⫶ෆど㙾᳨デ࡟ࡘ࠸࡚ࡣࡇࢀࡽࡢタᐃࡣ௒ᚋࡢㄢ㢟࡛࠶ࡿࠋ⌧≧࡛ࡣᮏ࣐ࢽࣗ̿  ̿

࢔࡛ࣝ♧ࡉࢀ࡚࠸ࡿᇶ‽ࢆࢡࣜ࢔ࡍࡿࡇ࡜ࡀ⫶ෆど㙾᳨デࢆᐇ᪋ࡍࡿᇶᮏ᮲௳࡜࡞ࡿࠋ


ᅗ 2. ࡀࢇ᳨デࡢ⢭ᗘ⟶⌮ᣦᶆ




ཧ⪃ᩥ⊩
1㸧 Vainio H, Bianchini F, eds. IARC Handbooks of cancer preventation. Volume 7. Breast cancer
screening. IARC Press, Lyon, 2002, 144–147.

㸦ᩪ⸨༤㸧̿  ̿



2.⫶ෆど㙾᳨デࡢࡓࡵࡢ⢭ᗘ⟶⌮1㸧⫶ෆど㙾᳨デࡢ⢭ᗘ⟶⌮ࡢᚲせᛶ
᳨デ࡟࠾࠸࡚ࡣ⢭ᗘ⟶⌮ࢆ⾜࠺ࡓࡵࡢయไࡢᵓ⠏ࡀ୙ྍḞ࡛࠶ࡾࠊࡑࢀ࡞ࡋ࡛ࡣ࠸ࢃࡺࡿ㺀ࡸࡾࡗᨺࡋ㺁ࡢ᳨デ࡜࡞ࡿࠋ⫶ෆど㙾᳨デࡣ౵くᛶࡀẚ㍑ⓗ኱ࡁ࠸ࡇ࡜࠿ࡽࠊ↓⑕≧⪅ࢆᑐ㇟࡜ࡋࡓ᳨
デ࡜ࡋ࡚ᗈࡃ⾜࠺ࡓࡵ࡟ࡣࠊᏳ඲⟶⌮ࢆྵࡵࡓ⢭ᗘ⟶⌮ࡀ௚ࡢ᳨デࡼࡾ㔜せ࡛࠶ࡿࠋ⫶ෆど㙾᳨デࡣࡇࢀࡲ୍࡛㒊ࡢᕷ༊⏫ᮧ࡟࠾࠸࡚ࠊ⊂⮬࡟ᕤኵࡉࢀࡓಶ᳨ูデࡢ௙⤌ࡳࡢ࡞࠿࡛⾜ࢃࢀ࡚ࡁࡓࠋࡋ࠿ࡋࠊ୍⯡࡟ಶ᳨ูデ࡛ࡣ⢭ᗘ⟶⌮Ỉ‽ࡀప࠸ࡇ࡜ࡀᣦ᦬ࡉࢀ࡚࠸ࡿ ࠋ ಶ᳨ูデࡣデ⒪ࡢᘏ㛗ࡢᙧ࡛ᑟධࡉࢀࠊ⢭ᗘ⟶⌮ࡢᯟ⤌ࡳࡀ୙༑ศ࡞ࡲࡲ࡟⾜ࢃࢀࡿࡇ࡜ࡀከ࠸ࡓࡵ
࡛࠶ࡿࠋࡉࡽ࡟ࠊ⫶ෆど㙾᳨デࡣ⫶ෆど㙾᳨ᰝࡢᶆ‽໬ࡀ㞴ࡋ࠸ࡇ࡜࠿ࡽࠊᑐ⟇ᆺ᳨デ࡜ࡋ࡚඲ᅜⓗ࡟⾜࠺ࡓࡵ࡟ࡣࠊ⢭ᗘ⟶⌮ࡢᇶ‽ࢆᥦ♧ࡍࡿࡇ࡜ࡀ୙ྍḞ࡛࠶ࡿࠋ
2㸧ᮏ࣐ࢽࣗ࢔ࣝࡢ఩⨨࡙ࡅᮏ࣐ࢽࣗ࢔ࣝࡣࠊ⫶ෆど㙾᳨デࡢᢏ⾡ࡸᏳ඲⟶⌮࡟㛵ࡍࡿ⢭ᗘ⟶⌮ࡢᇶ‽ࢆ♧ࡋ࡚࠸ࡿࠋ
⫶ࡀࢇṚஸ⋡ῶᑡࡢ┠ⓗ㐩ᡂࡢࡓࡵ࡟ࡣࠊ᳨デࣉࣟࢢ࣒ࣛ࡟㛵㐃ࡍࡿ඲ẁ㝵࡟ࡘ࠸࡚ࡢ⟶⌮ࡀᚲせ࡛࠶ࡿࠋ⫶ෆど㙾᳨デࡢ⢭ᗘ⟶⌮ࡢయไᵓ⠏ࡣࠊ௒ᚋ࡟ᮇᚅࡍࡿ㒊ศࡀከ࠸ࡀࠊᮏ᮶ࡣ⫶ X⥺᳨デ࡜ྠᵝࡢཎ๎࡛࠶ࡿࠋ
୍᪉ࠊ⫶ࡀࢇ᳨デࡢ⢭ᗘ⟶⌮ࡣᢏ⾡ⓗ࡞⟶⌮ࡣࡶࡕࢁࢇ࡛࠶ࡿࡀࠊࡀࢇ᳨デ⢭ᗘ⟶⌮ࡢཎ๎ࠊᯟ⤌ࡳࢆ⌮ゎࡍࡿࡇ࡜ࡀ๓ᥦ࡟࡞ࡾࠊᶆ‽໬ࡀ㞴ࡋ࠸⫶ෆど㙾᳨デ࡛ࡣ୍ᐃࡢ⢭ᗘࢆಖࡘࡇ࡜ࡀ≉࡟㔜せ࡛࠶ࡿࠋ㔜⠜࡞അⓎ⑕ࡶ࠶ࡿࡓࡵࠊ⫶ෆど㙾᳨デࡢᏳ඲ᛶࡢ☜ಖ࡟ࡣ௚ࡢ᳨デࡼࡾࡉࡽ࡟␃ពࡍ࡭ࡁ࡛࠶ࡿࠋ
㸦ᩪ⸨༤㸧̿  ̿

ϭ.⫶ෆど㙾᳨デᐇ᪋ࡢ᮲௳
1.⫶ෆど㙾᳨デࡢฎ⌮⬟                    1㸧⫶ෆど㙾᳨ᰝࡢᐇ᪋௳ᩘ⫶ෆど㙾᳨ᰝࡢ᭷ຠᛶࡀ☜❧ࡋࠊᑐ⟇ᆺ᳨デᑟධࡢᐇ⌧ࡀྍ⬟࡜࡞ࡗࡓࠋ⫶ෆど㙾᳨デࡣ୍㒊ᆅᇦ࡟ᑟධࡉࢀࠊࡑࡢ୺ࡓࡿᙺ๭ࢆデ⒪ᡤࡀᢸࡗ࡚࠸ࡿࠋ
་⒪᪋タㄪᰝ࡟ࡼࡿ࡜ࠊ⑓㝔࡟࠾ࡅࡿ⫶ෆど㙾᳨ᰝ௳ᩘࡣᶓࡤ࠸ࡔࡀࠊデ⒪ᡤ࡟࠾ࡅࡿ⫶ෆど㙾᳨ᰝ௳ᩘࡣቑຍࡋ࡚࠸ࡿ 1)ࠋデ⒪ᡤ࡟࠾ࡅࡿ⫶ෆど㙾᳨ᰝ௳ᩘࡣ 2008 ᖺ࡟ẚ࡭ࠊ2011 ᖺ࡟ 1 ࠿᭶ࡢቑຍᩘࡣ 58,312 ௳࡜࡞ࡾࠊᖺ㛫⣙ 70 ୓௳ࡀቑຍࡋࡓࠋ2014 ᖺࡢ 1 ་⒪ᶵ㛵ࡢ 1 ࠿᭶࠶ࡓࡾ
ࡢᖹᆒ⫶ෆど㙾᳨ᰝ௳ᩘࡣࠊ⑓㝔108.8 ௳ࠊデ⒪ᡤ28.3 ௳࡛࠶ࡿࠋ
2㸧⫶ෆど㙾᳨デࡢฎ⌮⬟ᕷ༊⏫ᮧࡢ᳨デᑐ㇟ᩘࡣࠊ2007 ᖺᅜẸ⏕άᇶ♏ㄪᰝࢆ⏝࠸ࡓ㒔㐨ᗓ┴ู᥎ィ್ࠊ᳨デཷデ⪅ᩘࡣ 2012 ᖺᗘᆅᇦಖ೺࣭೺ᗣቑ㐍஦ᴗሗ࿌ࠊ⫶ෆど㙾᳨ᰝ௳ᩘࡣ 2011 ᖺ་⒪᪋タㄪᰝࢆ⏝࠸࡚ࠊ⫶ෆど㙾᳨ᰝ௳ᩘࡢ౪⤥㔞࡟ࡘ࠸᳨࡚ウࡋࡓ 1, 2)ࠋ
⌧≧ࡢ⫶ࡀࢇ᳨デࡢ⫶ෆど㙾᳨ᰝ࡬ࡢ௦᭰⋡ࡀୖࡀࡿ࡟ࡘࢀ࡚ࠊᚲせ࡞⫶ෆど㙾᳨ᰝ௳ᩘࡀ
3.2%࠿ࡽ 31.0%ࡲ࡛ቑ࠼ࡿ ᅗ 1㸧ࠋࡇࢀࡣࠊ⑓㝔࡜デ⒪ᡤ୧᪉࡛➼ࡋࡃቑຍศࢆᢸ࠺ሙྜ࡛࠶ࡾࠊ
デ⒪ᡤ࡛ࡢẚ⋡ࢆ㧗ࡵࢀࡤቑຍ⋡ࡶ㧗ࡲࡿࠋ⌧ᅾ⾜ࢃࢀ࡚࠸ࡿ⫶ࡀࢇ᳨デࡢ᳨デཷデ⪅ᩘ
3,788,969 ே ࡢ࠺ࡕࠊ30%ࡀ⫶ෆど㙾᳨ᰝ࡟⨨ࡁ᭰ࢃࡗࡓሙྜࠊ⫶ෆど㙾᳨ᰝ௳ᩘ ⌧ᅾ 1,0976,508
௳ ࡣ 9.6% ⣙ 105 ୓௳ ቑຍࡍࡿࠋ

ᅗ 1. ⫶ X ⥺᳨デ࠿ࡽ⫶ෆど㙾᳨デ࡬ࡢ⛣⾜࡟క࠺⫶ෆど㙾᳨ᰝ௳ᩘࡢቑຍ⋡ ཷデ⋡⌧≧ ̿  ̿

㒔㐨ᗓ┴࡛ᚲせ⫶ෆど㙾᳨ᰝ௳ᩘࡢቑຍ⋡ࡢ┦㐪ࢆࡳࡿࡓࡵ࡟ࠊ⌧≧ࡢ 30%ࡀ⫶ෆど㙾᳨デ࡟⨨ࡁ᭰ࢃࡗࡓሙྜࡢヨ⟬ࢆ⾜ࡗࡓࠋ⌧≧ࡢ⫶ࡀࢇ᳨デཷデ⋡ࡸ⫶ෆど㙾ࡢ࠶ࡿ᪋タᩘ࡟ࡼࡗ࡚␗
࡞ࡿࡀࠊᒣཱྀ┴ࡢ 4.7% ཷデ⋡ࡣప࠸ࡀࠊேཱྀ࠶ࡓࡾࡢෆど㙾ಖ᭷᪋タࡣከ࠸ ࠿ࡽࠊ㟷᳃┴ࡢ
24.4% ཷデ⋡ࡣ㧗࠸ࡀࠊෆど㙾ಖ᭷᪋タࡣᑡ࡞࠸ ࡲ࡛ࡤࡽࡘࡁࡣ኱ࡁ࠸ࠋ⌧≧ࡼࡾ 20%௨ୖࡢ⫶ෆど㙾᳨ᰝ௳ᩘࢆቑຍࡉࡏࡿᚲせࡀ࠶ࡿ㟷᳃ࠊᒾᡭࠊᐑᇛ┴ࡣฎ⌮⬟ࡀၥ㢟࡜࡞ࡿྍ⬟ᛶࡶ࠶ࡿᅗ2 ࠋ
ྠᵝ࡟ࠊ⌧ᅾࡢ⫶ X ⥺᳨デࡢཷデ⪅ࡀ 30%⫶ෆど㙾᳨デ࡟⨨ࡁ᭰ࢃࡗࡓሙྜࠊᨻ௧ᣦᐃᕷ࣭୰
᰾ᕷ࡛ࡣࠊ5%௨ୗࡢ⫶ෆど㙾᳨ᰝ௳ᩘࡢቑຍ࡛ 48%ࡢᕷࡀᑐᛂྍ⬟࡛࠶ࡗࡓ ⾲ 1 ࠋ୍᪉ࠊ஧ḟ་⒪ᅪ࡛ 5%௨ୗࡢ⫶ෆど㙾᳨ᰝ௳ᩘࡢቑຍ࡛ᑐᛂྍ⬟࡞஧ḟ་⒪ᅪࡣ 14%࡟ࡍࡂ࡞࠿ࡗࡓࠋᚑࡗ࡚ࠊ⫶ෆど㙾᳨デࢆᐇ㝿࡟ᑟධ࡛ࡁࡿࡢࡣࠊᨻ௧ᣦᐃᕷ࣭୰᰾ᕷ࡟␃ࡲࡿྍ⬟ᛶࡀ࠶ࡿࠋ

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ὀ㸧2011 ᖺ་⒪᪋タㄪᰝ࡛ࡣ⚟ᓥ┴ࢆㄪᰝᑐ㇟ࡼࡾ㝖እࡋ࡚࠸ࡿࠋ  㸦ཌ⏕ປാ┬㸬ᖹᡂ 24 ᖺᗘᆅᇦಖ೺࣭೺ᗣቑ㐍஦ᴗሗ࿌ࡼࡾᢤ⢋㸧
ᅗ 2. 㒔㐨ᗓ┴ูࡢ⫶ෆど㙾᳨ᰝ௳ᩘࡢቑຍ⋡ ⫶ X ⥺᳨デࡢཷデ⪅ࡢ࠺ࡕ 30%ࡀ⫶ෆど㙾᳨デ࡟⛣⾜ࡋࡓሙྜ 
⾲1. ᨻ௧ᣦᐃᕷ࣭୰᰾ᕷཬࡧ஧ḟ་⒪ᅪูࡢ⫶ෆど㙾᳨ᰝ௳ᩘࡢቑຍ⋡
㸦⫶X⥺᳨デࡢཷデ⪅ࡢ࠺ࡕ30%ࡀ⫶ෆど㙾᳨デ࡟⛣⾜ࡋࡓሙྜ㸧

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̿  ̿3㸧⫶ෆど㙾᳨デࡢཧຍせᅉ⫶ෆど㙾᳨デࢆ࠿࠿ࡾࡘࡅ་࡛ཷࡅࡽࢀࡿࡇ࡜ࡣࠊཷデ⪅࡟࡜ࡗ࡚฼౽ᛶࡀ㧗࠸ࠋ⫶ෆど㙾᳨デࢆᑟධࡋ࡚࠸ࡿᆅᇦ་ᖌ఍࡬ࡢ࢔ࣥࢣ࣮ࢺㄪᰝ࡛ࡣࠊ⫶ෆど㙾᳨デ࡟ཧຍࡍࡿせᅉ࡜ࡋ࡚ࡣࠊ
㐣ཤ࡟⫶ෆど㙾᳨ᰝࡢ⤒㦂ࡀ࠶ࡿࡇ࡜ࠊ㝔㛗ࡢᖺ㱋ࡀⱝ࠸ࡇ࡜ࠊ኱Ꮫࡢᾘ໬ჾෆ⛉་ᒁࡢฟ㌟⪅ࠊデ⒪ᡤࡢ⥅ᢎணᐃࡀ࠶ࡿࡇ࡜ࡀ㛵୚ࡋ࡚࠸ࡓ 3)ࠋ⫶ෆど㙾᳨デࢆᑟධࡋ࡚࠸ࡿ௚ࡢᆅᇦࡢ་ᖌ఍ࢆ
ࡳ࡚ࡶࠊᆅᇦࡢ኱Ꮫࡢᾘ໬ჾෆ⛉་ᒁࡢฟ㌟⪅ࡀ୰ᚰ࡜࡞ࡾࠊㄞᙳ఍ࡀ㐠Ⴀࡉࢀ࡚࠸ࡿࡇ࡜ࡀከ
࠸ࠋㄞᙳ఍ࡢ㐠Ⴀࡶྵࡵࠊᙜึࡣࠊ኱Ꮫ་Ꮫ㒊ࡢ࠶ࡿ㒔ᕷࡸ┴ᗇᡤᅾᆅ࡞࡝ࡢ㒔ᕷ㒊࡟࠾࠸࡚ࠊ⫶ෆど㙾᳨デࡢᑟධࡀ㐍ࡳࡸࡍ࠸࡜⪃࠼ࡽࢀࡿࠋ
4㸧⫶ෆど㙾᳨デᐇ᪋ᩘࡢቑຍせᅉ⫶ෆど㙾᳨デࢆ㐠⏝ࡋ࡚࠸ࡃࡓࡵ࡟ࡣࠊᐇ᪋་⒪ᶵ㛵ࢆቑຍࡉࡏࡿࡤ࠿ࡾ࡛࡞ࡃࠊྛ་⒪ᶵ㛵ࡢ⫶ෆど㙾᳨ᰝ௳ᩘࢆቑຍࡉࡏࡿࡇ࡜ࡀᚲせ࡜࡞ࡿࠋࡋ࠿ࡋ࡞ࡀࡽࠊ⫶ෆど㙾᳨デࢆᐇ᪋ࡍࡿ་⒪ᶵ㛵ࡢከࡃࡣデ⒪ᡤ࡛࠶ࡾࠊ་ᖌࡣ᪥ࠎࡢデ⒪࡟㏣ࢃࢀ࡚࠸ࡿࠋ㝈ࡽࢀࡓ᫬㛫ࡢ୰࡛࠸࠿࡟ຠ
⋡ⓗ࡟᳨ᰝࢆ⾜࠺࡭ࡁ࠿᳨ウࡉࢀ࡞ࡃ࡚ࡣ࡞ࡽ࡞࠸ࠋ⫶ෆど㙾᳨ᰝࢆቑຍࡉࡏࡿ᳨ᰝ་ࡢせᅉ࡜ࡋ࡚ࠊ᪥ᮏᾘ໬ჾෆど㙾Ꮫ఍ᑓ㛛་࡛࠶ࡿࡇ࡜ࠊ65 ṓ௨ୗ࡛࠶ࡿࡇ࡜ࡀ኱ࡁ࠸ 4)ࠋタഛ㠃࡛ࡣࠊ⫶ෆど㙾ಖ᭷ᮏᩘࠊ⮬ືὙίᾘẘᶵࠊᑓ⏝ෆど㙾ᐊタ⨨ࡀᙳ㡪ࡍࡿࠋࡋ࠿ࡋࠊཷデ⪅ࡢ㌟యⓗ㈇ᢸࢆῶᑡࡉࡏࡿࡇ࡜ࡀᮇᚅࡉࢀࡿ⤒㰯ෆど㙾ࡣసᴗຠ⋡ࢆపୗࡉࡏࡿせᅉ࡜࡞ࡗ࡚࠸ࡓࠋ⫶ෆど㙾᳨デࢆᐇ᪋ࡍࡿሙྜࠊ᳨ᰝࡸㄞᙳࢆᢸᙜࡍࡿ་ᖌࡢ㈇ᢸ࡟┠ࡀྥࡁࡀࡕ࡛࠶ࡿࡀࠊ᳨
ᰝ࡟㝿ࡋ࡚┳ㆤᖌࡢᙺ๭ࡣᴟࡵ࡚㔜せ࡛࠶ࡿࠋ⫶ෆど㙾᳨ᰝࡢసᴗᕤ⛬ࡣࠊ๓సᴗࠊ᳨ᰝࠊᚋస
ᴗ࡟ศ㢮࡛ࡁࡿࠋࢱ࢖࣒ࢫࢱࢹ࢕ࡢ⤖ᯝࠊ඲ᕤ⛬࡟せࡍࡿ᫬㛫ࡣ 74 ศࡔࡗࡓࡀࠊࡇࡢ࠺ࡕ᳨ᰝࡑ
ࡢࡶࡢࡣ 10 ศ⛬ᗘ࡟㐣ࡂࡍࠊࡑࡢ௚ࡣ๓సᴗ࡜ᚋసᴗࡀ୺య࡜࡞ࡾࠊࡑࡢከࡃࢆ┳ㆤᖌࡀᢸᙜࡍ
ࡿࡇ࡜࡟࡞ࡿ 5)ࠋ⫶ෆど㙾᳨デࡢጤクࢆཷࡅࡓ་⒪ᶵ㛵ࡢከࡃࡣࠊ᳨デᐇ᪋࡟క࠺ேဨቑࢆ⾜ࡗ࡚࠾ࡽࡎࠊ┳ㆤᖌࡢປാ㈇ᢸࡀቑຍࡍࡿྍ⬟ᛶࡣ㧗࠸ࠋ᳨デ௳ᩘࡢቑຍ࡟ࡣࠊᚋసᴗ࡟᭱ࡶ᫬㛫ࢆせࡍࡿࡇ࡜࠿ࡽࡶࠊ⮬ືὙίᾘẘᶵࡢᑟධࡣ᳨デࡢຠ⋡໬࡟ᐤ୚ࡍࡿ ᅗ 3 ࠋ  

๓‽ഛ

๓ฎ⨨

䞉᳨ᰝᐊ䛾‽ഛ䞉ືస☜ㄆ䛺䛹

䞉๓ᢞ⸆䞉஦๓ㄝ᫂䛺䛹

ㄝ᫂

Ὑί

∦䛵䛡

䞉ᡭὙ䛔
䞉Ὑίᶵ
䞉䛧䜎䛔

᳨ᰝ

䞉

䞉ᤄධ䛛䜙
ᢤཤ䜎䛷

๓సᴗ

᳨ᰝ

ᚋసᴗ

┳ㆤᖌ䛺䛹

་ᖌ

┳ㆤᖌ䛺䛹

㻝㻘㻟㻜㻡㼼㻤㻢㻣⛊䠄㻞㻝㻚㻤ศ䠅㻢㻠㻞㻚㻤㼼㻝㻥㻟⛊䠄㻝㻜㻚㻣ศ䠅㻞㻘㻠㻤㻞㼼㻝㻘㻣㻞㻤⛊䠄㻠㻝㻚㻠ศ䠅㻣㻥㻞㻚㻢㼼㻡㻟㻣෇㻢㻣㻥㻚㻟㼼㻝㻥㻝෇㻝㻘㻡㻜㻤㼼㻝㻘㻜㻡㻜෇ປാ᫬㛫ྜィ 㻠㻘㻠㻡㻟㼼㻞㻘㻞㻢㻝⛊䠄㻣㻟㻚㻢ศ䠅ປാ㈝⏝ྜィ 㻞㻘㻥㻥㻝㼼㻝㻘㻠㻞㻠෇
㸦Goto R, et al., PLoS ONE. 2014, e88113㸧ᩥ⊩ 5 ᨵኚ

ᅗ 3. ෆど㙾᳨ᰝࡢసᴗᡭ㡰࡜ࡑࢀ࡟せࡍࡿ᫬㛫࣭㈝⏝̿  ̿ཧ⪃ᩥ⊩1㸧ཌ⏕ປാ┬㸬ᖹᡂ 20 ᖺཬࡧ 23 ᖺ་⒪᪋タㄪᰝ㸬 http://www.e-stat.go.jp/SG1/estat/
GL08020101.do?_toGL08020101_&tstatCode=000001030908&requestSender=dsearch[2015.10.3]

2㸧ཌ⏕ປാ┬㸬ᖹᡂ 24 ᖺᗘᆅᇦಖ೺࣭೺ᗣቑ㐍஦ᴗሗ࿌㸬http://www.e-stat.go.jp/SG1/estat/
GL08020101.do?_toGL08020101_&tstatCode=000001030884&requestSender=dsearch[2015.10.3]

3㸧᪂஭ᗣᖹ㸪ᚋ⸨ບ㸪ㅰⰼ඾Ꮚ㸪௚㸬ෆど㙾⫶ࡀࢇ᳨デࣉࣟࢢ࣒ࣛ࡬ࡢཧຍせᅉ㸬ཌ⏕ࡢᣦᶆ 2015;62:30–35.
4㸧ᚋ⸨ບ㸪᪂஭ᗣᖹ㸪ㅰⰼ඾Ꮚ㸪௚㸬デ⒪ᡤ࡟࠾ࡅࡿෆど㙾⫶ࡀࢇ᳨デᩘࡢỴᐃせᅉ㸬᪥ᮏ་⒪࣭⑓㝔⟶⌮Ꮫ఍ㄅ 2013; 50:25–34㸬
5㸧Goto R, Arai K, Kitada H, et al. Labor resource use for endoscopic gastric cancer screening in Japanese
primary care settings: a work sampling study. PLoS ONE 2014; 9:e88113.
㸦℈ᓥࡕࡉ࡜㸧̿  ̿



2. ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ⫶ෆど㙾᳨デࢆᑟධࡍࡿᕷ༊⏫ᮧ࡛ࡣࠊ᳨デࡢᐇ᪋ࢆ㐠Ⴀࡍࡿࡓࡵࡢ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍௬⛠ ࢆタ❧ࡍࡿࡇ࡜ࡀᮃࡲࡋ࠸ࠋࡲࡓࠊᕷ༊⏫ᮧࡀ⊂❧ࡋ࡚ጤဨ఍ࢆタ⨨࡛ࡁ࡞࠸ሙྜࡣࠊ஧
ḟ་⒪ᅪࠊ┴༢఩࡞࡝࡛ࡢタ⨨ࡀྍ⬟࡛࠶ࡿࠋࡓࡔࡋࠊ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࡟ࡣࠊ⫶ෆど㙾᳨デࢆᢸᙜࡍࡿᆅᇦࡢ་ᖌ఍ࠊ᳨デᶵ㛵ࡸᑓ㛛་࡞࡝ࡀྵࡲࢀ࡞ࡃ࡚ࡣ࡞ࡽ࡞࠸ ᅗ 1 ࠋ
 ᆅᇦ࡟࠾ࡅࡿ⢭ᗘ⟶⌮యไࢆᵓ⠏ࡍࡿୖ࡛ࠊ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࡀ୰ᚰⓗ࡞ᙺ๭ࢆᯝࡓࡍࡇ࡜࡟࡞ࡿࠋᮏጤဨ఍ࡣࠊ᳨デࡢᑐ㇟ࠊ᳨デࡢᐇ᪋᪉ἲࠊ᳨ᰝ་ࡢㄆᐃࠊㄞᙳጤဨ఍࡟ࡼ
ࡿࢲࣈࣝࢳ࢙ࢵࢡࡢ㐠⏝᪉ἲࠊ◊ಟ఍㛤ദࠊഅⓎ⑕ᑐ⟇ࠊ᳨デࢹ࣮ࢱ࣮࣋ࢫ⟶⌮࡞࡝ࢆ᳨ウࡍࡿࠋࡑࡢୖ࡛ࠊᆅᇦࡢᐇ᝟ࠊ≉࡟ෆど㙾ฎ⌮⬟࡟㓄៖ࡋࠊ⫶ෆど㙾᳨デࡢ㐠Ⴀ᪉㔪ࢆỴᐃࡍࡿࠋ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࡣࠊ⫶ෆど㙾᳨デࢆᢸᙜࡍࡿ᳨ᰝ་ࡢᇶᮏ᮲௳ࢆᥦ♧ࡋࠊ᳨ᰝ་ࡢㄆᐃࢆ⾜࠺ࠋ᳨ᰝ་࡜ࡋ࡚ࡢㄆᐃ᮲௳ࡣࠊᚋ㏙グ㍕ࢆཧ↷ࡍࡿ P.33 ࠋࡲࡓࠊ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࡣࠊࢲࣈࣝࢳ࢙ࢵࢡࢆᢸᙜࡍࡿㄞᙳጤဨ఍ࢆ⟶⌮ࡋࠊᮏ࣐ࢽࣗ࢔ࣝࢆཧ⪃࡟ࢲࣈࣝࢳ࢙ࢵࢡࡸ⏬ീⅬ᳨ࡢ᪉ἲࢆỴᐃࡋࠊᑓ㛛་࠶ࡿ࠸ࡣྠ➼ࡢᢏ㔞ࢆ᭷ࡍࡿ་ᖌ࠿ࡽᵓᡂࡉࢀࡿ
ㄞᙳጤဨ఍ࡢ࣓ࣥࣂ࣮ࢆ㑅௵ࡍࡿࠋࡉࡽ࡟ࠊ⫶ෆど㙾᳨デ࡟ᚲせ࡞▱㆑ࢆྲྀᚓࡋࠊࢫ࢟ࣝ࢔ࢵࣉ
ࢆᅗࡿࡓࡵ࡟ࠊ᳨ᰝ་࡞ࡽࡧ࡟⫶ෆど㙾᳨デࢆᑟධࡍࡿ་⒪ᶵ㛵࡟໅ົࡍࡿ࣓ࢹ࢕࢝ࣝࢫࢱࢵࣇ
┳ㆤᖌࠊ⮫ᗋ᳨ᰝᢏᖌ࡞࡝ ࡢ◊ಟ఍ࢆᐃᮇⓗ࡟㛤ദࡍࡿࠋ་ᖌࠊ࣓ࢹ࢕࢝ࣝࢫࢱࢵࣇࢆᑐ㇟࡜
ࡋࡓ◊ಟ࣒࢝ࣜ࢟ࣗࣛࡣࠊᚋ㏙グ㍕ࢆཧ↷ࡍࡿ P.48 ࠋ ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࡣࠊ⫶ෆど㙾᳨デࡀṇࡋࡃ㐠Ⴀࡉࢀࡿࡓࡵ࡟ࠊ≉࡟അⓎ⑕ᑐ⟇࡟␃ពࡍ࡭ࡁ࡛࠶ࡿࠋෆど㙾᳨ᰝ་࡟ࡣࠊഅⓎ⑕Ⓨ⏕᫬࡬ࡢᑐᛂ࡜ࡋ࡚ᩆᛴ࣮࢝ࢺࡢ‽ഛ࣭Ⅼ᳨ࢆ⩏ົ࡙ࡅࠊ⥭ᛴ᫬ᑐᛂ࡟ࡘ࠸࡚ࠊ᳨ᰝ་ࡢࡳ࡞ࡽࡎ࣓ࢹ࢕࢝ࣝࢫࢱࢵࣇ࡟ࡶࡑࡢ⌮ゎࢆᚭᗏࡉࡏࡿࠋࡲࡓࠊഅⓎ⑕Ⓨ⏕᫬ࡢሗ࿌᪉ἲࢆᐃࡵࠊഅⓎ⑕࡟㛵ࡍࡿࣔࢽࢱࣜࣥࢢࢆᐃᮇⓗ࡟⾜࠸ࠊ㍍
⑕࣭㔜⠜࡟࠿࠿ࢃࡽࡎഅⓎ⑕ࡢᐇែࢆᢕᥱ࡛ࡁࡿࡼ࠺㞟ィࢹ࣮ࢱࢆࡲ࡜ࡵࠊࡑࡢᑐ⟇ࢆ᳨ウࡋࠊᏳ඲⟶⌮ࢆ᥎㐍ࡍࡿࠋഅⓎ⑕ᑐ⟇࡟ࡘ࠸࡚ࡣࠊᚋ㏙グ㍕ࢆཧ↷ࡍࡿ P.71 ࠋྠጤဨ఍ࡣࠊ་⒪ᶵ㛵࡬ࡢゼၥㄪᰝࡸഅⓎ⑕ሗ࿌᭩ P.74 ࡢⅬ᳨ࢆ⾜࠸ࠊᏳ඲⟶⌮ࡢ㑂Ᏺ≧ἣࢆ☜ㄆࡍࡿࡇ࡜ࡀᮃࡲࡋ࠸ࠋ
ࡉࡽ࡟ࠊྠጤဨ఍ࡣࠊ᳨デࢹ࣮ࢱ࣮࣋ࢫࢆసᡂࡋࠊ⟶⌮ࡍࡿࠋ᳨デࢹ࣮ࢱ࣮࣋ࢫ࡟ࡘ࠸࡚ࡣࠊ
ᚋ㏙グ㍕ࢆཧ↷ࡍࡿ P.43 ࠋ
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̿  ̿
ᅗ 1㸬⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࡢᙺ๭㸦℈ᓥࡕࡉ࡜㸧̿  ̿



3.᳨デཷデᑐ㇟ ᑐ⟇ᆺ᳨デ࡟࠾ࡅࡿ⫶ෆど㙾᳨デࡢᑐ㇟ࡣࠊ50 ṓ௨ୖࡢఫẸ࡛ࠊ⫶⑌ᝈ࡟㛵㐃ࡍࡿ⑕≧ࡢ࡞࠸⪅࡛࠶ࡿࠋࡓࡔࡋࠊ⫶㒊ศ᦬㝖ᚋࡢཷデ⪅ࡣࠊ⤒㐣ほᐹ୰௨እࡣ⑕≧ࡀ࡞ࡅࢀࡤ⫶ෆど㙾᳨デࡢᑐ㇟࡜ࡍࡿࠋࡲࡓࠊ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜ㝖⳦ᚋࡢཷデ⪅ࡣࠊ㝖⳦ᚋࡢᖺᩘ࡟࠿࠿ࢃࡽࡎࠊ᳨デࡢᑐ㇟࡜ࡍࡿࠋ
ᢠ⾑ᰦ⸆᭹⏝୰ࡢཷデ⪅࡬ࡢ⫶ෆど㙾᳨ᰝࡣៅ㔜ࢆせࡍࡿࠋ᪥ᮏᾘ໬ჾෆど㙾Ꮫ఍ࡢ㺀ᢠ⾑ᰦ⸆᭹⏝⪅࡟ᑐࡍࡿᾘ໬ჾෆど㙾デ⒪࢞࢖ࢻࣛ࢖ࣥ㺁1)࡛ࡣࠊᢠ⾑ᑠᯈ⸆ ࢔ࢫࣆࣜࣥࠊࢳ࢚ࣀࣆࣜࢪࣥ
ㄏᑟయ➼ ࡜ᢠจᅛ⸆ ࣡ࣝࣇ࢓ࣜࣥࠊ࣊ࣃࣜࣥࠊࢲࣅ࢞ࢺࣛࣥ➼ ࢆྜࢃࡏ࡚ᢠ⾑ᰦ⸆࡜ࡋ࡚࠸ࡿ
ࡇ࡜࠿ࡽࠊᮏ࣐ࢽࣗ࢔࡛ࣝࡶྠᵝ࡜ࡍࡿࠋ⏕᳨࡛ࡣࠊᢠ⾑ᰦ⸆᭹⏝࡟࠿࠿ࢃࡽࡎࠊ୍ᐃ㢖ᗘࡢฟ⾑ࡀ࠶ࡿ 2, 3)ࠋ⏕᳨ࢆ⾜ࢃ࡞࠸ሙྜ࡛ࡶ⢓⭷⿣๰ ࣐࣮ࣟࣜ࣡࢖ࢫ⑕ೃ⩌࡞࡝ ࡟ࡼࡿฟ⾑ࡢྍ⬟ᛶࡶ࠶ࡿࠋࡇࡢࡓࡵࠊ⫶ෆど㙾᳨ᰝ᫬ࡢฟ⾑ࡀ࠶ࡗࡓሙྜ࡟ࠊ㐺ษ࡞Ṇ⾑ฎ⨨ࡀᐇ᪋࡛ࡁ࡞࠸་⒪᪋タ࡛ࡣࠊᢠ⾑ᰦ⸆᭹⏝୰ࡢཷデ⪅࡬ࡢ⫶ෆど㙾᳨ᰝࢆཎ๎࡜ࡋ່࡚ࡵ࡞࠸ࠋᢠ⾑ᰦ⸆᭹⏝୰ࡢཷデ⪅࡟ᑐᛂ࡛ࡁ࡞࠸ሙྜ࡟ࡣࠊ⫶ෆど㙾᳨ᰝࡣᐇ᪋ࡏࡎࠊ⫶ࡀࢇ᳨デࡢ㑅ᢥ⫥࡜ࡋ࡚⫶ X ⥺᳨デ࡟ࡘ࠸࡚ㄝ᫂ࡍࡿࠋࡇࡢ࡯࠿ࠊୗグ࡟ヱᙜࡍࡿ⪅ࡣ⫶ෆど㙾᳨デࡢᑐ㇟࠿ࡽࡣ㝖እࡍࡿࠋ1㸧᳨デᑐ㇟ࡢ㝖እ᮲௳
㸦1㸧⫶ෆど㙾᳨デ࡟㛵ࡍࡿ࢖ࣥࣇ࢛࣮࣒ࢻ࣭ࢥࣥࢭࣥࢺࡸྠព᭩ࡢྲྀᚓࡀ࡛ࡁ࡞࠸⪅㸦2㸧ዷፎ୰ࡢ⪅㸦3㸧⑌ᝈࡢ✀㢮࡟࠿࠿ࢃࡽࡎࠊධ㝔୰ࡢ⪅
㸦4㸧ᾘ໬ᛶ₽⒆࡞࡝ࡢ⫶⑌ᝈ࡛ཷ⒪୰ࡢ⪅ ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜ㝖⳦୰ࡢ⪅ࢆྵࡴ 㸦5㸧⫶඲᦬⾡ᚋࡢ⪅
2㸧⫶ෆど㙾᳨ᰝࡢ⚗ᚷ
㸦1㸧ဗ㢌ࠊ㰯⭍࡞࡝࡟㔜⠜࡞⑌ᝈࡀ࠶ࡾࠊෆど㙾ࡢᤄධࡀ࡛ࡁ࡞࠸⪅㸦2㸧࿧྾୙඲ࡢ࠶ࡿ⪅㸦3㸧ᛴᛶᚰ➽᱾ሰࡸ㔜⠜࡞୙ᩚ⬦࡞࡝ࡢᚰ⑌ᝈࡢ࠶ࡿ⪅㸦4㸧᫂ࡽ࠿࡞ฟ⾑ഴྥࡲࡓࡣࡑࡢ␲࠸ࡢ࠶ࡿ⪅ࠋ
㸦5㸧཰⦰ᮇ⾑ᅽࡀᴟࡵ࡚㧗࠸⪅ࠋ㧗⾑ᅽ἞⒪୰ࡢሙྜࠊ᳨ᰝ┤๓࡟⾑ᅽࢆࡾࠊཷ᳨ࡢྍྰࢆุ᩿ࡍࡿࠋ㝆ᅽ๣ฎ⨨ᚋ࡟⫶ෆど㙾᳨ᰝࢆ⾜࠺ࡇ࡜ࡣྍ⬟ࡔࡀࠊᛴ⃭࡟⾑ᅽࢆ㝆ୗࡉࡏࡿࡇ࡜ࡣࣜࢫࢡࢆక࠺ࠋ
㸦6㸧඲㌟≧ែࡀᝏࡃࠊ⫶ෆど㙾᳨ᰝ࡟⪏࠼ࡽࢀ࡞࠸࡜ุ᩿ࡉࢀࡿ⪅ཧ⪃ᩥ⊩1㸧⸨ᮏ୍┾㸪⸨ᇛගᘯ㸪ຍ⸨ඖႹ㸪௚㸬ᢠ⾑ᰦ⸆᭹⏝⪅࡟ᑐࡍࡿᾘ໬ჾෆど㙾デ⒪࢞࢖ࢻࣛ࢖
ࣥ㸬Gastroenterol Endosc 2012; 54:2075–2102.
2㸧 Sieg A, Hachmoeller-Eisenbach U, Eisenbach T. Prospective evaluation of complications in outpatient
GI endoscopy: a survey among German gastroenterologists. Gastrointest Endosc 2001; 53:620–627.
3㸧 Parra-Blanco A, Kaminaga N, Kojima T, et al. Hemoclipping for postpolypectomy and postbiopsy
colonic bleeding. Gastrointest Endosc 2000; 51:37–41.            㸦ᡂ⃝ᯘኴ㑻㸧̿  ̿

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4. ᳨ᰝ་࣭࣓ࢹ࢕࢝ࣝࢫࢱࢵࣇ
1㸧᳨ᰝ་ࡢ᮲௳ ⫶ෆど㙾᳨デ࡟ࡣࠊᑓ㛛་ࡤ࠿ࡾ࡛ࡣ࡞ࡃࠊᾘ໬ჾ⛉௨እࡢ་ᖌࡀ㛵୚ࡍࡿྍ⬟ᛶࡀ࠶ࡿࠋᑓ
㛛་࡛࠶ࡿࡇ࡜ࡣᚲ㡲᮲௳࡛ࡣ࡞࠸ࡀࠊ⫶ෆど㙾᳨デ࡟㛵ࡍࡿ㐺ษ࡞▱㆑࡜ᢏ㔞ࢆഛ࠼࡚࠸ࡿᚲせࡀ࠶ࡿࠋ
㸦1㸧ᑐ⟇ᆺ᳨デࡢ▱㆑ デ⒪࡜ࡀࢇ᳨デ࡜ࡣ┠ⓗࡸᑐ㇟࡞࡝ࡢ⪃࠼᪉ࡀ␗࡞ࡿࠋ౛࠼ࡤࠊ㏻ᖖࡢデ⒪࡛ࡣぢ㏨ࡋࢆ㜵ࡄࡓࡵ࡟ឤᗘࢆ㔜どࡍࡿ᳨ᰝࢆᐇ᪋ࡋࡓࡾࠊ㈝⏝ࡀ㧗ࡃ࡚ࡶ⢭ᗘࡢ㧗࠸᳨ᰝࢆᐇ᪋ࡋࡓࡾࡍࡿࡀࠊ
ࡀࢇ᳨デ࡛ࡣឤᗘࡔࡅ࡛ࡣ࡞ࡃ≉␗ᗘࡸ㈝⏝ࢆࡶ⪃៖ࡋࡓ᳨ᰝࢆ᥇⏝ࡍࡿࠋࢃࡀᅜ࡛ࡣ࠸ࡃࡘ࠿ࡢࡀࢇ᳨デ࡟㛵ࡍࡿᏛ఍ࡀᏑᅾࡍࡿࡀࠊタ❧ᙜึ࠿ࡽᑐ⟇ᆺ⫶ࡀࢇ᳨デࢆᑓ㛛࡟◊✲ࡋ࡚࠸ࡿᏛ఍࡜ࡋ࡚᪥ᮏᾘ໬ჾࡀࢇ᳨デᏛ఍ࡀ࠶ࡿࠋ᪥ᮏᾘ໬ჾࡀࢇ᳨デᏛ఍ㄆᐃ་
ࡣࠊ⫶ࡀࢇ᳨デࡢ⤒㦂࡜◊✲࡟ࡼࡾྲྀᚓྍ⬟ࡔࡀࠊࡀࢇ᳨デࡢᇶ♏▱㆑ࡶせồࡉࢀࡿࠋ⫶ෆど㙾᳨デ࡟ࡘ࠸࡚ࡶࠊྠ➼ࡢ▱㆑ࢆ᭷ࡍࡿࡇ࡜ࡀᚲせ࡛࠶ࡿࠋ㸦2㸧⫶ෆど㙾᳨ᰝࡢᢏ㔞 ⫶ෆど㙾᳨ᰝࡢᢏ㔞ࡣᐈほⓗ࡞ホ౯ࡀᅔ㞴ࡔࡀࠊ⫶ෆど㙾᳨デ࡟ཧຍࡍࡿ௨๓࡟⫶ෆど㙾᳨ᰝࢆᐇ᪋ࡋ࡚ࡁࡓ⤒㦂ࡀồࡵࡽࢀࡿࠋ᪥ᮏᾘ໬ჾෆど㙾Ꮫ఍࡛ࡣᑓ㛛་つᐃࢆタࡅ࡚࠾ࡾࠊᑡ࡞ࡃ
࡜ࡶ 5 ᖺ௨ୖࡢ⤒㦂࡜ᡤᐃࡢᢏ⬟ࢆ᭷ࡋࠊୖ㒊ᾘ໬⟶ෆど㙾᳨ᰝࡢ⤒㦂ࡀ 1,000 ௳௨ୖ࡛ཷ㦂㈨᱁
ࡀᚓࡽࢀࡿࠋ ࡲࡓࠊ᪥ᮏᾘ໬ჾࡀࢇ᳨デᏛ఍࡛ࡣࠊᏛ఍ຍධṔࡀ 3 ᖺ௨ୖ࡛ࠊୖ㒊ᾘ໬⟶ෆど㙾᳨ᰝࡢ⤒㦂
ࡀ 1,000 ௳௨ୖࠊ࠿ࡘⓎぢ⫶ࡀࢇ 15 ౛௨ୖࡢ⤒㦂ࡀ࠶ࡿ་ᖌࡀㄆᐃ་ࢆ⏦ㄳ࡛ࡁࡿࠋ⫶ෆど㙾᳨デ࡟ཧຍࡍࡿ་ᖌࡣࠊᑓ㛛་ࡢ㈨᱁ࢆ᭷ࡋ࡚࠸࡞࠸ሙྜ࡛ࡶࠊ⌧ᅾࠊデ⒪࡟࠾࠸࡚ᐃᮇⓗ࡟⫶ෆど㙾᳨ᰝࢆᐇ᪋ࡋ࡚࠸ࡿࡇ࡜ࡀ᭱ప᮲௳࡜࡞ࡿࠋ ⫶ෆど㙾᳨ᰝࢆᐇ᪋ࡋ࡚࠸ࡿ་ᖌ࡛࠶ࡗ࡚ࡶࠊᑓ㛛་࡜ࡑࢀ௨እࡢ་ᖌ࡛ࡣᢏ㔞࡟ᕪࡀ࠶ࡿࡇ
࡜ࡀᣦ᦬ࡉࢀ࡚࠸ࡿ 1)ࠋᑓ㛛་௨እࡢ་ᖌࡣࠊࡑࡢᢏ㔞ࢆᨵၿࡉࡏࡿࡓࡵࠊࢲࣈࣝࢳ࢙ࢵࢡࡢࡓࡵ
ࡢㄞᙳ఍ࡸ◊ಟ఍࡟ฟᖍࡍࡿ࡜࡜ࡶ࡟ࠊ⏬ീⅬ᳨࡛ᣦ᦬ࡉࢀࡓⅬ࡟ࡘ࠸࡚ᨵၿࡍ࡭ࡃᖖ࡟ດຊࡍ
࡭ࡁ࡛࠶ࡿࠋ
㸦3㸧᳨ᰝ་㈨᱁ㄆᐃ
⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࡣࠊྛᆅᇦࡢᐇ᝟࡟ᛂࡌࡓ᳨ᰝ་㈨᱁ㄆᐃࡢᇶ‽ࢆᐃࡵࠊ⫶ෆど㙾᳨デ࡟ཧຍ࡛ࡁࡿ᳨ᰝ་ࢆㄆᐃࡍࡿࠋጤဨ఍࡟ࡼࡾㄆᐃࡉࢀࡓ᳨ᰝ་ࡢࡳࡀࠊ⫶ෆど㙾᳨デ࡟ᦠࢃࡿࡼ࠺࡟ࡍࡿ࡭ࡁ࡛࠶ࡿࠋ
౛࠼ࡤࠊ᪂₲ᕷ་ᖌ఍ࡣࠊᕼᮃࡍࢀࡤ་ᖌࡣࡑࡢ㈨᱁ࡢ᭷↓࡟࠿࠿ࢃࡽࡎ⫶ෆど㙾᳨デ࡟ཧຍ࡛ࡁࡿࠋࡓࡔࡋࠊ㈨᱁ࡢ᭷↓࡟࠿࠿ࢃࡽࡎ⫶ෆど㙾᳨デ࡜ࡋ࡚⾜ࡗࡓ⏬ീ 㟁Ꮚ፹య࡞࡝ ࡢࢲࣈࣝࢳ࢙ࢵࢡࡀ⩏ົ࡙ࡅࡽࢀ࡚࠸ࡿࠋ୍᪉ࠊ㫽ྲྀ┴࡛ࡣ┴೺ᗣᑐ⟇༠㆟఍࡛ࠊ⫶ෆど㙾᳨デ࡟ཧຍ࡛ࡁࡿ་ᖌࡣᖺ㛫 50 ௳௨ୖࡢ᳨ᰝᐇ⦼ࡀ࠶ࡾࠊ༠㆟఍ࡢᐃࡵࡿㅮ⩦఍࡬ࡢฟᖍࡀ୍ᐃᅇᩘ௨ୖ࠶
ࡿ་ᖌ࡟㝈ᐃࡋ࡚࠸ࡿࠋࡉࡽ࡟ࠊ㫽ྲྀ┴ᮾ㒊་ᖌ఍࡛ࡣࠊೃ⿵⪅ࡀࡇࢀࡲ࡛࡟ᐇ᪋ࡋࡓ௵ពࡢෆど㙾⏬ീࢆࢳ࢙ࢵࢡࡋࠊࡑࡢᢏ㔞࡟ࡼࡾุ᩿ࡉࢀࡿࠋ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࡣࠊ⫶ෆど㙾᳨デࡢᐇ⦼ࢆ຺᱌ࡋࠊ᳨ᰝ་࡜ࡋ࡚ཧຍྍ⬟࠿ྰ̿  ̿

࠿ࢆุ᩿ࡍࡿࠋ᳨ᰝ་࡜ࡋ࡚ࡢ⥅⥆ࡣࠊ᳨ᰝ௳ᩘࡢࡳ࡞ࡽࡎࠊࢲࣈࣝࢳ࢙ࢵࢡࡢࡓࡵࡢㄞᙳ఍ࡸ
◊ಟ఍࡬ࡢฟᖍ≧ἣ࡟ࡘ࠸࡚ࡶ຺᱌ࡍ࡭ࡁ࡛࠶ࡿࠋ
㸦4㸧᳨ᰝ་ࡢ㈨᱁
 ⫶ෆど㙾᳨デ࡟ཧຍࡍࡿ་ᖌࡢ㈨᱁࡜ࡋ࡚ࠊ᪥ᮏᾘ໬ჾࡀࢇ᳨デᏛ఍ㄆᐃ་࡜᪥ᮏᾘ໬ჾෆど㙾Ꮫ఍ᑓ㛛་ࡢ୧᪉ࡢ㈨᱁ࢆ᭷ࡍࡿࡇ࡜ࡀ⌮᝿ⓗ࡛࠶ࡿࡀࠊࡑࡢྲྀᚓࢆ๓ᥦ࡜ࡍࡿࡇ࡜ࡣᅔ㞴࡛࠶ࡿࠋࡋ࠿ࡋࠊ㐺ษ࡞ᩍ⫱ࣉࣟࢢ࣒ࣛ࡜⢭ᗘ⟶⌮ᑐ⟇ࢆᐇ᪋ࡍࡿࡇ࡜࡟ࡼࡗ࡚ࠊ⫶ෆど㙾᳨デ࡟ᦠࢃࡿ᳨ᰝ་ࡢ▱㆑࣭ᢏ㔞ࡢ㉁ࢆᨵၿࡋࠊࡦ࠸࡚ࡣ᳨デࡢ㉁ࢆᢸಖࡍࡿࡇ࡜ࡣྍ⬟࡛࠶ࡿࠋ ᚑࡗ࡚ࠊ⫶ෆど㙾᳨デࡢ᳨ᰝ་ࡢཧຍ᮲௳࡜ࡋ࡚ࠊ௨ୗࡢ࠸ࡎࢀ࠿ࡢ᮲௳ࢆ‶ࡓࡍ་ᖌ࡛࠶ࡿ
ࡇ࡜ࡀᮃࡲࡋ࠸ࠋ
ձ᪥ᮏᾘ໬ჾࡀࢇ᳨デᏛ఍ㄆᐃ་ࠊ᪥ᮏᾘ໬ჾෆど㙾Ꮫ఍ᑓ㛛་ࠊ᪥ᮏᾘ໬ჾ⑓Ꮫ఍ᑓ㛛་ࡢ࠸ࡎࢀ࠿ࡢ㈨᱁ࢆ᭷ࡍࡿ་ᖌ
ղ デ⒪ࠊ᳨デ࡟࠿࠿ࢃࡽࡎᴫࡡᖺ㛫 100 ௳௨ୖࡢ⫶ෆど㙾᳨ᰝࢆᐇ᪋ࡋ࡚࠸ࡿ་ᖌճ ᆅᇦࡢ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࡀᐃࡵࡿ᮲௳࡟㐺ᛂࡋࠊձ ࡲࡓࡣ ղ ࡢ᮲௳ࢆ‶ࡓࡍ་ᖌ࡜ྠ➼ࡢ⤒㦂ࠊᢏ㔞ࢆ᭷ࡍࡿ࡜ㄆᐃࡉࢀࡓሙྜ
2㸧࣓ࢹ࢕࢝ࣝࢫࢱࢵࣇࡢᙺ๭ Ᏻ඲࡞⫶ෆど㙾᳨ᰝࡢᐇ᪋࡟࠶ࡓࡗ࡚ࠊ┳ㆤᖌ࣭⮫ᗋ᳨ᰝᢏᖌ࡞࡝ࡢ࣓ࢹ࢕࢝ࣝࢫࢱࢵࣇࡢᙺ
๭ࡣᴟࡵ࡚኱ࡁ࠸ࠋ᳨デࢆᐇ᪋ࡍࡿ་⒪ᶵ㛵࡛ࡣ᳨デ࡟㛵ࡍࡿ▱㆑ࡸ᳨デࡢ฼┈࣭୙฼┈࡟㛵ࡍࡿㄝ᫂ࠊ᳨ᰝࡢഅⓎ⑕࡟㛵ࡍࡿㄝ᫂ࡸྠពࡢྲྀᚓࠊഅⓎ⑕࡟ᑐࡋ࡚㐺ษ࡞ᑐᛂࢆࡍࡿ࡞࡝ᑓ㛛▱㆑ࢆ᭷ࡍࡿ࣓ࢹ࢕࢝ࣝࢫࢱࢵࣇࡀᚲせ࡛࠶ࡿࠋࡇࡢࡓࡵࠊ࣓ࢹ࢕࢝ࣝࢫࢱࢵࣇ࡟ᑐࡋ࡚ࡶࠊ㐺ษ࡞ᩍ⫱ᶵ఍ࢆᥦ౪ࡍࡿࡓࡵ࡟ࠊྛᆅᇦࡢ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࡀ◊ಟ఍࡞࡝ࢆ㛤ദࡋࠊࡑࡢᩍ⫱࡟ດࡵࡿࠋ◊ಟ࣒࢝ࣜ࢟ࣗࣛ࡟ࡘ࠸࡚ࡣࠊᚋ㏙グ㍕ࢆཧ↷ࡍࡿ P.48 ࠋ࡞࠾ࠊ᪥ᮏᾘ໬ჾෆど㙾Ꮫ఍࡛ࡣࠊᣦᐃࡉࢀࡓ࣒࢝ࣜ࢟ࣗࣛ࡟ࡼࡿᐇ⩦࡜Ꮫ఍࣭◊ಟ఍ཧຍ࡞
࡝ࡢ㈨᱁せ௳ࢆ‶ࡓࡋࠊヨ㦂࡟ྜ᱁ࡋࡓ⪅ࢆᾘ໬ჾෆど㙾ᢏᖌ࡜ࡋ࡚ㄆᐃࡋ࡚࠸ࡿ 2)ࠋ
 

ཧ⪃ᩥ⊩
1㸧 ⊦⫤ⰾᩥ㸪ຍ⸨຾❶㸪ᓥ⏣๛ᘏ㸪௚㸬ഇ㝜ᛶ⋡࠿ࡽぢࡓෆど㙾᳨ᰝࡢ⢭ᗘ⟶⌮ࡢၥ㢟Ⅼ࠾ࡼࡧᑐ⟇࡟ࡘ࠸࡚ࡢ᳨ウ㸬᪥ᾘࡀࢇ᳨デㄅ 2009; 47:542–551㸬
2㸧 ᪥ᮏᾘ໬ჾෆど㙾ᢏᖌ఍㸬ᾘ໬ჾෆど㙾ᢏᖌไᗘつ๎㸪2001 ᖺ 10 ᭶ 17 ᪥ᨵᐃ㸬
http://www.jges.net/index.php/bannerlink/archives/118㸬㹙2015.7.17㹛

㸦῰㇂኱ຓ㸧̿  ̿



5. ᳨ᰝ㛵㐃ᶵჾ
1㸧ෆど㙾ࡢ✀㢮ෆど㙾ࡣ⤒ཱྀෆど㙾࡜⤒㰯ෆど㙾࡟኱ูࡉࢀࡿ ⾲ 1 1)ࠋ⤒ཱྀෆど㙾ࡣࠊ἞⒪࡟ࡶ⏝࠸ࡽࢀࡿࠋ
୍᪉ࠊ⤒㰯ෆど㙾࡛ࡶ⏕᳨ࡣྍ⬟࡛࠶ࡾࠊཷデ⪅ࡢ㈇ᢸࢆ㍍ῶ࡛ࡁࡿࠋࡲࡓࠊ㏆ᖺ࡛ࡣ⤒㰯ෆど㙾ࡢᨵၿࡀ㐍ࡳࠊほᐹྍ⬟࡞ど㔝ࡶ⤒ཱྀෆど㙾࡜ྠ➼ࣞ࣋ࣝ࡜࡞ࡗ࡚࠸ࡿࠋ
᳨ᰝ་ࡀᡭ័ࢀࡓᶵჾࢆ⏝࠸ࡿࡇ࡜ࡀዲࡲࡋ࠸ࡀࠊᶵჾࡢᨵⰋࡀ㐍ࡳࠊ⏬ീࡢ㩭㗦ᗘࡀቑࡋ࡚
࠸ࡿࡢ࡛ࠊ࠶ࡲࡾ࡟ᪧᘧ࡞ᶵჾࡢ౑⏝ࡣ㑊ࡅࡿ࡭ࡁ࡛࠶ࡿࠋ↓⑕≧⪅ࢆᑐ㇟࡜ࡍࡿࡀࢇ᳨デ࡟⏝࠸ࡽࢀࡿෆど㙾ᶵჾࡣཷデ⪅ࡢ㈇ᢸࡀᑡ࡞࠸ࡇ࡜ࡀ᮲௳࡜࡞ࡿࠋࡑࡢࡓࡵ࡟ࡣෆど㙾እᚄࡀ⣽ࡃࠊဗ㢌ࡸ⯉᰿࡟ᑐࡍࡿ่⃭ࡀᑡ࡞࠸ࡶࡢ࠿ࡽ㑅ᢥࡍࡿࡇ࡜ࡀᮃࡲࡋ࠸ࠋ
⏬ീᙉㄪᣑ኱ほᐹ IEE: image-enhanced endoscopy デ᩿ࡢ㐍Ṍࡣⴭࡋ࠸ࡀࠊࡇࡢほᐹἲࡣⓑⰍග
ほᐹ࡛ᣠ࠸ୖࡆࡽࢀࡓ⑓ᕢࡢᛶ≧デ᩿࡟᭷⏝࡛ࡣ࠶ࡗ࡚ࡶࠊᣠ࠸ୖࡆࡑࡢࡶࡢ࡟ᑐࡍࡿຠᯝࡣᑠ
ࡉ࠸ࡢ࡛ࠊ⿦ഛࡉࢀࡿᚲせࡣ࡞࠸ࠋ⾲ 1. ⤒ཱྀෆど㙾࡜⤒㰯ෆど㙾ࡢẚ㍑
⤒ཱྀෆど㙾

⤒㰯ෆど㙾

ඛ➃㒊ࡢኴࡉ

ኴ࠸ 8 ੈ࠿ࡽ 12 ੈ⣽࠸ 5 ੈ࠿ࡽ 6 ੈ⏕᳨⤌⧊᥇ྲྀࡸษ㝖࡝ࡕࡽࡶ࡛ࡁࡿ

⏕᳨ࡣྍ⬟ࡔࡀษ㝖ࡣᅔ㞴᳨ᰝ୰ࡢⱞ③࠶ࡾᑡ࡞࠸᳨ᰝ୰ࡢ఍ヰ

࡛ࡁ࡞࠸

࡛ࡁࡿ

ᚠ⎔ືែ࡬ࡢᙳ㡪

࠶ࡾ

ᑡ࡞࠸

2㸧᳨デ⏝ෆど㙾ࡢ✀㢮⌧ᅾࠊࢃࡀᅜ࡟࠾࠸࡚ࡣ࢜ࣜࣥࣃࢫࠊᐩኈࣇ࢖࣒ࣝࠊ࣍ࣖ ࣌ࣥࢱࢵࢡࢫ ࡢ 3 ♫࠿ࡽୖ㒊ᾘ໬⟶⏝ࡢෆど㙾ࠊࡑࢀ࡟௜㝶ࡋࡓෆど㙾ࢩࢫࢸ࣒ࡀᕷ㈍ࡉࢀ࡚࠸ࡿࠋཷデ⪅࡟㈇ᢸࡀᑡ࡞ࡃࠊࡋ࠿
ࡶ⏬ീࡢ㩭㗦ᗘࡀⰋዲ࡛ぢ㏨ࡋࡀᑡ࡞ࡃࠊ⫶ෆࡢ࡝ࡢ㒊఩࡛ࡶ⏕᳨ࢆᐇ᪋ࡍࡿࡇ࡜ࡀྍ⬟࡞ᶵ✀ࡀ⌮᝿࡛࠶ࡾࠊྛ♫࡜ࡶࡼࡾ୍ᒙࡢᢏ⾡ᨵⰋࡀᮇᚅࡉࢀࡿࠋ
3㸧⮬ືὙίᾘẘᶵᕷ㈍ࡉࢀ࡚࠸ࡿෆど㙾⮬ືὙίᾘẘᶵࡣࠊࢢࣝࢱ࣮ࣝ࢔ࣝࢹࣄࢻࠊࣇࢱ࣮ࣛࣝ〇๣ࠊ㐣㓑㓟࡜࠸ࡗࡓ㧗Ỉ‽ᾘẘ⸆ࢆ౑⏝ࡍࡿᶵჾ࡜ࠊᙉ㓟ᛶ㟁ゎỈࡸ࢜ࢰࣥỈ࡜࠸ࡗࡓᶵ⬟Ỉࢆ౑⏝ࡍࡿᶵჾ࡟༊ศࡉࢀࡿࠋ㺀ᾘ໬ჾෆど㙾ࡢឤᰁไᚚ࡟㛵ࡍࡿ࣐ࣝࢳࢯࢧ࢚ࢸ࢕ᐇ㊶࢞࢖ࢻ㺁2)ࡣࠊ㧗Ỉ‽ᾘẘ⸆ࡢ౑⏝ࢆ๓ᥦ࡜ࡋ࡚᭩࠿ࢀ࡚࠾ࡾࠊᶵ⬟Ỉࢆ౑⏝ࡍࡿᶵჾ࡟㛵ࡋ࡚ࡢᾘẘຠᯝࡢホ౯ࡣ༑ศ࡞
ࡶࡢ࡛ࡣ࡞࠸ࠋ㧗Ỉ‽ᾘẘ⸆ࡣⱆ⬊ࡀከᩘᏑᅾࡍࡿሙྜࢆ㝖ࡁࡍ࡭࡚ࡢᚤ⏕≀ࡢᾘẘ࡟᭷ຠ࡛ࠊ
⾑ᾮ࡞࡝ࡀ௜╔ࡋ࡚ࡶຠຊࡀࡑࢀ࡯࡝పୗࡋ࡞࠸ࠋ୍᪉ࠊᶵ⬟Ỉࢆ౑⏝ࡋࡓ⮬ືὙίᾘẘᶵࡶ࠶ࡿࡀࠊࡑࡢẅ⳦ຠᯝࡣ୙᫂☜࡛࠶ࡿࠋ̿  ̿ཧ⪃ᩥ⊩1㸧 ⰾ㔝⣧἞㸪௚㸬⫶ෆど㙾᳨デ࡟࠾ࡅࡿ⣽ᚄෆど㙾ࡢᙺ๭࡜ព⩏㸬᪥ᮏᾘ໬ჾࡀࢇ᳨デᏛ఍⫶⣽ᚄෆど㙾᳨デ◊✲఍⦅㸪⤒㰯ෆど㙾࡟ࡼࡿ⫶ࡀࢇ᳨デ࣐ࢽࣗ࢔ࣝ㸪་Ꮫ᭩㝔, ᮾி㸪2014㸪2–9㸬
2㸧 ㉥ᯇὈḟ, ▼ཎ❧, బ⸨බ, ௚ ᪥ᮏᾘ໬ჾෆど㙾Ꮫ఍ 㸬ᾘ໬ჾෆど㙾ࡢឤᰁไᚚ࡟㛵ࡍࡿ࣐ࣝࢳࢯࢧ࢚ࢸ࢕ᐇ㊶࢞࢖ࢻ㸬Gastroenterol Endosc 2014; 56:89–107㸬㸦⣽ᕝ἞㸧̿  ̿

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6. ㄞᙳయไ
1㸧ࢲࣈࣝࢳ࢙ࢵࢡࡢᚲせᛶ⫶ෆど㙾᳨デࡢ⢭ᗘࢆ୍ᐃ࡟ಖࡘࡓࡵ࡟ࡣࠊࢲࣈࣝࢳ࢙ࢵࢡࡣᚲ㡲࡛࠶ࡿࠋ⫶ෆど㙾᳨デ࡟ཧຍࡍࡿ་ᖌࡣࠊ୍ᐃࡢᢏ㔞ࡣせồࡉࢀࡿࡶࡢࡢࠊᚲࡎࡋࡶᑓ㛛་࡜ࡣ㝈ࡽ࡞࠸ࠋᑓ㛛་௨እࡢ་ᖌࡀෆど㙾᳨ᰝࢆ⾜ࡗࡓሙྜࠊࡑࡢ⢭ᗘࡀపୗࡍࡿࡇ࡜ࡀሗ࿌ࡉࢀ࡚࠸ࡿ 1)ࠋ
⫶ෆど㙾᳨デ࡟ࡣᢏ㔞ࡢ␗࡞ࡿ་ᖌࡀཧຍࡍࡿࡇ࡜࠿ࡽࠊࡑࡢᢏ㔞ࡢᕪࢆ⿵࠸ᶆ‽໬ࡍࡿࡓࡵ࡟
ࢲࣈࣝࢳ࢙ࢵࢡࢆ⾜࠺ࠋඛ⾜ࡋ࡚⫶ෆど㙾᳨デࢆᑟධࡋࡓᆅᇦ࠿ࡽࡶࠊࢲࣈࣝࢳ࢙ࢵࢡࢆ⾜࠺ࡇ࡜࡟ࡼࡾࠊぢ㏨ࡋࡢᅇ㑊ࡸࠊ୙せ࡞⏕᳨ࢆῶᑡ࡛ࡁࡓࡇ࡜ࡀሗ࿌ࡉࢀ࡚࠸ࡿ 2, 3)ࠋࡇࡢࡓࡵࠊ⫶ෆど㙾᳨デࢆᐇ᪋࡛ࡁࡿ
᳨ᰝ་ࡢ᮲௳ࢆᐃࡵࡿ࡜࡜ࡶ࡟ P.33ཧ↷ ࠊ⫶ෆど㙾᳨デ࡜ࡋ࡚⾜ࢃࢀࡿ᳨ᰝࡣࠊ඲౛ࢲࣈࣝࢳ࢙
ࢵࢡࢆ⾜࠺ᚲせࡀ࠶ࡿࠋ2㸧ㄞᙳጤဨ఍ࡢᙺ๭ෆど㙾᳨ᰝᢏ⾡࡜デ᩿⬟ࡢᶆ‽໬࡞ࡽࡧ࡟ࡑࡢྥୖࢆᅗࡿࡇ࡜ࢆ┠ⓗ࡜ࡋࠊྛᕷ༊⏫ᮧ࡛ㄞᙳయไࢆᵓ⠏ࡋࠊࡑࡢ୰ᚰⓗᙺ๭ࢆㄞᙳጤဨ఍ࡀᢸ࠸ࠊ⢭ᗘ⟶⌮ࢆ⾜࠺ࠋᕷ༊⏫ᮧࡀ⫶ෆど㙾᳨デࢆእ㒊࡟ጤクࡍࡿሙྜ࡟ࡣࠊጤクᶵ㛵࡜࡜ࡶ࡟⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࢆタ⨨ࡋࠊㄞᙳጤဨ఍ࡢタ⨨ࡣጤクඛ࡟୍௵ࡋ࡚ࡶࡼ࠸ࠋ
᳨ᰝ་ࡣ᳨デࡢෆど㙾⏬ീࢆㄞᙳጤဨ఍࡟ᥦฟࡋࠊㄞᙳጤဨ఍࡟ࡼࡿ඲⑕౛ࡢ඲ෆど㙾⏬ീࡢࢲࣈࣝࢳ࢙ࢵࢡࢆᚲ㡲࡜ࡍࡿࠋࢲࣈࣝࢳ࢙ࢵࢡ࡜ࡣࠊෆど㙾᳨ᰝ་௨እࡢㄞᙳጤဨ఍ࡢ࣓ࣥࣂ࣮ࡀෆど㙾⏬ീࡢࢳ࢙ࢵࢡࢆ⾜࠺ࡇ࡜ࢆ࠸࠺ࠋㄞᙳጤဨ఍ࡢ࣓ࣥࣂ࣮ࡀ 1 ே࠶ࡿ࠸ࡣ 2 ே௨ୖ࡛⾜࠺࠿ࡣࠊᆅᇦࡢ≧ἣࡸ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࡢ᪉㔪࡟ࡼࡾ␗࡞ࡿࠋ
ࢲࣈࣝࢳ࢙ࢵࢡࢆᢸᙜࡍࡿㄞᙳጤဨ఍ࡢ࣓ࣥࣂ࣮࡟ࡣࠊཎ๎ࠊ᪥ᮏᾘ໬ჾࡀࢇ᳨デᏛ఍ㄆᐃ་ࠊ
᪥ᮏᾘ໬ჾෆど㙾Ꮫ఍ᑓ㛛་ࡢ㈨᱁ࢆᣢࡘ་ᖌ࠿ࠊ࠶ࡿ࠸ࡣ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࡀࢲࣈࣝࢳ࢙ࢵࢡࢆ⾜࠺࡟㊊ࡿᢏ㔞ࡀ࠶ࡿ࡜ㄆᐃࡋࡓ་ᖌࡀヱᙜࡍࡿࠋෆど㙾᳨ᰝ་ࡣࠊㄞᙳጤဨ఍
ࡀࢲࣈࣝࢳ࢙ࢵࢡࢆ⾜࠺ㄞᙳ఍࡟ྍ⬟࡞㝈ࡾฟᖍࡋࠊࢲࣈࣝࢳ࢙ࢵࢡᢸᙜ་࠿ࡽᣦᑟࡸຓゝࢆཷࡅࡿࡇ࡜ࡀᮃࡲࡋ࠸ࠋ
ࢲࣈࣝࢳ࢙ࢵࢡࡣࠊ᳨ᰝ་ࡀᑓ㛛་࠿ྰ࠿࡟࠿࠿ࢃࡽࡎࠊᚲࡎ⾜࠺࡭ࡁ࡛࠶ࡿࠋࡓࡔࡋࠊᑓ㛛་ࡀ」ᩘ໅ົࡍࡿ་⒪ᶵ㛵᳨࡛デࢆ⾜࠺ሙྜ࡟ࡣࠊ᪋タෆ࡛ࡢ┦஫ࢳ࢙ࢵࢡࢆࢲࣈࣝࢳ࢙ࢵࢡࡢ
௦᭰᪉ἲ࡜ࡍࡿࡇ࡜ࡀ࡛ࡁࡿࠋࡲࡓࠊ3 ࡟♧ࡍࡼ࠺࡟⏬ീ㏦ಙࢩࢫࢸ࣒ࢆ฼⏝ࡋࠊ኱Ꮫ⑓㝔ࡸᆅᇦࡢ୰᰾⑓㝔ࠊ་ᖌ఍࡞࡝࡟ࠊࢲࣈࣝࢳ࢙ࢵࢡࢆ౫㢗ࡍࡿࡇ࡜ࡶྍ⬟࡛࠶ࡿࠋ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࡣࠊ᳨ᰝ་ࡢࡓࡵ࡟ᐃᮇⓗ࡟◊ಟ఍ࢆ㛤ദࡋࠊ᳨ᰝᢏ⾡࡜デ᩿⬟ࡢᶆ‽໬࡞ࡽࡧ࡟ࡑࡢྥୖࠊ⢭ᗘ⟶⌮ࡢ▱㆑ࡢ☜ㄆࡸ᭦᪂ࢆᅗࡿᶵ఍ࢆᥦ౪ࡍࡿࠋࡍ࡭࡚ࡢᢸ
ᙜ་ࡣࠊ◊ಟ఍࡟ฟᖍࡋࢫ࢟ࣝ࢔ࢵࣉࢆᅗࡿࡼ࠺ດࡵࡿࠋ
3㸧᳨ᰝ⏬ീࡢᥦฟෆど㙾᳨ᰝ་ࡣㄞᙳጤဨ఍࡟グ㘓⏬ീࢆᥦฟࡋࠊㄞᙳጤဨ఍࡟ࡼࡾ᭱⤊ุᐃ⤖ᯝࡀ☜ᐃࡍࡿࠋࢲࣈࣝࢳ࢙ࢵࢡ࡟ࡣグ㘓ࡉࢀࡓ඲⏬ീࡢᥦฟࡀᚲせ࡛࠶ࡾࠊ᳨ᰝ་ࡀ㑅ᢥࡋࡓ୍㒊ࡢ⏬ീ࡛ࡣ㐺ษ࡞デ᩿ࡣ⾜࠼࡞࠸ࠋෆど㙾᳨ᰝ᫬࡟ࡣㄆ㆑࡛ࡁ࡞࠿ࡗࡓ⑓ኚࢆᣠ࠸ୖࡆࡿࡓࡵ࡟ࡣࠊ඲⏬ീࢆࢲࣈࣝࢳ࢙ࢵࢡࡋࠊṇࡋ࠸デ᩿ࢆ☜ᐃࡍ࡭ࡁ࡛࠶ࡿࠋࡓࡔࡋࠊෆど㙾⏬ീࡣಶே᝟ሗ࡛࠶ࡿࡓࡵࠊ̿  ̿

ㄞᙳጤဨ఍࡟ᥦฟࡉࢀࡿ㛵ಀ㈨ᩱࡢ㐺ษ࡞ྲྀᢅ࠸࡟ດࡵࡿࠋ࡞࠾ࠊಶே᝟ሗࡢྲྀᢅ࠸ࡣࠊ㺀་⒪࣭
௓ㆤ㛵ಀ஦ᴗ⪅࡟࠾ࡅࡿಶே᝟ሗࡢ㐺ษ࡞ྲྀᢅ࠸ࡢࡓࡵࡢ࢞࢖ࢻࣛ࢖ࣥ㺁4)ࢆཧ↷ࡍࡿࠋ㏆ᖺࡣࠊෆど㙾ࣉࣟࢭࢵࢧ࣮࠿ࡽ┤᥋ࠊ࠶ࡿ࠸ࡣࢥࣥࣂ࣮ࢱ࣮࡛㌿᥮ᚋ࡟グ㘓࣓ࢹ࢕࢔࡟ࢥࣆ
࣮ࡋ࡚ㄞᙳጤဨ఍࡟ᥦฟࡍࡿࡇ࡜ࡀ࡛ࡁࡿࠋࡲࡓࠊ᭱㏆࡛ࡣ࢙࢘ࣈ࡛㏦ࡿ㟁㏦ࢩࢫࢸ࣒ࡶ㛤Ⓨࡀ㐍ࢇ࡛࠸ࡿ ᅗ 1㸧ࠋᅗ 1. ᳨デෆど㙾⏬ീࡢ᧜ᙳ࡜ㄞᙳጤဨ఍࡬ࡢ⏬ീᥦฟ

4㸧⏬ീⅬ᳨
⑓ኚࢆṇࡋࡃᣠ࠸ୖࡆࡿࡓࡵࠊ⫶ෆど㙾᳨デ࡛ࡣ⥙⨶ᛶࡢ㧗࠸⏬ീࡀせồࡉࢀࡿࠋࡑࡢࡓࡵࠊ
ㄞᙳጤဨ఍ࡣࠊ᳨ᰝ་ࡢᢏ㔞ࢆᨵၿࡍࡿࡓࡵ࡟ࡶࠊ⏬ീ࡟ࡘ࠸࡚ᐃᮇⓗ࡞Ⅼ᳨ㄪᰝࢆ⾜࠺࡭ࡁ࡛࠶ࡿࠋࢲࣈࣝࢳ࢙ࢵࢡ࡜ࡣ␗࡞ࡾࠊ඲౛඲ࢥ࣐ࡢ⏬ീⅬ᳨ࢆせồࡍࡿࡶࡢ࡛ࡣ࡞࠸ࠋ
⏬ീⅬ᳨࡛ࡣࠊ⏬ീࡢ⥙⨶ᛶࠊ⏬ീࡢ᮲௳ࠊෆど㙾᧯స࡟ࡼࡿ≀⌮ⓗ⢓⭷ᦆയࡢ⛬ᗘࠊ✵Ẽ㔞ࠊ⏬ീࡢࢥ࣐ᩘࠊ๓ฎ⨨࡞࡝ࢆホ౯ࡍࡿ ⾲ 1㸧ࠋ๓ฎ⨨ࡀ୙༑ศ࡛࠶ࡗࡓࡾࠊෆど㙾᧯స࡟ࡼࡿ≀⌮ⓗ⢓⭷ᦆയࡀ኱ࡁ࠿ࡗࡓሙྜࡶࠊほᐹࢆ㜼ᐖࡍࡿせᅉ࡜࡞ࡿࠋ⏬ീࡢࢥ࣐ᩘࡀከ࠸࡟ࡶ࠿࠿ࢃࡽࡎࠊ⥙⨶ⓗ࡞᧜ᙳࡀ⾜ࢃࢀ࡚࠸࡞࠸ሙྜࡣࠊほᐹࡀ୙༑ศ࡜ุ᩿ࡉࢀࡿࠋࡲࡓࠊ⏕᳨ࢆ⾜ࡗࡓሙྜࡣࠊ⏕᳨ࡢጇᙜᛶࢆホ౯ࡍࡿࠋ⏕᳨ᚋࡢฟ⾑࡟ࡼࡿཷデ⪅ࡢ୙฼┈࡟㓄៖ࡋࠊ⏕᳨ࡣ᭱ᑠ㝈࡟␃ࡵࡿ࡭ࡁ࡛࠶ࡿࠋ
⏬ീⅬ᳨ࡢホ౯⤖ᯝ ⾲ 1 ࡣࠊྛ᳨デᶵ㛵࡟ࣇ࢕࣮ࢻࣂࢵࢡࡍࡿࠋࣇ࢕࣮ࢻࣂࢵࢡࡢ᪉ἲ࡟ࡘ࠸
࡚ࡣࠊྛᕷ⏫ᮧࡢ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࡢ᪉㔪࡟ᚑ࠺ࠋྛ᳨デᶵ㛵ࡣࠊホ౯࡛ᣦ᦬ࡉࢀ
ࡓⅬ࡟ࡘ࠸࡚ࡢᨵၿ࡟ດࡵࡿࠋ⏬ീⅬ᳨࡛ࡣࠊᣦ᦬ࡉࢀࡓⅬ࡟ࡘ࠸࡚ᨵၿࡀࡳࡽࢀ࡚࠸ࡿ࠿ྰ࠿
ࢆᐃᮇⓗ࡟ホ౯ࡋࠊᨵၿࡀࡳࡽࢀ࡞࠸ሙྜ࡟ࡣࠊ⧞ࡾ㏉ࡋຓゝࡍࡿࠋཧ⪃ᩥ⊩
1㸧 ⊦⫤ⰾᩥ㸪ຍ⸨຾❶㸪ᓥ⏣๛ᘏ㸪௚㸬ഇ㝜ᛶ⋡࠿ࡽぢࡓෆど㙾᳨ᰝࡢ⢭ᗘ⟶⌮ࡢၥ㢟Ⅼ࠾ࡼࡧᑐ⟇࡟ࡘ࠸࡚ࡢ᳨ウ㸬᪥ᾘࡀࢇ᳨デㄅ 2009; 47:542–551.
2㸧 ᑠ㉺࿴ᰤ㸪ᡂ⃝ᯘኴ㑻㸪ຍ⸨ಇᖾ㸪௚㸬᪂₲ᕷఫẸ࡟ᑐࡍࡿ⫶ࡀࢇෆど㙾᳨デ㸬ENDOSCOPIC
FORUM for digestive disease 2010; 26:5–16.

̿  ̿

3㸧 ኱㔝೺ḟ㸪㧗␊୍㑻㸪すᮧඖ୍㸪௚㸬ከ᪋タ⫶ෆど㙾᳨デ࡟࠾ࡅࡿ㔠ἑᕷ᪉ᘧ 3 ḟࣞࣇ࣮ࣜㄞᙳ ࡢ᳨ウ̿ࢲࣈࣝࢳ࢙ࢵࢡࡢ⢭ᗘ⟶⌮࡟ࡘ࠸࡚㸬᪥ᾘࡀࢇ᳨デㄅ 2014; 52(6):715–722.
4㸧 ཌ⏕ປാ┬㸬་⒪࣭௓ㆤ㛵ಀ஦ᴗ⪅࡟࠾ࡅࡿಶே᝟ሗࡢ㐺ษ࡞ྲྀᢅ࠸ࡢࡓࡵࡢ࢞࢖ࢻࣛ࢖ࣥ㸬ᖹᡂ 16 ᖺ 12 ᭶ 24 ᪥௜ࡅ་ᨻⓎ➨ 1224001 ྕ࣭⸆㣗Ⓨ➨ 1224002 ྕ࣭⪁Ⓨ➨ 1224002 ྕཌ⏕ປാ┬་ᨻᒁ㛗࣭་⸆㣗ရᒁ㛗࣭⪁೺ᒁ㛗㏻▱ูῧ㸬2004㸬̿  ̿⾲ 1. ⏬ീⅬ᳨⚊㸦౛㸧᪋タྡ          ་㝔࣭デ⒪ᡤ࣭⑓㝔 ᚚ୰     ᖹᡂ ᖺ ᭶ ᪥⫶ࡀࢇ᳨デ ෆど㙾⏬ീホ౯㸯㸬⏬ീࡢ⥙⨶ᛶ ‫‶ڧ‬㊊ࡋ࠺ࡿ‫ڧ‬ከᑡᨵၿࡢవᆅ࠶ࡾ‫ࡾ࡞࠿ڧ‬ᨵၿࡢవᆅ࠶ࡾ‫ڧ‬኱ᖜ࡟ᨵၿࡢᚲせ࠶ࡾ  㸯㸫㸰㸬ᨵၿࢆせࡍࡿ㒊఩㸦ࠕ‶㊊ࡋ࠺ࡿࠖ௨እࡢ᫬࡟ࢳ࢙ࢵࢡ㸧    ‫ڧ‬㣗㐨    ‫ڧ‬ᄇ㛛㒊    ‫❞✴ڧ‬㒊    ‫⫶ڧ‬యୖ㒊 э ‫ڧ‬๓ቨ‫ڧ‬ᚋቨ‫ڧ‬ᑠᙙ‫ڧ‬኱ᙙ    ‫⫶ڧ‬య୰㒊 э ‫ڧ‬๓ቨ‫ڧ‬ᚋቨ‫ڧ‬ᑠᙙ‫ڧ‬኱ᙙ    ‫⫶ڧ‬యୗ㒊 э ‫ڧ‬๓ቨ‫ڧ‬ᚋቨ‫ڧ‬ᑠᙙ‫ڧ‬኱ᙙ    ‫⫶ڧ‬ゅ㒊  э ‫ڧ‬๓ቨ‫ڧ‬ᚋቨ‫ڧ‬ᑠᙙ‫ڧ‬኱ᙙ    ‫ڧ‬๓ᗞ㒊  э ‫ڧ‬๓ቨ‫ڧ‬ᚋቨ‫ڧ‬ᑠᙙ‫ڧ‬኱ᙙ    ‫ڧ‬ᗃ㛛㍯    ‫⌫ڧ‬㒊   ^‫ڧ‬༑஧ᣦ⭠ୗ㝆㒊㸦⬮㸧`㸸ほᐹࡣᚲ㡲࡛ࡣ࡞࠸

㸰㸬⏬ീࡢ᮲௳ ‫‶ڧ‬㊊ࡋ࠺ࡿ ‫ڧ‬ከᑡᨵၿࡢవᆅ࠶ࡾ ‫ࡾ࡞࠿ڧ‬ᨵၿࡢవᆅ࠶ࡾ ‫ڧ‬኱ᖜ࡟ᨵၿࡢᚲせ࠶ࡾ  㸰㸫㸰㸬ᨵၿࢆせࡍࡿⅬ㸦ࠕ‶㊊ࡋ࠺ࡿࠖ௨እࡢ᫬࡟ࢳ࢙ࢵࢡ㸧    ‫Ⰽڧ‬ㄪ        э ‫ڧ‬㉥ࡳࡀᙉ࠸ ‫ڧ‬㯤Ⰽࡳࡀᙉ࠸  ‫ڧ‬㟷ࡳࡀᙉ࠸    ‫ڧ‬㟢ฟ     э ‫࣮ࣂ࣮࢜ڧ‬Ẽ࿡ࠊ‫࣮ࢲࣥ࢔ڧ‬Ẽ࿡    ‫ࢬࣥࣞڧ‬㠃ࡢࡢࡗ࠿ࡾ э ‫ڧࡘ❧┠ڧ‬ከᑡ┠❧ࡘ    ‫ ࢀࡎࡢࢺࣥࣆ࣭ࢀࡪڧ‬э ‫ڧࡘ❧┠ڧ‬ከᑡ┠❧ࡘ㸱㸬ෆど㙾᧯స࡟ࡼࡿ≀⌮ⓗ⢓⭷ᦆയࡢ⛬ᗘ ‫‶ڧ‬㊊ࡋ࠺ࡿࠊ‫ڧ‬ከᑡᨵၿࡢవᆅ࠶ࡾࠊ‫ࡾ࡞࠿ڧ‬ᨵၿࡢవᆅ࠶ࡾࠊ‫ڧ‬኱ᖜ࡟ᨵၿࡢᚲせ࠶ࡾ  㸱㸫㸰㸬ᨵၿࢆせࡍࡿⅬ㸦ࠕ‶㊊ࡋ࠺ࡿࠖ௨እࡢ᫬࡟ࢳ࢙ࢵࢡ㸧    ‫ڧ‬ෆど㙾ࡢ᥋ゐࡸ྾ᘬ࡟ࡼࡿฟ⾑࣭Ⓨ㉥࡞࡝ࡢኚ໬ э ‫ڧࡘ❧┠ڧ‬ከᑡ┠❧ࡘ㸲㸬✵Ẽ㔞 ‫ڧ  ࠸Ⰻ࡝࠺ࡻࡕڧ‬ከ࠸‫ڧ‬ከᑡᑡ࡞࠸  ‫ࡾ࡞࠿ڧ‬ᑡ࡞࠸  㸳㸬⏬ീࡢࢥ࣐ᩘ ‫ࡾ࡞࠿ڧ  ࠸Ⰻ࡝࠺ࡻࡕڧ‬ከ࠸‫ڧ‬ከᑡከ࠸‫ڧ‬ከᑡᑡ࡞࠸

㸴㸬๓ฎ⨨ ‫‶ڧ‬㊊ࡋ࠺ࡿ‫ڧ‬ከᑡᨵၿࡢవᆅ࠶ࡾ‫ࡾ࡞࠿ڧ‬ᨵၿࡢవᆅ࠶ࡾ‫ڧ‬኱ᖜ࡟ᨵၿࡢᚲせ࠶ࡾ  㸴㸫㸰㸬ᨵၿࢆせࡍࡿⅬ㸦ࠕ‶㊊ࡋ࠺ࡿࠖ௨እࡢ᫬࡟ࢳ࢙ࢵࢡ㸧    ‫ڧ‬⢓ᾮ࣭ෆ᭹⸆࡞࡝ࡢ⢓⭷࡬ࡢ௜╔  э ‫ڧࡘ❧┠ڧ‬ከᑡ┠❧ࡘ    ‫ڧ‬㣗≀ṧ´             э ‫ڧࡘ❧┠ڧ‬ከᑡ┠❧ࡘ㸵㸬ࡑࡢ௚㸦ࡑࡢ௚ࡢẼ࡙࠸ࡓⅬࢆグධ㸧⥲ྜホ౯㸸‫‶ڧ‬㊊ࡋ࠺࠺ࡿ     ‫࠺ࡶڧ‬ᑡࡋᨵၿࡍࡿ࡜ࠕ‶㊊ࡋ࠺ࡿࠖᇦ࡟㐩ࡍࡿ     ‫ࡾ࡞࠿ڧ‬ᨵၿࡋ࡞࠸࡜ࠕ‶㊊ࡋ࠺ࡿࠖᇦ࡟㐩ࡋ࡞࠸     ‫」ڧ‬ᩘࡢጤဨ᳨࡛ウࡋࡓ⤖ᯝࠊୖグ⌮⏤࡛ࠊ᳨デ࡟㊊ࡿ⏬ീ࡛ࡣ࡞࠸࡜ࡢ⤖ㄽ࡟㐩ࡍࡿ⥲ྜホ౯࡛ࠊ
ࠕ‶㊊ࡋ࠺ࡿࠖ௨እࡢホ౯ࢆཷࡅࡓ᳨ᰝ་ࡣࠊ୍ᗘࠊㄞᙳጤဨ఍࡟ࡼࡿࢲࣈࣝࢳ࢙ࢵࢡ
࡟ࡈฟᖍୗࡉ࠸ࠋࡑࡢሙ࡛ᨵၿ⟇ࢆࡈ┦ㄯ࡛ࡁࡲࡍࡋࠊ௚᪋タࡀ࡝ࡢࡼ࠺࡞⏬ീࢆ᧜ᙳࡋ࡚࠸ࡿࡢ࠿ࢆࡈぴ࠸ࡓࡔࡃࡇ࡜ࡶ㈗᪋タࡢᨵၿ࡟ࡘ࡞ࡀࡾࡲࡍࠋ                          ⫶ෆど㙾ㄞᙳጤဨ఍             㸦ᡂ⃝ᯘኴ㑻ࠊ⣽ᕝ἞ࠊ℈ᓥࡕࡉ࡜㸧̿  ̿



7. ⤖ᯝุᐃ ⫶ෆど㙾᳨デࡢ⤖ᯝࡣࠊ⏕᳨ࡢ᭷↓ࠊุᐃ 4 ẁ㝵 ࠊデ᩿ྡࢆᇶ‽࡜ࡍࡿࠋデ᩿ྡࡣᚲ㡲࡛ࡣ࡞ࡃࠊᚲせ࡟ᛂࡌ࡚グ㍕ࡍࡿࠋ⫶ෆど㙾᳨デࡢุᐃࡣࠊㄞᙳጤဨ఍࡟ࡼࡿࢲࣈࣝࢳ࢙ࢵࢡࢆཎ๎࡜ࡍࡿࠋ⏕᳨ࡢ᭷↓௨እࡣෆど㙾᳨ᰝ་࡜ㄞᙳጤဨ఍ࡢุᐃ⤖ᯝࡀ␗࡞ࡿሙྜࡶ࠶ࡾ࠺ࡿࡀࠊࢲࣈࣝࢳ࢙ࢵࢡࡢุᐃ⤖ᯝࢆ᭱⤊ุᐃ࡜ࡍࡿ ⾲ 1 ࠋ1㸧⏕᳨ ⫶ෆど㙾᳨ᰝ᪋⾜᫬ࡢ⏕᳨ࡢ᭷↓ࢆグ㍕ࡍࡿࠋ
2㸧ุᐃᇶ‽ 㺀⫶ࡀࢇ࡞ࡋ㺁㺀⫶ࡀࢇ␲࠸㺁㺀⫶ࡀࢇ࠶ࡾ㺁㺀⫶ࡀࢇ௨እࡢᝏᛶ⑓ኚ㺁ࡢ 4 ẁ㝵࡛࠶ࡿࠋ⫶₽⒆࡞࡝
᫂ࡽ࠿࡞Ⰻᛶ⑓ኚࡣ㺀⫶ࡀࢇ࡞ࡋ㺁ࠊᝏᛶ⑓ኚ࡛࠶ࡗ࡚ࡶ⫶ࡀࢇ࡜ࡣ㆑ูࡋ㺀⫶ࡀࢇ௨እࡢᝏᛶ⑓
ኚ㺁࡜ࡍࡿࠋ
3㸧デ᩿ྡ
 デ᩿ྡࡣᚲせ࡟ᛂࡌ࡚グ㍕ࡍࡿࠋ≉࡟ࠊ㺀⫶ࡀࢇ࡞ࡋ㺁ࡢሙྜ࡟ࡣࠊ⫶༑஧ᣦ⭠₽⒆࡞࡝ࡢⰋᛶ
⑓ኚ࡜ࡋ࡚἞⒪࠶ࡿ࠸ࡣ⤒㐣ほᐹࡀᚲせ࡞⑓ኚࠊ㺀⫶ࡀࢇ௨እࡢᝏᛶ⑓ኚ㺁࡜ࡋ࡚ࡣࠊ㣗㐨ࡀࢇࠊᝏᛶࣜࣥࣃ⭘࡞࡝ࡀ࠶ࡾ࠺ࡿࠋ⫶ࡀࢇࡀ࡞࠸ሙྜ࡛ࡶࠊ἞⒪ࢆせࡍࡿሙྜ࡟ࡣ㐺ษ࡞ཷデࢆಁࡍ
ᚲせࡀ࠶ࡿࡇ࡜࠿ࡽࠊデ᩿ྡࢆせࡍࡿሙྜࡀ࠶ࡿࠋ἞⒪᪉ἲࡣ⑌ᝈ࡟ࡼࡾ␗࡞ࡿࡇ࡜࠿ࡽࠊ஦ᚋ
ᣦᑟ࡜ࡋ࡚㐺ษ࡞ㄝ᫂ࡀᚲせ࡜࡞ࡿࠋ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁデ᩿ࡣࠊ௒ᚋࡢㄢ㢟࡜ࡋࠊᆅᇦࡢ≧ἣ࡟ᛂࡌ࡚グ㍕ࢆ㏣ຍࡋ࡚ࡶ
ࡼ࠸ࠋ࡞࠾ࠊ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁデ᩿ࡢෆど㙾ᡤぢ࡟ࡘ࠸࡚ࡣࠊᚋ㏙グ㍕ࢆཧ↷ࡍࡿ P.88–
93 ࠋ
4㸧෌᳨ᰝࡢᚲせᛶ ㄞᙳጤဨ఍ࡣࠊ᳨ᰝ་࠿ࡽᥦฟࡉࢀࡓ⏬ീࡢࢲࣈࣝࢳ࢙ࢵࢡࢆ⾜࠸ࠊ᳨ᰝ་ࡢデ᩿ࡸ⏕᳨ࡢጇᙜᛶࢆ᳨ドࡍࡿࠋࢲࣈࣝࢳ࢙ࢵࢡࡢ㝿ࠊ᪂ࡓ࡟㺀⫶ࡀࢇ␲࠸㺁ࡢ⑓ኚࢆㄆࡵࡓሙྜ࡟ࡣ㺀෌᳨ᰝࡢᚲ
せᛶ࠶ࡾ㺁࡜ุ᩿ࡍࡿࠋ               ̿  ̿

⾲ 1. ⫶ෆど㙾᳨デ⤖ᯝุᐃ⚊ 㸦౛㸧Ặ ྡ ⏨ ࣭ ዪ

᳨デ᪥

⏕ᖺ᭶᪥
㸦ᖺ㱋㸧

኱ṇ ᫛࿴    ᖺ  ᭶  ᪥⏕㸦    ṓ㸧ᖺ   ᭶   ᪥᪉ ἲ

‫⤒ڧ   ཱྀ⤒ڧ‬㰯ෆど㙾᳨ᰝ་
⑓ኚ㒊఩  㣗㐨      ⫶       ༑஧ᣦ⭠㸦⑓ኚ㒊఩ࠊᡤぢࠊ⏕᳨㒊఩࡞࡝㸧
 




⑓ኚ㒊఩  㣗㐨      ⫶       ༑஧ᣦ⭠㸦⑓ኚ㒊఩ࠊᡤぢࠊ⏕᳨㒊఩࡞࡝㸧
 




⏕ ᳨

 ࠶ࡾ     ࡞ࡋ

ุ ᐃ
デ᩿ྡ
㐺ᐅグ㍕ 

⫶ࡀࢇ࡞ࡋ⫶ࡀࢇ␲࠸⫶ࡀࢇ࠶ࡾ⫶ࡀࢇ௨እࡢᝏᛶ⑓ኚ ㄞᙳጤဨ఍
㏣ຍ⑓ኚ㸸㒊఩ࠊᡤぢ࡞࡝㸧
 




ุ ᐃ
デ᩿ྡ
㐺ᐅグ㍕ 
෌᳨ᰝࡢᚲせᛶ⫶ࡀࢇ࡞ࡋ⫶ࡀࢇ␲࠸⫶ࡀࢇ࠶ࡾ⫶ࡀࢇ௨እࡢᝏᛶ⑓ኚ ࠶ࡾ࡞ࡋ

㸦℈ᓥࡕࡉ࡜㸧̿  ̿

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8. ᳨デࢹ࣮ࢱ࣮࣋ࢫ
1㸧᳨デࢹ࣮ࢱࡢ⟶⌮㸦1㸧⫶ෆど㙾᳨ᰝ⫶ෆど㙾᳨ᰝࡢグ㘓 㟁Ꮚ፹య࡞࡝ ཬࡧ⏕᳨ࡢグ㘓ࠊ෌᳨ᰝ౫㢗᭩ࢥࣆ࣮ࡣࠊཎ๎ⓗ࡟⫶ෆど㙾᳨デᐇ᪋ࡢ་⒪ᶵ㛵࡛ಖ⟶ࡍࡿࠋ≉࡟ࠊ⏕᳨ࡣ་⒪ಖ㝤ࡢ㐺⏝࡜࡞ࡿࡇ࡜࠿ࡽࠊデ⒪グ㘓࡟‽ࡌ 5 ᖺ㛫ࡢಖ⟶ࡀᚲせ࡛࠶ࡿࠋࡑࡢ௚ࠊၥデ⚊ࠊྠព᭩ࠊ⤖ᯝุᐃ⚊ࠊᡭ⾡⤖ᯝ⚊ࡣࠊᕷ༊⏫ᮧ
࡛ 5 ᖺ㛫ಖ⟶ࡍࡿࠋ
㸦2㸧᳨デࢹ࣮ࢱ࣮࣋ࢫࡢᵓ⠏⫶ෆど㙾᳨デࡢᐇ᪋ᶵ㛵࡜࡞ࡿ་ᖌ఍࠶ࡿ࠸ࡣ᳨デᶵ㛵ࡣࠊചୗࡢ་⒪ᶵ㛵࡟࠾ࡅࡿ⫶ෆど㙾᳨デࡢᐇ᪋≧ἣࢆᢕᥱࡍࡿ࡜࡜ࡶ࡟ࠊࡑࡢᚋࡢ㏣㊧ㄪᰝࢆ⾜࠺ࡇ࡜ࡀᮃࡲࡋ࠸ࠋ⫶ෆど㙾᳨デᐇ᪋་⒪ᶵ㛵ࡣࠊࢲࣈࣝࢳ࢙ࢵࢡ᪋⾜᫬࡟ࠊ᳨ᰝ⏬ീ 㟁Ꮚ፹య࡞࡝ ࡜࡜ࡶ࡟ࠊ
ุᐃ⚊ P.42 ཧ↷ ࢆᥦฟࡍࡿࠋ
ᐇ᪋୺య࡛࠶ࡿᕷ༊⏫ᮧࡣ᳨デࢹ࣮ࢱ࣮࣋ࢫࢆసᡂࠊ⟶⌮ࡍࡿ ⾲ 1 ࠋ༢ᖺᗘࡈ࡜࡟సᡂࡍࡿሙ
ྜ࡜ಶே༢఩ࡢ⤒ᖺⓗ࡞ࢹ࣮ࢱ࣮࣋ࢫࢆసᡂࡍࡿሙྜࡀ࠶ࡿࠋ⥅⥆ⓗ࡞ཷデ່ዡࡸ㐣ཤࡢཷデ⤖ᯝࢆཧ↷࡛ࡁࡿ࡞࡝ࡢほⅬ࠿ࡽࠊಶே༢఩࡛⤒ᖺⓗ࡞ࢹ࣮ࢱ࣮࣋ࢫࢆసᡂࡍࡿࡇ࡜ࡀᮃࡲࡋ࠸ࠋ
ࢹ࣮ࢱ࣮࣋ࢫࡢసᡂࡣྎᖒࠊ㟁Ꮚ፹యࡢ࠸ࡎࢀ࡛ࡶࡼ࠸ࠋࢹ࣮ࢱ࣮࣋ࢫࢆ᏶ᡂࡉࡏࡿࡓࡵ࡟ࠊ㏣㊧ㄪᰝ࡟ࡼࡾ⢭᳨ཷデ⪅ᩘࠊⓎぢࡀࢇᩘࢆᢕᥱࡍࡿࠋ
 ⾲ 1. ᳨デࢹ࣮ࢱ࣮࣋ࢫ㸦౛㸧
ಶே␒ྕ

Ặ ྡ

ᛶู

ఫᡤ

᳨デཷデ᪥⏕᳨ࡢ᭷↓

*URXS࠶ࡾ   *URXS
  
 

 

 

 

 

*URXS࡞ࡋ*URXS
*URXS




㸿㔝㹀Ꮚ

ዪ

୰ኸ༊⠏ᆅ




࡞ࡋ

̿

 㹁஭㹂ኴ㑻 ⏨୰ኸ༊㖟ᗙ




࠶ࡾ 

*URXS

㻌㻌

㻌㻌

㻌㻌

㻌㻌

㻌㻌

㻌㻌

᳨ᰝ་
ุᐃ

ㄞᙳጤဨ఍
ุᐃ⫶ࡀࢇ࡞ࡋ
⫶ࡀࢇ␲࠸
⫶ࡀࢇ࠶ࡾ
⫶ࡀࢇ௨እࡢ
ᝏᛶ⑓ኚ⫶ࡀࢇ࡞ࡋ
⫶ࡀࢇ␲࠸ ෌᳨ᰝ࠶ࡾ
⫶ࡀࢇ࠶ࡾ
෌᳨ᰝ࡞ࡋ
⫶ࡀࢇ௨እࡢ
ᝏᛶ⑓ኚ

⑓⌮デ᩿

㻌

⢭᳨ཷデ

᭱⤊デ᩿

࠶ࡾ      ࡞ࡋ⫶ࡀࢇ࡞ࡋ  ⫶ࡀࢇ࡞ࡋ  ࡞ࡋ

࡞ࡋ

 

⫶ࡀࢇ࡞ࡋ

⫶ࡀࢇ␲࠸

࠶ࡾ 

࠶ࡾ 

⫶ࡀࢇ

㻌㻌

㻌㻌

㻌

㻌㻌

㻌㻌

2㸧㏣㊧ㄪᰝ⫶ෆど㙾᳨デ࡛ࡣࠊ ≉࡟ ⢭᳨ཷデ⪅ᩘࠊ Ⓨぢࡀࢇᩘ࡟ࡘ࠸࡚ࡣ⥅⥆ⓗ࡞ㄪᰝࡀᚲせ࡜࡞ࡿ ࠋ㏣㊧ㄪᰝࡢ᪉ἲࡣࠊᐇ᪋୺యࡢཧຍ࡜࡞ࡿ་⒪ᶵ㛵࡬ࡢᜳⓙㄪᰝࠊཷデ⪅ಶே࡬ࡢ࢔ࣥࢣ࣮ࢺㄪᰝࠊ
ࡀࢇⓏ㘓࡜ࡢ↷ྜࡀ࠶ࡿࠋࢹ࣮ࢱࡢᤕᤊࢆ 100%࡜ࡍࡿࡇ࡜ࡣᅔ㞴࡛࠶ࡿࡀࠊ࡛ࡁࡿ㝈ࡾ᝟ሗࢆ཰
㞟ࡍࡿࡼ࠺࡟ດࡵࡿࠋ
Ⓨぢ⫶ࡀࢇ࡟㛵ࡍࡿ᝟ሗ デ᩿᪥ࠊ἞⒪᪉ἲࠊ㐍⾜ᗘࠊ⑓⌮࡞࡝ ࡢヲ⣽᝟ሗࢆ⥅⥆ⓗ࡟཰㞟ࡍࡿࡇ࡜ࡀᮃࡲࡋ࠸ࠋ෌᳨ᰝ࡞࡝ู་⒪ᶵ㛵࡬ࡢ෌᳨ᰝ౫㢗᭩ව⤖ᯝ㏻▱᭩ ⾲ 2 ࡜ࠊ⫶ᡭ⾡⤖ᯝ⚊
⾲ 3 ࡢ౛ࢆ♧ࡋࡓࠋ̿  ̿

⾲ 2. ෌᳨ᰝ౫㢗᭩ව⤖ᯝ㏻▱᭩ 㸦౛㸧                              ෌᳨ᰝ౫㢗᭩ ව ⤖ᯝ㏻▱᭩ᖹᡂ  ᖺ  ᭶  ᪥㹝㹝㹝㹝㹝㹝㹝㹝㹝㹝㹝㹝㹝㹝㹝㹝⑓㝔ᚚ୰ᐇ᪋ᶵ㛵ྡ㸸
ᢸᙜ་ᖌྡ㸸
ᮏ᭩ᣢཧࡢ᪉ࡣࠊㄞᙳጤဨ఍࡟ࡼࡿࢲࣈࣝࢳ࢙ࢵࢡࡢ⤖ᯝࠊ෌᳨ᰝࡀᚲせ࡜ุ᩿⮴ࡋࡲࡋࡓࠋ
ࡈከᛁ୰࡜ࡣᏑࡌࡲࡍࡀࠊࡈ⢭ᰝࡃࡔࡉࡿࡼ࠺࠾㢪࠸⏦ࡋୖࡆࡲࡍࠋ

ࣇࣜ࢞ࢼ

ᛶู
⏨࣭ዪ

Ặ ྡ

⏕ᖺ᭶᪥

᫂
኱ 
᫛

ᖺ

᭶  ᪥㸦  㸧

㟁ヰ␒ྕ

ఫ ᡤ

ᖺ   ᭶  ᪥

᳨デᖺ᭶᪥

ᡤ ぢ

㸦ኴᯟࡢḍࡣ୺἞་ࡀࡈグධࡃࡔࡉ࠸ࠋ
㸧෌᳨ᰝᖺ᭶᪥    ᖺ  ᭶  ᪥



デ ᩿

ෆ
ど
㙾
᳨
ᰝ
࣭
⏕
᳨
⤌⧊デ᩿ศ㢮
Group㸦 1,

ุ ᐃ

2, 3,

4,

5 㸧

1㸬⫶ࡀࢇ࡞ࡋ

2㸬⫶ࡀࢇ␲࠸̿  ̿

3㸬⫶ࡀࢇ࠶ࡾ



4㸬⫶ࡀࢇ௨እࡢᝏᛶ⑓ኚ

⾲ 3. ⫶ᡭ⾡⤖ᯝ⚊ 㸦౛㸧⫶ ᡭ ⾡ ⤖ ᯝ ⚊
ࣇࣜ࢞ࢼ



Ặ ྡ



⏨࣭ዪ

᫂

⏕ᖺ᭶᪥

኱   ᖺ   ᭶   ᪥⏕ 㸦   ṓ㸧

᫛ 

ఫ ᡤ

ࠛ

⑓㝔ᝈ⪅␒ྕ㹝㹝㹝㹝㹝㹝㹝㹝㹝㹝㹝㹝     グ
἞ ⒪ 㛤 ጞ ᪥ᖹᡂ἞‫ ࡋ࡞ ׻‬ձ እ⛉ⓗᡭ⾡㹙 ࢔ ⭡⭍㙾 ࢖ 㛤⭡ ࢘ 㛤⬚࣭㛤⭡ ࢚ ࡑࡢ௚ 㹛ղ ෆど㙾ⓗ⢓⭷ษ㝖㹙 ࢔ EMR  ࢖ ESD  ࢘ ࡑࡢ௚        㹛ճ ᨺᑕ⥺⒪ἲ մ ໬Ꮫ⒪ἲ յ ච␿⒪ἲ ն ࡑࡢ௚ࡢ἞⒪㸦      㸧

⒪

ෆ

ᐜ

ᡭ⾡ᖺ᭶᪥
⾡

ᖺ

᭶

᪥㸦἞⒪࡞ࡋࡢሙྜࡣデ᩿᪥㸸ᖹᡂᘧ⫗║ุᐃ᫬ᮇձ ⮫ᗋᡤぢ   ղ ᡭ⾡ᡤぢ   ճ ⥲ྜᡤぢ
㸮ᆺ

༨ᣐ㒊఩

ձ I  ղ II a  ճ II a㸩II c  մ II b  յ II c  ն II c㸩IIIշ II c㸩II a  ո III㸩II c  չ III  պ ࡑࡢ௚  ջ ୙᫂

1㹼5 ᆺ ձ 1 ᆺ  ղ 2 ᆺ  ճ 3 ᆺ  մ 4 ᆺ  յ 5 ᆺ  ն ୙᫂a. ձ U ղ U M ճ M U մ M յ M L ն L M շ L ո ඲యչ 㸩E
պ 㸩D ջ ୙᫂b. ձ ๓ቨ

ղ ᚋቨ

ճ ኱ᙙ

մ ᑠᙙ

⫗

᭱኱ᚄ

║

ࡀࢇ⑓ᕢᩘ

ձ 1 ಶ   ղ ከⓎ     

ಶ

ⓗ

ቨ῝㐩ᗘ

ձ T 1a M
յ T 4a S E

ճ T2 MPշ TX

ᡤࣜࣥࣃ⠇㌿⛣‫ ׻‬N0

ձ N1

ղ N2

⫢㌿⛣

‫ ׻‬H0

ձ H1

ղ HX

⭡⭷㌿⛣

‫ ׻‬P0

ձ P1

ղ PX

⭡⭍⣽⬊デ

‫ ׻‬CY 0

ձ CY 1ղ CY X㐲㝸㌿⛣‫ ׻‬M0

ձ M1

ղ MX

ཱྀഃ᩿➃

‫ ׻‬PM 㸫ձ PM 㸩

ղ P MX⫠㛛ഃ᩿➃‫ ׻‬DM 㸫ձ DM 㸩

ղ D MX

㐍⾜ᗘ

ձ IA

ղ IB

ճ II A

մII B⭘⒆ࡢ㑇ṧ㸦R㸧 ձ R 0

ղ R1

ճ R2

մ RX

ձ       

ղ T 1b S M
ն T 4b S I

ճ N3

մ T3 SSյ III Aո IV

չ୙᫂

ղ T 1b S M 㹙 ࢔ S M1 ࢖ S M2 㹛  ճ T 2 M P ն T 4b S I
շ TX

մ T3 SSձ T 1a M
յ T 4a S E

ࣜࣥࣃ⠇㌿⛣‫ ׻‬N0

ձ N1

ղ N2

ճ N3

մ NX

㐍⾜ᗘ

ձ IA

ղ IB

ճ II A

մII B

յ III A⭘⒆ࡢ㑇ṧ㸦R㸧 ձ R 0

ղ R1

ճ R2

᭱

⤊

⤌⧊ᆺ

ն ୙᫂

մ NX

ቨ῝㐩ᗘ

ձ pap
շ muc

յ ඲࿘

ੈ  ղ ୙᫂

⑓
⌮
⤌
⧊
Ꮫ
ⓗ
ᡤ
ぢ

ղ tub1ո ≉Ṧᆺն III Bն III Bշ III Cշ III Cո IV

մ RX
ճ tub2չ ୙᫂

մ por1᩿་ ⒪ ᶵ 㛵 ྡ㸦་ ᖌ ྡ㸧ഛ᪥㸧ձ ⫶ᒁᡤษ㝖⾡ ղ ⫶ศ⠇ษ㝖⾡ ճ ᄇ㛛ഃ⫶ษ㝖⾡ մ ᗃ㛛ಖᏑ⫶ษ㝖⾡յ ᗃ㛛ഃ⫶ษ㝖⾡ ն ⫶඲᦬⾡ շ ࡑࡢ௚ࡢษ㝖⾡ ո ࿀ྜ⾡ չ ༢㛤⭡⾡պ ⫶⒦࣭⭠⒦㐀タ⾡ ջ ࡑࡢ௚ࡢጡᜥᡭ⾡‫׻‬㹂0 ձ㹂1
ղ 㹂 2 ճ 㹂 3 մ 㒌Ύ࡞ࡋ ෆど㙾ⓗ἞⒪
յ ୙᫂

⫗║ศ㢮

デ

᭶

ᖹᡂ     ᖺ    ᭶    ᪥ࣜࣥࣃ⠇㒌Ύᗘぢᖺ⪃̿  ̿յ p o r 2

ն sig

չ୙᫂

9. ⢭ᗘ⟶⌮ᣦᶆࡢ⟬ฟ
1㸧ࣉࣟࢭࢫᣦᶆࡢ⟬ฟ⫶ෆど㙾᳨デࡢ⢭ᗘ⟶⌮ࢆ⾜࠺ࡓࡵ࡟ࡣࠊࣉࣟࢭࢫᣦᶆࡢ⟬ฟࡀᚲせ࡛࠶ࡿࠋࣉࣟࢭࢫᣦᶆ࡜
ࡣ⢭ᗘ⟶⌮ࡀ㐺ษ࡟⾜ࢃࢀ࡚࠸ࡿ࠿ࢆ☜ㄆࡍࡿࡓࡵࡢᣦᶆ࡛࠶ࡾࠊ1 ᖺ༢఩࡛⟬ฟࡍࡿࠋ⟬ฟࡍ࡭ࡁࣉࣟࢭࢫᣦᶆࡣࠊཷデ⋡ࠊࡀࢇⓎぢ⋡ࠊせ⢭᳨⋡ࠊ⢭᳨ཷデ⋡ࠊ㝧ᛶ཯ᛂ㐺୰ᗘ࡛࠶ࡿࠋ ࡑࢀࡒࢀࡢ⟬ฟ᪉ἲࢆ⾲ 1 ࡟♧ࡋࡓࠋ ⫶ෆど㙾᳨デࡣ 2 ᖺ࡟ 1 ᗘࡢཷデ࡛࠶ࡿࡇ࡜࠿ࡽࠊ ཷデ⋡⟬ฟ࡟ࡣ 2 ᖺ㛫ࡢཷデ⪅ᩘ࠿ࡽࠊ2 ᖺ㐃⥆ࡋ࡚ཷデࡋࡓ⪅ࢆ㝖እࡋ࡚⟬ฟࡍࡿࠋ⫶ෆど㙾᳨デ࡟࠾࠸࡚ࠊ㺀せ⢭᳨㺁࡜ุ᩿ࡉࢀࡿࡢࡣࠊ㺀⏕᳨࠶ࡾ㺁࡜㺀෌᳨ᰝ㺁࡛࠶ࡿࠋࡀࢇⓎぢ⋡ࡀప࠸ሙྜ࡟ࡣࠊ᳨デཷデ⪅ࡢ࠺ࡕ⫶ࡀࢇ⨯ᝈ⋡ࡢప࠸ዪᛶࡸⱝᖺ⪅ࡀከࡃྵࡲࢀ
࡚࠸ࡿྍ⬟ᛶࡸ⢭ᐦ᳨ᰝࡢ⤖ᯝࡀ༑ศ࡟ᢕᥱࡉࢀ࡚࠸࡞࠸ྍ⬟ᛶࡀ࠶ࡿࠋ୍᪉ࠊ㧗࠸ሙྜ࡟ࡣࠊ
ᮏ᮶ࡣデ⒪ࡢᑐ㇟࡜࡞ࡿ᭷⑕≧⪅ࡀྵࡲࢀ࡚࠸ࡿྍ⬟ᛶࡀ㧗࠸ࠋせ⢭᳨⋡ࡣࠊ୙ᚲせ࡞⏕᳨ࢆ㑊ࡅࡿࡓࡵ࡟ࡣ㧗ࡍࡂࡿࡢࡣᮃࡲࡋࡃ࡞࠸ࡀࠊపࡍࡂࡿሙྜࡣഇ㝜ᛶࡀ㧗ࡃ࡞ࡿࠋཷデ⋡ࠊ⢭᳨ཷデ⋡ࡣ㧗࠸࡯࡝ᮃࡲࡋ࠸ࠋ㝧ᛶ཯ᛂ㐺୰ᗘࡣᑐ㇟㞟ᅋࡢ᭷⑓⋡ࡢᙳ㡪ࢆཷࡅࡿࠋ
⾲ 1. ࣉࣟࢭࢫᣦᶆࡢ⟬ฟ  





















2㸧ឤᗘ࣭≉␗ᗘࡢ⟬ฟឤᗘ࣭≉␗ᗘࡣࠊ⫶ෆど㙾᳨デࡢ⢭ᗘࢆุ᩿ࡍࡿୖ࡛ࠊࣉࣟࢭࢫᣦᶆࡼࡾࡉࡽ࡟ཝᐦ࡞ᣦᶆ࡛
࠶ࡿࠋࡑࡢ⟬ฟ࡟ࡣࠊ୰㛫ᮇࡀࢇࡢᢕᥱࡀᚲせ࡜࡞ࡿࠋ୰㛫ᮇࡀࢇ࡜ࡣࠊ᳨デཷデ᫬࡟ࡀࢇ࡞ࡋ 㝜ᛶ ࡜ุ᩿ࡉࢀࠊḟᅇ᳨デࡲ࡛࡟デ᩿ࡉࢀࡓࡀࢇ࡜ᐃ⩏ࡉࢀࡿ 1)ࠋ≉࡟ࠊ୰㛫ᮇࡀࢇࡢᢕᥱ࡟ࡣ⣔⤫ⓗ࡞ㄪᰝࡀᚲせ࡜࡞ࡿࡇ࡜࠿ࡽࠊࡀࢇⓏ㘓࡜ࡢ↷ྜࢆ⾜࠺ࡇ࡜ࡀᮃࡲࡋ࠸ࠋ
ឤᗘࡣ㺀⫶ࡀࢇࡀ࠶ࡿ㺁࡜ṇࡋࡃデ᩿ࡉࢀࡿᣦᶆ࡛࠶ࡾࠊ≉␗ᗘࡣ㺀⫶ࡀࢇ࡞ࡋ㺁࡜ṇࡋࡃデ᩿ࡉࢀࡿᣦᶆ࡛࠶ࡿࠋ⟬ฟ᪉ἲࢆᅗ 1 ࡟♧ࡋࡓࠋឤᗘ࣭≉␗ᗘࡣ࡝ࡕࡽࡶ㧗࠸ࡇ࡜ࡀᮃࡲࡋ࠸ࡀࠊ୍᪉ࡀ㧗ࡃ࡞ࡿ࡜௚᪉ࡀపࡃ࡞ࡿࢺ࣮ࣞࢻ࣭
࢜ࣇࡢ㛵ಀ࡟࠶ࡿࠋ㐺ษ࡞ឤᗘ࣭≉␗ᗘࢆタᐃࡍࡿ᪉ἲ࡜ࡋ࡚ ROC ศᯒ receiver operating
characteristic analysis ࡀ࠶ࡿ ᅗ 2 ࠋឤᗘ࣭≉␗ᗘඹ࡟ 100%࡟࡞ࡿ A Ⅼ࡟᭱ࡶ㏆࠸ B Ⅼࡀ᭱㐺ࡢឤᗘ࣭≉␗ᗘ࡜࡞ࡿࠋ̿  ̿

ᅗ 1. ឤᗘ࣭≉␗ᗘࡢ⟬ฟ

ᅗ 2. ឤᗘ࣭≉␗ᗘࡢ⟬ฟ㸦ROC ศᯒ ཧ⪃ᩥ⊩1䠅 Perry N, Broeders, M, de Wolf C, et al. European guidelines for quality assurance in breast cancer
screening and diagnosis. Fourth ed, European Commission, Luxemburg, 2006.

䠄℈ᓥ䛱䛥䛸䠅̿  ̿



10.◊ಟ࣒࢝ࣜ࢟ࣗࣛ⫶ෆど㙾᳨デ࡟ᚑ஦ࡍࡿ་ᖌࠊ࣓ࢹ࢕࢝ࣝࢫࢱࢵࣇ ┳ㆤᖌࠊ⮫ᗋ᳨ᰝᢏᖌ࡞࡝ ࡣࠊ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࡢ୺ദࡍࡿ◊ಟ఍࡟ཧຍࡋࠊࡀࢇ᳨デ࡟㛵ࡍࡿ▱㆑࡟⩦⇍ࡍࡿࡼ࠺ດࡵࡿࠋ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࡛ࡣࠊ௨ୗ࡟♧ࡍ࣒࢝ࣜ࢟ࣗࣛࢆᏛ⩦ࡍࡿࡓࡵ◊ಟ఍ࢆᐃᮇⓗ࡟㛤ദࡍࡿࠋ࣓ࢹ࢕࢝ࣝࢫࢱࢵࣇ ┳ㆤᖌࠊ⮫ᗋ᳨ᰝᢏᖌ࡞࡝ ࡟ࡣ⫶ෆど㙾ࡢὙί࣭ᾘẘ࡟㛵ࡍࡿ◊ಟࡣᚲ㡲ࡔࡀࠊ௚ࡢ◊ಟ㡯┠ࡣດຊ┠ᶆ࡛࠶ࡿࠋ

◊ಟ࣒࢝ࣜ࢟ࣗࣛ㸦᱌㸧ㄢ 㢟ෆ ᐜ  1⫶ࡀࢇࡢ⨯ᝈ࣭Ṛஸࡢືྥ

࣭ࡀࢇⓏ㘓
࣭ேཱྀືែ⤫ィ

2⫶ࡀࢇࡢࣜࢫࢡせᅉ࣭࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ
࣭⏕ά⩦័㸸ႚ↮ࠊ㧗ሷศ㣗࡞࡝3ࡀࢇ᳨デࡢᇶᮏᴫᛕ

࣭ᑐ㇟㸸㐺ᛂ࡜㝖እ᳨࣭デ࡜デ⒪ࡢ┦㐪Ⅼ࣭ᑐ⟇ᆺ᳨デ࡜௵ពᆺ᳨デ4

ࡀࢇ᳨デࡢ᭷ຠᛶホ౯࣭◊✲᪉ἲ࣭࢔࢘ࢺ࣒࢝ᣦᶆ㸸㐺ษ࡞ᣦᶆ࡜ࡣఱ࠿
࣭࢞࢖ࢻࣛ࢖ࣥ

5ࡀࢇ᳨デࡢ฼┈࣭Ṛஸ⋡ῶᑡຠᯝ

6ࡀࢇ᳨デࡢ୙฼┈࣭ഇ㝧ᛶ㸸ᐃ⩏ࠊᑐ⟇࣭㐣๫デ᩿㸸ᐃ⩏ࠊᑐ⟇
࣭ឤᰁ
࣭അⓎ⑕

7

⢭ᗘ⟶⌮

࣭⢭ᗘ⟶⌮ࡢ᪉ἲ㸸ࢳ࢙ࢵࢡࣜࢫࢺ
࣭⢭ᗘ⟶⌮ᣦᶆ㸸ཷデ⋡ࠊࡀࢇⓎぢ⋡ࠊせ⢭᳨⋡ࠊ⢭᳨ཷデ⋡ࠊ㝧ᛶ཯ᛂ㐺୰ᗘ
࣭ឤᗘ࣭≉␗ᗘ
࣭㏣㊧ㄪᰝࡢ᪉ἲ

8⫶ෆど㙾᳨デࡢ᪉ἲ࣭ᑐ㇟ᖺ㱋᳨࣭デ㛫㝸
࣭᧜ᙳ᪉ἲ
࣭ㄞᙳᇶ‽
࣭⑕౛᳨ウ

9

ឤᰁ⑕ᑐ⟇

࣭⫶ෆど㙾᳨ᰝ࡟ࡼࡿឤᰁ஦ᨾ࣭⫶ෆど㙾ࡢὙί࣭ᾘẘ

10

അⓎ⑕ᑐ⟇

࣭⫶ෆど㙾᳨ᰝ࡟ࡼࡿഅⓎ⑕࣭Ᏻ඲⟶⌮ᑐ⟇࣭അⓎ⑕ࡢሗ࿌᪉ἲ

℈ᓥࡕࡉ࡜ ̿  ̿

Ϯ. ᳨ᰝᡭ㡰

1. ᳨ᰝࡢ‽ഛ
1㸧᳨ᰝ๓᪥ࡢ㣧㣗๓᪥ࡢ༗ᚋ 9 ᫬ ᳨ᰝ㛤ጞணᐃ᫬้ࡢ 12 ᫬㛫๓ ௨㝆ࡢ㣗஦ࡣ⚗ࡎࡿࡀࠊ⬺Ỉண㜵ࡢࡓࡵ㐺ᙜ㔞ࡢ㣧Ỉࡣ᳨ᰝ┤๓ࡲ࡛ྍ࡜ࡍࡿࠋ㣧Ỉ㔞࡟ࡣ≉࡟ไ㝈ࡣ࡞࠸ࠋ
2㸧᳨ᰝᙜ᪥ࡢ᭹⸆ ᙜ᪥ᮅ࡟ෆ᭹ࡀᚲせ࡞⸆ 㝆ᅽ⸆࡞࡝ ࡣࠊ᳨ᰝᙜ᪥ࡢ༗๓ 6 ᫬ ᳨ᰝ㛤ጞணᐃ᫬้ࡢ 3 ᫬㛫๓ࡲ࡛࡟ෆ᭹ࡍࡿࠋ
3㸧᳨ᰝ๓ࡢႚ↮⫶ෆど㙾᳨ᰝ࡟ᨭ㞀ࡀฟࡿྍ⬟ᛶࡀ࠶ࡿࡇ࡜࠿ࡽࠊᙜ᪥ࡢ⫶ෆど㙾᳨ᰝ๓ࡢႚ↮ࡣ㑊ࡅࡿࠋ
4㸧⫶ෆど㙾᳨ᰝཬࡧ๓ฎ⨨࡟ᚲせ࡞☜ㄆ஦㡯 ᳨ᰝ࡟ඛ❧ࡕၥデ⚊ࢆ⏝࠸ࠊ᪤ Ṕࠊ⌧⑓Ṕࠊ⏕ά⩦័ࠊ᳨デཷデṔ࡞࡝ࢆ☜ㄆࡍࡿ ⾲ 1 ࠋ⫶ෆど㙾᳨デ࡟㝿ࡋ࡚ࠊ஦๓ࡢឤᰁ᳨ᰝࡣᚲ㡲࡛ࡣ࡞࠸ࠋࡓࡔࡋࠊ᳨ᰝᚋࡢ⫶ෆど㙾ࡢὙί࣭ᾘẘ࡟ࡘ࠸࡚ᚭᗏࡍࡿࡇ࡜ࡀ๓ᥦ࡛࠶ࡿࠋ⫶ෆど㙾ࡢὙί࣭ᾘẘ࡟ࡘ࠸࡚ࡣࠊᚋ㏙グ㍕ࢆཧ↷ࡍࡿ P.64 ࠋ
㸦1㸧ཷデ⪅ࡀ⫶ෆど㙾᳨ᰝ࡟㐺ᛂ࠿࡝࠺࠿
㸦2㸧ཷデ⪅࡟᳨ᰝࢆཷࡅࡿពᛮࡀ࠶ࡿ࠿࡝࠺࠿
㸦3㸧ྠព᭩ࡢ᭷↓࡞ࡽࡧ࡟⨫ྡࡢ᭷↓㸦4㸧⫶ෆど㙾᳨ᰝࡢ⤒㦂ࠊྛ✀⸆๣࢔ࣞࣝࢠ࣮ࡢ᭷↓㸦5㸧ᚰ⑌ᝈࠊ⥳ෆ㞀ࠊ๓❧⭢⫧኱⑕ࠊ⏥≧⭢ᶵ⬟ஹ㐍⑕ࡢ᭷↓㸦6㸧ᢠ⾑ᰦ⸆᭹⏝ࡢ᭷↓ࡢ☜ㄆ㸦7㸧⤒㰯ෆど㙾ࢆ⏝࠸ࡿሙྜ࡟ࡣࠊ㔜⠜࡞๪㰯⭍⅖ࠊ㰯Ⲗࠊ࢔ࣞࣝࢠ࣮ᛶ㰯⅖࡞࡝ࡢ⪥㰯⛉⑌ᝈࡢ᭷↓࡞ࡽࡧ࡟㰯⭍ࡢᡭ⾡Ṕ᪤ ࡢ᭷↓
㸦8㸧⩏ṑࡢ᭷↓㸦9㸧⾑ᅽ ᐃ5㸧⫶ෆど㙾᳨ᰝᚋࡢὀព஦㡯
㸦1㸧᳨ᰝᚋ 1 ᫬㛫⛬ᗘࡣỈศࡸ㣗஦ࢆᦤྲྀࡋ࡞࠸ࠋ
㸦2㸧⏕᳨࡟ࡼࡾ⫶⢓⭷࡟യࡀ⏕ࡌࡿࡓࡵࠊ⏕᳨᳨ᰝᚋࠊᙜ᪥ࡢ㣗஦ࡣ㌾ࡽ࠿࠸ᾘ໬ࡢⰋ࠸㣗≀ࢆᦤྲྀࡍࡿࠋ㐣⃭࡞㐠ືࠊ㛗‫ࠊ‮‬᪑⾜࡞࡝ࡣ㑊ࡅࡿࠋ
㸦3㸧᳨ᰝ⤊஢ᚋ࡟ఱࡽ࠿ࡢ␗ኚࡀ࠶ࡿሙྜ࡟ࡣࠊ᳨ᰝ་࡟┦ㄯࡋࠊࡑࡢᣦ♧ࢆ࠶࠾ࡄࠋ̿  ̿⾲ 1.ၥデ⚊

౛ 

Ặ ྡ
⏕ᖺ᭶᪥

ᖺ    ᭶     ᪥⫶ࡀࢇ᳨デࡢ✀㢮          ṓ

ᖺ㱋

ఫ ᡤ
ཷデ᪥

⏨ ࣭ ዪ

ᛶู

㟁ヰ㸸

ᖺ    ᭶     ᪥‫⫶ ڧ‬ෆど㙾‫⫶ ڧ‬X⥺

1. ⫶ࡀࢇ࡟࠿࠿ࡗࡓࡇ࡜ࡣ࠶ࡾࡲࡍ࠿ࠋ
‫࠸ࡣڧ‬㸦     ᖺ     ṓ㸧   ‫࠸࡞ࡽ࠿ࢃڧ    ࠼࠸࠸ڧ‬2. ⌧ᅾࠊ⫶ࡢ⑓Ẽ ⫶₽⒆࡞࡝ ࡛἞⒪ࡋ࡚࠸ࡲࡍ࠿ࠋ ‫࠼࠸࠸ڧ  ࠸ࡣڧ‬3. ࣆࣟࣜ⳦ࡢ㝖⳦ࢆཷࡅࡓࡇ࡜ࡣ࠶ࡾࡲࡍ࠿ࠋ
‫࠸ࡣڧ‬㸦     ᖺ     ṓ㸧   ‫࠸࡞ࡽ࠿ࢃڧ    ࠼࠸࠸ڧ‬4. ⸆๣࢔ࣞࣝࢠ࣮ࡣ࠶ࡾࡲࡍ࠿ࠋ
‫✀ࡢ⸆ ࠸ࡣڧ‬㢮㸸              ‫࠸࡞ࡽ࠿ࢃڧ  ࠼࠸࠸ڧ‬5. ⌧ᅾࠊ㧗⾑ᅽࡢ἞⒪ࢆཷࡅ࡚࠸ࡲࡍ࠿ࠋ
‫࠸࡞ࡽ࠿ࢃڧ   ࠼࠸࠸ڧ   ࠸ࡣڧ‬6. ⌧ᅾࠊᢠ⾑ᰦ⸆ ࣡ࣝࣇ࢓ࣜࣥࠊࣂࣇ࢓ࣜࣥ࡞࡝ ࢆ᭹⏝ࡋ࡚࠸ࡲࡍ࠿ࠋ‫✀ࡢ⸆ ࠸ࡣڧ‬㢮㸸                  ‫࠼࠸࠸ڧ‬‫࠸࡞ࡽ࠿ࢃڧ‬7. ⊃ᚰ⑕ࡸ୙ᩚ⬦࡞࡝ࡢᚰ⮚ࡢ⑓Ẽࡣ࠶ࡾࡲࡍ࠿ࠋ
‫࠸࡞ࡽ࠿ࢃڧ   ࠼࠸࠸ڧ   ࠸ࡣڧ‬8. ධࢀṑࢆධࢀ࡚࠸ࡲࡍ࠿ࠋ   ‫࠼࠸࠸ڧ   ࠸ࡣڧ‬9. ୗグࡢ⑓Ẽ࡛἞⒪ࢆཷࡅ࡚࠸ࡲࡍ࠿ࠋ
‫⥳ڧ‬ෆ㞀 ‫ڧ‬๓❧⭢⫧኱⑕ ‫⭢≧⏥ڧ‬ᶵ⬟ஹ㐍⑕ ‫ڧ‬ᚰ⑌ᝈ‫࠼࠸࠸ڧ‬

10. ୗグࡢ㰯ࡢ⑓Ẽࢆࡋࡓࡇ࡜ࡀ࠶ࡾࡲࡍ࠿ࠋ
‫ڧ‬๪㰯⭍⅖ ‫ڧ‬㰯Ⲗ ‫࣮ࢠࣝࣞ࢔ڧ‬ᛶ㰯⅖‫࠸࡞ࡽ࠿ࢃڧ‬‫࠼࠸࠸ڧ‬‫ ࠸࡞ࡽ࠿ࢃڧ‬11. ṑࡢ἞⒪࡛㯞㓉ࢆ౑ࡗࡓࡇ࡜ࡀ࠶ࡾࡲࡍ࠿ࠋ
‫࠸࡞ࡽ࠿ࢃڧ   ࠼࠸࠸ڧ   ࠸ࡣڧ‬Ѝṑࡢ἞⒪ࡢ㯞㓉ࢆ౑ࡗࡓ᫬࡟ࠊఱ࠿ၥ㢟ࡣ࠶ࡾࡲࡋࡓ࠿ࠋ
‫࠸࡞ࡽ࠿ࢃڧ   ࠼࠸࠸ڧ   ࠸ࡣڧ‬12. 㰯⭍ࡢᡭ⾡ࢆࡋࡓࡇ࡜ࡀ࠶ࡾࡲࡍ࠿ࠋ   ‫࠸࡞ࡽ࠿ࢃڧ  ࠼࠸࠸ڧ   ࠸ࡣڧ‬13. ࢱࣂࢥࡣ྾࠸ࡲࡍ࠿ࠋ
‫⌧ڧ‬ᅾࠊ྾ࡗ࡚࠸ࡿ   ‫ڧ‬㐣ཤ࡟྾ࡗ࡚࠸ࡓࡀࠊࡸࡵࡓ   ‫ڧ‬྾ࡗ࡚࠸࡞࠸
14. ᐙ᪘࡟⫶ࡀࢇ࡟࠿࠿ࡗࡓேࡣ࠸ࡲࡍ࠿ࠋ
‫࠸ࡣڧ‬㸦∗ࠊẕࠊ㓄അ⪅ࠊᏊࠊ඗ᘵ /ጜጒࠊ♽∗ࠊ♽ẕ㸧‫࠸࡞ࡽ࠿ࢃڧ  ࠼࠸࠸ڧ‬15. ௨๓࡟⫶ࡀࢇ᳨デࢆཷࡅࡓࡇ࡜ࡀ࠶ࡾࡲࡍ࠿ࠋ ‫࠸࡞ࡽ࠿ࢃڧ  ࠼࠸࠸ڧ  ࠸ࡣڧ‬16. ⫶ࡀࢇ᳨デࢆཷࡅࡓࡇ࡜ࡀ࠶ࡿ᪉ࡣࠊࡶࡗ࡜ࡶ᭱㏆ࡢ᳨ᰝ࡟ࡘ࠸࡚࠾▱ࡽࡏࡃࡔࡉ࠸ࠋ
1㸧 ࡝ࡕࡽ࡛ཷࡅࡲࡋࡓ࠿ࠋ
‫ڧ‬ᕷ༊⏫ᮧ  ‫⫋ڧ‬ሙ  ‫ڧ‬ே㛫ࢻࢵࢡ   ‫ࡢࡑڧ‬௚㸦          㸧  
2㸧 ᳨ᰝࡢ᪉ἲ‫ ⫶ڧ‬X ⥺᳨ᰝ  ‫⫶ڧ‬ෆど㙾᳨ᰝ   ‫⾑ڧ‬ᾮ᳨ᰝ ࣌ࣉࢩࣀࢤ᳨ࣥᰝࠊࣆࣟࣜ⳦᳨ᰝ
3㸧 ᳨デࡢ᫬ᮇ:       ᖺ       ṓ㸦ᡂ⃝ᯘኴ㑻㸧̿  ̿



2. ࢖ࣥࣇ࢛࣮࣒ࢻ࣭ࢥࣥࢭࣥࢺ
1㸧࢖ࣥࣇ࢛࣮࣒ࢻ࣭ࢥࣥࢭࣥࢺࡢ┠ⓗ࢖ࣥࣇ࢛࣮࣒ࢻ࣭ࢥࣥࢭࣥࢺ࡜ࡣ㺀ㄝ᫂࡜ྠព㺁࡜ヂࡉࢀࠊ་⒪⾜Ⅽࢆ㑅ᢥࡍࡿ࡟࠶ࡓࡾᝈ⪅⮬㌟ࡀ᭱⤊ⓗ࡟Ỵᐃࡍࡿ㺀⮬ᕫỴᐃᶒ㺁ࢆᑛ㔜ࡍࡿ⪃࠼᪉࡛࠶ࡿࠋ⫶ෆど㙾᳨デࡢཷデ⪅࡟ᑐࡋ࡚ࡶࠊ
ྠᵝ࡟ࠊ᳨ᰝࡢ᪉ἲࡸ฼┈࣭୙฼┈࡞࡝࡟ࡘ࠸࡚༑ศ࡞ㄝ᫂ࢆ⾜࠸ࠊ᳨ᰝࡢྠពࢆᚓࡿ࢖ࣥࣇ࢛
࣮࣒ࢻ࣭ࢥࣥࢭࣥࢺࡣᚲ㡲࡛࠶ࡿࠋྠពࡣ᭩㠃ࢆ⏝࠸࡚グ㘓ࢆṧࡋࠊಖ⟶ࡍࡿࠋྠព᭩ ⾲ 1 ࡟ࡣㄝ᫂ࡢෆᐜ࡜ㄝ᫂⪅ཬࡧཷデ⪅ࡢ⨫ྡࢆグ㍕ࡍࡿࠋ
࢖ࣥࣇ࢛࣮࣒ࢻ࣭ࢥࣥࢭࣥࢺ࡛ࡣࠊ࡛ࡁࡿࡔࡅᖹ᫆࡞ゝⴥ࡛ㄝ᫂ࡋࠊཷデ⪅ࡢ⌮ゎࢆᚓࡸࡍࡃ
ࡍࡿࡇ࡜ࡸࠊഅⓎ⑕ࡢㄝ࡛᫂ࡣཷデ⪅࡟୙Ᏻࡤ࠿ࡾࢆ୚࠼࡞࠸ࡼ࠺࡞㓄៖ࡶᚲせ࡛࠶ࡿࠋ2㸧࢖ࣥࣇ࢛࣮࣒ࢻ࣭ࢥࣥࢭࣥࢺࡢෆᐜ
࢖ࣥࣇ࢛࣮࣒ࢻ࣭ࢥࣥࢭࣥࢺ࡟ࡣࠊ௨ୗࡢෆᐜࡀྵࡲࢀ࡞ࡃ࡚ࡣ࡞ࡽ࡞࠸ࠋ
㸦1㸧⫶ࡀࢇ᳨デࡢ᪉ἲ࡟ࡣࠊ⫶ X ⥺᳨ᰝ࡜⫶ෆど㙾᳨ᰝ ⤒ཱྀ࣭⤒㰯 ࡀ࠶ࡿࠋ
㸦2㸧⫶ෆど㙾᳨ᰝࡢ⾜࠸᪉ࠊ⢭ᗘࠊ฼┈࣭୙฼┈ࢆㄝ᫂ࡍࡿࠋ
࡞࠾ࠊㄝ᫂࡟ࡣ௨ୗࡢ 3 㹼 5 ࢆྵࡵࡿࠋ
㸦3㸧⫶ෆど㙾᳨ᰝࡢഅⓎ⑕࡟ࡣࠊฟ⾑ࠊ✸Ꮝࠊ⸆๣࡟ࡼࡿ࢔ࣞࣝࢠ࣮࡞࡝ࡀ࠶ࡿࠋ
㸦4㸧⫶ෆど㙾᳨ᰝ࡛ࡣ⑓ኚࢆㄆࡵࡓሙྜ࡟ࡣᚲせ࡟ᛂࡌ࡚⏕᳨ࢆ⾜࠺ࠋ⏕᳨࡟ࡼࡾ⫶⢓⭷࡟യࡀ⏕ࡌࡿࡓࡵࠊ᳨ᰝᚋࠊᙜ᪥ࡢ㣗஦ࡣ㌾ࡽ࠿࠸ᾘ໬ࡢⰋ࠸㣗≀ࢆᦤྲྀࡍࡿࠋ㐣⃭࡞㐠ືࠊ㛗‫ࠊ‮‬᪑⾜࡞࡝ࡶ㑊ࡅࡿࠋࡲࡓࠊ⏕᳨ࢆ⾜ࡗࡓሙྜ࡟ࡣࠊ⏕᳨ࡢ㒊ศ࡟ࡘ࠸࡚ࡣಖ㝤デ⒪࡜࡞ࡾࠊู
㏵ᩱ㔠ࡀᚲせ࡜࡞ࡿࠋ㸦5㸧⫶ෆど㙾᳨ᰝᚋࡢ㸯᫬㛫⛬ᗘࡣࠊỈศࡸ㣗஦ࢆᦤྲྀࡋ࡞࠸ࠋ㸦⤒㰯ෆど㙾ࢆ⏝࠸ࡿሙྜ࡟㏣ຍࡍ࡭ࡁෆᐜ㸧
㸦1㸧๓ฎ⨨࡜ࡋ࡚㰯⭍⢓⭷ࢆ㯞㓉ࡍࡿࡇ࡜ࡸࠊෆど㙾ࡢᤄධ᪉ἲࢆㄝ᫂ࡍࡿࠋ
㸦2㸧അⓎ⑕࡜ࡋ࡚㰯③ࠊ㰯ฟ⾑࡞࡝ࡀ࠶ࡿࠋཧ⪃ᩥ⊩1㸧 ᪥ᮏᾘ໬ჾࡀࢇ᳨デᏛ఍ ⫶ෆど㙾᳨デᶆ‽໬◊✲఍⦅㸬⫶ෆど㙾᳨デ࣐ࢽࣗ࢔ࣝ. ་Ꮫ᭩㝔,ᮾி㸪2010㸬2㸧᪥ᮏᾘ໬ჾࡀࢇ᳨デᏛ఍ ⫶⣽ᚄෆど㙾᳨デ◊✲఍⦅㸬⤒㰯ෆど㙾࡟ࡼࡿ⫶ࡀࢇ᳨デ࣐ࢽࣗ࢔ࣝ.
་Ꮫ᭩㝔, ᮾி㸪2014㸬3㸧 ᪂₲ᕷ࣭᪂₲ᕷ་ᖌ఍㸬᪂₲ᕷ⫶ࡀࢇ᪋タ᳨デᐇ᪋せ㡿㸬᪂₲ᕷ⫶ࡀࢇෆど㙾᳨デ 10 ᖺࡢ࠶ࡺࡳ㸪୍⯡♫ᅋἲே᪂₲ᕷ་ᖌ఍㸪᪂₲ᕷ㸪2014, 111–114.
̿  ̿

⾲ 1. ྠព᭩㸦౛㸧ྠ ព ᭩࠙⫶ࡀࢇ᳨デࡢ┠ⓗ࡜᪉ἲࠚ⫶ࡀࢇ᳨デࡣࠊ⑕≧ࡀ࡞࠸᫬ᮇ࡟࡛ࡁࡿࡔࡅ᪩ࡃ⫶ࡀࢇࢆぢࡘࡅࠊ᪩ࡃ἞⒪ࡍࡿ┠ⓗ࡛⾜ࢃࢀ࡚࠸ࡲࡍࠋࡑࡢ᪉ἲ࡟ࡣࠊࣂ࣒ࣜ࢘ࢆ⏝࠸ࡿ᪉ἲ ⫶ X ⥺᳨ᰝ ࡜ෆど㙾ࢆ⏝࠸ࡿ᪉ἲ ⫶ෆど㙾᳨ᰝ ࡀ࠶ࡾࠊ࠸ࡎࢀࡶࡑࡢຠᯝࡀド᫂ࡉࢀ࡚࠸ࡲࡍࠋࡲࡓࠊ୧⪅ࡢ᪉ἲ࡟ࡣ
Ⰻ࠸࡜ࡇࢁ࡜ᝏ࠸࡜ࡇࢁࡀ࠶ࡾࡲࡍࠋ࠙⫶ෆど㙾᳨ᰝࡢ᪉ἲࠚ
ཱྀ࠿ࡽ⫶ෆど㙾ࢆᤄධࡋࠊ㣗㐨࣭⫶࣭༑஧ᣦ⭠ࢆෆ⭍࠿ࡽほᐹࡋࠊ⑓Ẽࢆ᥈ࡋࡲࡍࠋ␗ᖖࡀ
࠶ࡿሙྜ࡟ࡣࠊ⑓ኚࡢ୍㒊ࢆࡘࡲࡳ ⏕᳨㸧ࠊ⣽⬊ࡢ᳨ᰝࢆ⾜࠺ࡇ࡜ࡀ࠶ࡾࡲࡍࠋ ࡲࡓࠊⰍ⣲ࢆᩓᕸࡋ࡚ࠊ⑓ኚࢆぢࡸࡍࡃࡍࡿࡇ࡜ࡀ࠶ࡾࡲࡍࠋ
࡞࠾ࠊ⏕᳨ࡀ⾜ࢃࢀࡓሙྜࠊ⏕᳨࡟ࡘ࠸࡚ࡣಖ㝤デ⒪࡜ࡋู࡚㏵ㄳồࡀ࠶ࡾࡲࡍࠋᙜ᪥
ࡣ೺ᗣಖ㝤ドࢆᣢཧࡋ࡚ࡃࡔࡉ࠸ࠋࡲࡓࠊ⏕᳨࡟ࡼࡾ⢓⭷࡟യࡀ࡛ࡁࡲࡍࡢ࡛ࠊ᳨ᰝᚋᙜ᪥
ࡢ㣗஦ࡣ㌾ࡽ࠿࠸ᾘ໬ࡢⰋ࠸ࡶࡢࢆ㣗࡭࡚ࡃࡔࡉ࠸ࠋ㐣⃭࡞㐠ືࠊ㛗‫ࠊ‮‬᪑⾜࡞࡝ࡣ㑊ࡅ࡚
ࡃࡔࡉ࠸ࠋ
࠙അⓎ⑕ࠚ
അⓎ⑕ࡀⓎ⏕ࡍࡿ㢖ᗘࡣࠊ⫶ෆど㙾᳨デ࡛ࡣ 10 ୓௳࡟ 78 ௳࡜඲ᅜㄪᰝ࡟ࡼࡾሗ࿌ࡉࢀ
࡚࠸ࡲࡍࠋࡇࡢ୰࡟ࡣ㰯ฟ⾑࡞࡝ࡢ㍍ᚤ࡞ࡶࡢ࠿ࡽධ㝔౛ࡲ࡛ྵࡲࢀ࡚࠸ࡲࡍࠋ⌧ᅾࠊ⫶ෆど㙾᳨デ࡟ࡼࡿṚஸ஦ᨾࡣሗ࿌ࡉࢀ࡚࠸ࡲࡏࢇࡀࠊࡈࡃࡲࢀ࡟Ṛஸࡢྍ⬟ᛶࡶ࠶ࡾࡲࡍࠋ⫶ෆど㙾᳨ᰝ࡛ࡣࠊ௨ୗࡢഅⓎ⑕ࡀ㉳ࡁࡿྍ⬟ᛶࡀ࠶ࡾࡲࡍࠋ
1㸧⫶ෆど㙾࡟ࡼࡾ⢓⭷࡟യࡀࡘࡃࡇ࡜ࡸࠊฟ⾑ࠊ✸Ꮝ ✰ࡀ࠶ࡃࡇ࡜㸧
2㸧⏕᳨࡟ࡼࡾฟ⾑ࠊ✸Ꮝ
3㸧⸆๣࡟ࡼࡿ࢔ࣞࣝࢠ࣮ ࿧྾ᅔ㞴ࠊ⾑ᅽపୗ࡞࡝㸧
4㸧᳨ᰝ๓࠿ࡽ࠶ࡗࡓ⑌ᝈࡢᝏ໬ ⑕≧ࡢฟ࡚࠸࡞࠿ࡗࡓ⑌ᝈࡶྵࡴ㸧࡞࠾ࠊᙜ᪋タ࡛ࡣഅⓎ⑕ࡢ㜵Ṇࡢࡓࡵ࡟༑ศ࡞ὀពࢆᡶ࠺࡜࡜ࡶ࡟ࠊഅⓎ⑕ࡀⓎ⏕ࡋࡓሙྜ࡟ࡣ᭱ၿࡢᑐᛂࢆ࠸ࡓࡋࡲࡍࠋᖹᡂ   ᖺ  ᭶  ᪥   ㄝ᫂་ᖌྡ            ୖグࡢ஦㡯࡟ࡘ࠸࡚ࠊㄝ᫂ࢆཷࡅࠊ༑ศ࡟⌮ゎࡋࡲࡋࡓࡢ࡛ࠊࡑࡢᐇ᪋࡟ྠពࡋࡲࡍࠋᖹᡂ   ᖺ  ᭶  ᪥ཷデ⪅⨫ྡ                          ཷデ⪅௦⌮⨫ྡ              㸦⥆᯶㸧       㸦ⰾ㔝⣧἞㸧̿  ̿



3. ๓ฎ⨨1㸧ᾘἻ⸆࡞ࡽࡧ࡟⢓ᾮ㝖ཤ⸆ࡢෆ᭹
ࢪ࣓ࢳࢥࣥࢩࣟࢵࣉ ࢞ࢫࢥࣥ‫ ࣉࢵࣟࢻט‬5mL ࢆ 10 ಸ㹼20 ಸᕼ㔘ࡋࠊ50㹼100mL ᭹⏝ࡉࡏࡿࠋࡉࡽ࡟ࠊࣉࣟࢼ࣮ࢮ ࣉࣟࢼ࣮ࢮ‫ט‬MSࠊ࢞ࢫࢳ࣮࣒‫ ט‬2 ୓༢఩࡜㔜᭪ 1㹥ࢆ⏝࠸ࡿ࡜⫶ෆࡢ⢓ᾮ㝖ཤࡀᐜ᫆࡜࡞ࡿࠋ
ࡲࡓࠊ᭱㏆࡛ࡣࠊ⢓ᾮࡢ⢓ᗘࢆࡉࡽ࡟పୗࡉࡏࠊ⫶ෆཬࡧࣞࣥࢬ㠃ࡢὙίຠᯝࢆ࠶ࡆࡿ┠ⓗ࡛ࠊ⤒㰯ෆど㙾᪋⾜᫬࡟ࡣࠊ࢞ࢫࢥࣥỈ ࢪ࣓ࢳࢥࣥࢩࣟࢵࣉ 40mL ࢆỈ 1,000mL ࡟⁐࠿ࡋࡓࡶࡢ ࢆ
150mL ౑⏝ࡍࡿ᪉ἲࡶ᥎ዡࡉࢀ࡚࠸ࡿ 1)ࠋ
2㸧㙠②⸆࡞࡝    ᚰ⑌ᝈࠊ⥳ෆ㞀ࠊ๓❧⭢⫧኱⑕ࠊ⏥≧⭢ᶵ⬟ஹ㐍⑕࡞࡝ࡢ⑌ᝈࡢ࡞࠸ሙྜࡣࠊᾘ໬⟶ࡢ⽸ືࡸ
ၚᾮࡢศἪࢆᢚไࡍࡿࡓࡵࡢࠊ㙠②⸆ ࣈࢫࢥࣃࣥ‫ࡣ⏝౑ࡢ ࡝࡞ט‬ᕪࡋᨭ࠼࡞࠸ࠋ
ᚰ⑌ᝈࠊ⥳ෆ㞀ࠊ๓❧⭢⫧኱⑕ࡢཷデ⪅࡟ࡣࠊࢢࣝ࢝ࢦࣥࢆ౑⏝ࡍࡿࡇ࡜ࡀ࡛ࡁࡿࠋࡓࡔࡋࠊ
〓Ⰽ⣽⬊⭘ࡢᝈ⪅࡟ࡣ⚗ᚷ࡛࠶ࡿࠋᮏ๣ࡣ᳨ᰝ⤊஢ᚋ ㏻ᖖᢞ୚ᚋ 90 ศ௨㝆 ࡟ࣜࣂ࢘ࣥࢻ࡟ࡼࡿ
ప⾑⢾ࢆࡁࡓࡍࡇ࡜ࡀ࠶ࡿࡢ࡛ࠊ౑⏝࡟ࡣ༑ศὀពࢆせࡍࡿࠋࡲࡓࠊl–࣓ࣥࢺ࣮ࣝ〇๣ ࣑ࣥࢡࣜ࢔‫ࠋࡿ࠶࡛⬟ྍ⏝౑ࡶ ט‬ෆ⏝ᩓᕸᾮ 0.8㸣 20mL ࢆෆど㙾㖀Ꮚཱྀࡼࡾ⫶ᗃ㛛๓ᗞ㒊඲య࡟ᩓᕸࡋ
࡚⏝࠸ࡿࠋ3㸧㙠③⸆࣭㙠㟼⸆⫶ෆど㙾᳨デ࡛ࡣࠊಖ㝤デ⒪௨ୖ࡟Ᏻ඲࡟⾜࠺ᚲせࡀ࠶ࡿࡓࡵࠊཎ๎࡜ࡋ࡚㙠③⸆ ࢜ࣆ࢜࢖ࢻ⣔࡞࡝ ࣭㙠㟼⸆ ࣋ࣥࢰࢪ࢔ࢮࣆࣥ⣔࡞࡝ ࡣ౑⏝ࡋ࡞࠸ࠋ⫶ෆど㙾᳨デ࡛ࡣࠊ⏕᳨ࡢ᭷↓࡟࠿࠿
ࢃࡽࡎࠊ㏻ᖖࡣ 10㹼15 ศ⛬ᗘ᳨࡛ᰝࡣ⤊஢ࡋࠊ㙠③⸆࣭㙠㟼⸆࡞ࡋ࡟ほᐹࡣྍ⬟࡛࠶ࡿࠋ᪥ᮏᾘ໬ჾෆど㙾Ꮫ఍࡟ࡼࡿ඲ᅜㄪᰝ࡛ࡣࠊ⫶ෆど㙾᳨ᰝ࡟క࠺അⓎ⑕࡟㛵ࡍࡿṚஸ౛ࡢከࡃ
ࡀ๓ฎ⨨࡟⏝࠸ࡿ㙠③⸆࣭㙠㟼⸆࡞࡝࡟㉳ᅉࡋ࡚࠸ࡓ 2)ࠋ᪥ᮏᾘ໬ჾࡀࢇ᳨デᏛ఍ࡢഅⓎ⑕ሗ࿌࡛ࡶࠊෆど㙾᳨デࡢ㝿ࡢ㙠㟼⸆౑⏝࡟ࡼࡿ࿧྾ᢚไࡀẖᖺሗ࿌ࡉࢀ࡚࠸ࡿ P.15 ཧ↷ ࠋ᪥ᮏᾘ໬ჾෆど㙾Ꮫ఍㺀ෆど㙾デ⒪࡟࠾ࡅࡿ㙠㟼࡟㛵ࡍࡿ࢞࢖ࢻࣛ࢖ࣥ㺁3)࡛ࡣࠊෆど㙾᳨ᰝ᫬ࡢ㙠㟼࡟ࡘ࠸࡚ಖ㝤㐺⏝ࡢᢎㄆࢆᚓ࡚࠸ࡿ⸆๣ࡣ࡞࠸ࡇ࡜ࡀ᫂グࡉࢀ࡚࠸ࡿࠋࡲࡓࠊ㙠㟼⸆ࡢ౑⏝࡟ࡣ་ᖌࡢㄏᑟࡀ࠶ࡗ࡚ࡣ࡞ࡽࡎࠊ࢖ࣥࣇ࢛࣮࣒ࢻ࣭ࢥࣥࢭࣥࢺࡀᚲせ࡜ࡋ࡚࠸ࡿࠋྠᵝ࡟ࠊ᪥ᮏ㯞㓉⛉Ꮫ఍ࡢ㺀᪥ᖐࡾ㯞㓉ࡢᏳ඲ࡢࡓࡵࡢᇶ‽㺁4) ࡛ࡣࠊ᪥ᖐࡾࡢ㯞㓉࡛࠶ࡗ࡚ࡶ஦๓࡟㯞㓉⛉་࡟ࡼࡿデᐹࡸ࢖ࣥࣇ࢛࣮࣒ࢻ࣭ࢥࣥࢭࣥࢺࢆ⾜࠸ࠊࡲࡓ┳ㆤࠊタഛ࡞࡝ࡢయไᩚഛࢆồࡵ࡚࠸ࡿࠋࡉࡽ࡟ࠊᏳ඲⟶⌮ࡢࡓࡵࠊ㺀Ᏻ඲࡞㯞㓉ࡢࡓࡵࡢࣔࢽࢱ࣮ᣦ㔪㺁5)࡟ᚑ࠸ࠊ㯞㓉୰ࡣ⌧ሙ࡟㯞㓉ࢆᢸᙜࡍࡿ་ᖌࡀ⤯࠼㛫࡞ࡃ┳どࡋࠊ㓟⣲໬ࠊ᥮Ẽࠊᚠ⎔ࠊయࠊ➽ᘱ⦆ࠊ⬻Ἴࡢࢳ࢙ࢵࢡࢆࡍ

ࡿࡇ࡜ࢆᚲせ࡜ࡉࢀ࡚࠸ࡿࠋᚑࡗ࡚ࠊ㺀ෆど㙾デ⒪࡟࠾ࡅࡿ㙠㟼࡟㛵ࡍࡿ࢞࢖ࢻࣛ࢖ࣥࠖཬࡧ㺀᪥ᖐࡾ㯞㓉ࡢᏳ඲ࡢࡓࡵࡢᇶ‽㺁ࢆ㑂Ᏺ࡛ࡁࡿ⎔ቃ࡛࡞ࡅࢀࡤࠊ㙠③⸆࣭㙠㟼⸆ࡢ౑⏝ࡣᮃࡲࡋࡃ࡞
࠸ࠋ
4㸧⤒ཱྀෆど㙾ࡢ㯞㓉
㏻ᖖࠊဗ㢌㯞㓉ࡣ࢟ࢩࣟ࢝࢖ࣥ‫ࠋ࠺⾜࡛ࢫ࢝ࢫࣅ ט‬ဗ㢌࡟ಖࡘ᪉ἲ࡜㣧⏝ࡍࡿ᪉ἲ 2 ᅇ⛬ᗘࡺࡗࡃࡾ㣧ࡳ㎸ࡴ ࡀ࠶ࡿࡀࠊྛ᳨デᶵ㛵࡛㏻ᖖ⾜ࡗ࡚࠸ࡿ᪉ἲ࡛⾜࠺ࠋࡑࢀ௨እ࡟ࠊ࢟ࢩࣟ࢝࢖ࣥ‫ט‬̿  ̿

ࢫࣉ࣮ࣞࢆ⏝࠸ࡿ᪉ἲࡀ࠶ࡿࡀࠊࢫࣉ࣮ࣞࡣ⃰ᗘࡀ㧗࠸ୖ࡟ࠊ྾཰ࡀⰋ࠸ࡓࡵࠊ࢔ࣞࣝࢠ࣮ᛶࢩ
ࣙࢵࢡࡸ୰ẘ࡟༑ศὀពࡍࡿᚲせࡀ࠶ࡿࠋࡲࡓࠊࣅࢫ࢝ࢫࡸࢫࣉ࣮ࣞ࡞࡝ࢆే⏝ࡍࡿሙྜ࡛࠶ࡗ
࡚ࡶࠊ࢟ࢩࣟ࢝࢖ࣥ‫⥲ࡢ ט‬㔞ࡢୖ㝈ࡣ 200mg࡜ࡍࡿࠋ5㸧⤒㰯ෆど㙾ࡢ㯞㓉㸦1㸧ᤄධ㰯⭍ࡢỴᐃ㯞㓉ࢆࡍࡿ๓࡟ᤄධࡍࡿ࣮ࣝࢺࢆỴࡵࡿᚲせࡀ࠶ࡿࠋ㰯⭍ࡢᗈࡉ࡟ࡣಶேᕪࠊᕥྑᕪࡀ࠶ࡿࡓࡵࠊෆど㙾᳨ᰝ་ࡣཷデ⪅࡟᭱ࡶ㐺ࡋࡓᤄධ࣮ࣝࢺࢆ▱ࡿᚲせࡀ࠶ࡿࠋᤄධ࣮ࣝࢺࢆㄗࡿ࡜ࠊ౑
⏝ࡍࡿ㯞㓉⸆ࡢቑຍࡸཷデ⪅ࡢ㈇ᢸ࡟ࡶࡘ࡞ࡀࡿࠋ
࣮ࣝࢺࢆỴࡵࡿලయⓗ࡞᪉ἲ࡜ࡋ࡚ࡣࠊ୧ഃ㰯⩼ࢆ஺஫࡟ᣦ࡛ᢲࡉ࠼࡚ᜥࢆྤ࠸࡚ࡶࡽ࠸㏻㐣
ࡢⰋ࠸࡯࠺ࢆ㑅ࡪ᪉ἲࠊ㰯㙾 ࿴㎷ᘧ࡞࡝ ࢆ⏝࠸࡚୧ഃ㰯⭍ࢆほᐹࡍࡿ᪉ἲࠊෆど㙾࡛ほᐹࡍࡿ᪉ἲ࡞࡝ࡀ࠶ࡿ 6)ࠋ
ࡲࡓࠊ㰯⭍㯞㓉᫬࡟࢟ࢩࣟ࢝࢖ࣥ‫ࢆ ט‬ሬᕸࡋࡓ⥥Წࡸࢫࢸ࢕ࢵࢡ࡛┤᥋㰯⭍ࢆ☜ㄆࡋࠊ㐺ษ࡞ᤄධ࣮ࣝࢺࢆỴᐃࡋ࡚ࡶࡼ࠸ࠋࡇࡢሙྜࠊෆど㙾᳨ᰝ་ࡣᐇ㝿ࡢ㰯⭍ࡢᗈࡉࢆឤࡌࡿࡇ࡜ࡀ࡛ࡁࡿ
ࡓࡵࠊࡑࢀ࡟ᛂࡌࡓෆど㙾ࡸ㯞㓉᪉ἲࢆ㑅ࡪࡇ࡜ࡶྍ⬟࡛࠶ࡿࠋៅ㔜࡟㰯⭍ࢆデᐹࡋ࡞࠸࡜ࠊཷ
デ⪅ࡢ㈇ᢸ࡜࡞ࡿࡢ࡛ὀពࡀᚲせ࡛࠶ࡿࠋᐇ㝿ࡢᤄධࡢ࣮ࣝࢺࠊෆど㙾㏻㐣᫬ࡢ㰯③࡞࡝ࡢ᝟ሗࡣグ㘓࡟ṧࡋ࡚࠾ࡁࠊḟࡢ᳨ᰝ࡟ᙺ❧࡚ࡿࡇ࡜ࡀ኱ษ࡛࠶ࡿࠋ
㸦2㸧ᒁᡤ⾑⟶཰⦰⸆⤒㰯ෆど㙾࡛ࡣࠊ0.005%ࢼࣇ࢓ࢰࣜࣥ◪㓟ሷ࡞࡝ࡢᒁᡤ⾑⟶཰⦰⸆ࢆ୧ഃࡢ㰯⭍ෆ࡟Ⅼ㰯 2ࠊ3
⁲ ࡋ࡚࠾ࡃࠋࡑࡢ㝿ࡢయ఩ࡣ⸆๣ࡢ⪥⟶࡬ࡢ㏫ὶࢆ㜵ࡄࡓࡵ࡟ᗙ఩࡛⾜࠺ࠋࡇࡢ㝿ࠊ㰯㙾ࢆ⏝࠸࡚እ㰯Ꮝࢆᣑᙇࡋ࡚⾜࠺࡯࠺ࡀᮃࡲࡋ࠸ࠋⅬ㰯ࢫࣉ࣮ࣞࡸ Jackson ᘧᄇ㟝ჾࢆ⏝࠸ࡿ࡜ࠊ☜ᐇ࡟㐺㔞ࡢ⸆ᾮࡀ㰯⭍ෆ࡟ὀධࡉࢀࡿࠋ᭱㏆࡛ࡣࠊࢹ࢕ࢫ࣏࣮ࢨࣈࣝࡢࢩࣜࣥࢪ௜ࡁࣀࢬࣝࡶ㈍኎ࡉࢀ
࡚࠸ࡿࠋ࡞࠾ࠊᒁᡤ⾑⟶཰⦰⸆ᢞ୚ᚋࠊ༑ศ࡞ຠᯝࡀⓎ⌧ࡍࡿࡲ࡛࡟ࠊ⣙ 15 ศࢆせࡍࡿࠋᒁᡤ⾑⟶཰⦰⸆ࡣࠊ㰯⭍⢓⭷ࡢ⾑⟶཰⦰స⏝࡟ࡼࡾࠊෆど㙾ᤄධ᫬ࡢ㰯ฟ⾑ࢆண㜵ࡍࡿࡤ࠿ࡾ
࡛࡞ࡃࠊ㯞㓉⸆ࡢస⏝᫬㛫ࡢᘏ㛗࡜ᒁᡤ㯞㓉୰ẘࡢ㜵Ṇ࡟ᙺ❧ࡘࠋࡉࡽ࡟ࠊ㰯⏥௓ࡢ཰⦰࡟ࡼࡗ
࡚㰯⭍ࡀᣑᙇࡋࠊෆど㙾ࡢᤄධࡶᐜ᫆࡜࡞ࡿࠋ
㸦3㸧㰯⭍㯞㓉
㰯⭍㯞㓉࡟ࡣࠊࢫࢸ࢕ࢵࢡἲࠊࢫࣉ࣮ࣞἲࠊࢫࢸ࢕ࢵࢡἲ࣭ࢫࣉ࣮ࣞే⏝ἲࠊὀධἲ࡞࡝ࡢ᪉
ἲࡀ࠶ࡿࡀࠊ࡝ࡢ᪉ἲ࡛࠶ࢀࠊ᫬㛫ࢆ࠿ࡅ࡚୎ᑀ࡟ᐇ᪋ࡍࡿࡇ࡜ࡀ኱ษ࡛࠶ࡿࠋ⤒ཱྀෆど㙾ࡢሙྜ࡜ྠᵝ࡟ࠊ࢟ࢩࣟ࢝࢖ࣥ‫⥲ࡢ ט‬㔞ࡢୖ㝈ࡣ 200mg ࡜ࡍࡿࠋ
㸦4㸧ဗ㢌㯞㓉
㏻ᖖࠊ⤒㰯ෆど㙾࡛ࡣဗ㢌㯞㓉ࡣᚲせ࡜ࡋ࡞࠸ࡀࠊ᳨ᰝ་ࡀᚲせ࡜ุ᩿ࡋࡓሙྜࡣࠊ㰯⭍㯞㓉࡜࠶ࢃࡏ࡚࢟ࢩࣟ࢝࢖ࣥ‫⥲ ט‬㔞ࡀ 200mg ௨ෆ࡛࠶ࢀࡤࠊဗ㢌㯞㓉ࢆ⾜ࡗ࡚ࡶࡼ࠸ࠋ

ཧ⪃ᩥ⊩ 1䠅 ᕝ⏣࿴᫛, ᗈᕝ㞞ᙪ, ࿃ᕝᘯஅ䠊䜺䝇䝁䞁Ỉ 150ml 䜢⏝䛔䛯⤒㰯ෆど㙾᳨ᰝ䇷䝺䞁䝈㠃䛾Ὑίຊ䜢⿵䛖䛯䜑䛾ᕤኵ䠊Gastroenterol Endosc 2009; 51:1586–1587.
̿  ̿

2㸧 ⰾ㔝⣧἞㸪஬༑ᔒⰋ඾㸪኱ཎᘯ㝯㸪௚㸬ᾘ໬ჾෆど㙾㛵㐃ࡢഅⓎ⑕࡟㛵ࡍࡿ➨ 5 ᅇ඲ᅜㄪᰝሗ
࿌ؐ2003 ᖺࡼࡾ 2007 ᖺࡲ࡛ࡢ 5 ᖺ㛫䇷㸬Gastroenterol Endosc 2010; 52:95–103.
3㸧 ᑠཎ຾ᩄ㸪᫓㛫㈼㸪ධ⃝⠜ᚿ㸪௚㸬ෆど㙾デ⒪࡟࠾ࡅࡿ㙠㟼࡟㛵ࡍࡿ࢞࢖ࢻࣛ࢖ࣥ㸬Gastroenterol
Endosc 2013; 55:3822–3847.
4䠅 ᪥ᮏ㯞㓉⛉Ꮫ఍䠊᪥ᖐ䜚㯞㓉䛾Ᏻ඲䛾䛯䜑䛾ᇶ‽ 2009 ᖺ 2 ᭶ᨵゞ 䠊2009䠊
http://www.anesth.or.jp/guide/pdf/higaerimasui_20090323150405.pdf[2016.1.12]

5㸧 ᪥ᮏ㯞㓉⛉Ꮫ఍䠊Ᏻ඲䛺㯞㓉䛾䛯䜑䛾䝰䝙䝍䞊ᣦ㔪 2014 ᖺ 7 ᭶ᨵゞ 䠊2014䠊
http://www.anesth.or.jp/guide/pdf/monitor3.pdf [2016.1.12]
6㸧 ᪥ᮏᾘ໬ჾࡀࢇ᳨デᏛ఍ ⫶⣽ᚄෆど㙾᳨デ◊✲఍⦅㸬⤒㰯ෆど㙾࡟ࡼࡿ⫶ࡀࢇ᳨デ࣐ࢽࣗ࢔ࣝ. ་Ꮫ᭩㝔, ᮾி㸪2014㸬㸦ᡂ⃝ᯘኴ㑻㸧̿  ̿



4. ⫶ෆど㙾᳨ᰝᡭ㡰
1㸧᧜ᙳࡢᇶᮏཎ๎
⫶ࡀࢇ᳨デ࡛ࡣࠊಖ㝤デ⒪࡛ࡢ᳨ᰝ࡜ࡣ␗࡞ࡾࠊ↓⑕≧⪅ࢆᑐ㇟࡜ࡍࡿࠋ50 ṓ௨ୖ࡛࠶ࡗ࡚ࡶ
↓⑕≧⪅ࡢ⫶ࡀࢇⓎぢ⋡ࡣ㏻ᖖ 0.5%௨ୗࠊከࡃ࡚ࡶ 1%⛬ᗘ࡜ሗ࿌ࡉࢀ࡚࠸ࡿࠋࢃࡎ࠿ࡋ࠿Ꮡᅾࡋ
࡞࠸⫶ࡀࢇ⑓ኚࢆぢⴠ࡜ࡉࡎࠊࡋ࠿ࡶ኱ከᩘࡢཷデ⪅࡟ࡣ⫶ࡀࢇ⑓ኚࡀ࡞࠸ࡇ࡜ࢆࠊᐈほⓗ࡟ุᐃ࡛ࡁࡿࡶࡢ࡛࡞ࡅࢀࡤ࡞ࡽ࡞࠸ࠋࡑࡢࡓࡵࠊ⫶ෆど㙾᳨デ࡛ࡣ㐺ṇ࡞ࣞ࣋ࣝࡢ⏬ീ࡛⫶ෆࢆࡃࡲ࡞ࡃグ㘓ࡍࡿᚲせᛶࡀ࠶ࡿࠋ
⢓⭷㠃ࡣ࢞ࢫࢥࣥỈ࡞࡝࡛༑ศ࡟Ὑࡗ࡚ࠊ⢓ᾮࡸἻ࡞࡝࡟そࢃࢀ࡞࠸≧ែ࡛᧜ᙳࡍࡿࠋࣞࣥࢬ
㠃࡟⺮ⓑ㉁࡞࡝ࡀ௜╔ࡋ࡚࠸ࡿ࡜ࠊ᳨ᰝ୰ࡢởࢀࡀ㏦Ẽ㏦Ỉ࣎ࢱࣥࢆᢲࡋࡓ⛬ᗘ࡛ࡣ㝖ཤࡉࢀ࡞࠸ࡢ࡛ࠊ᳨ᰝ๓࡟ࢡ࣮ࣜࢼ࣮௜ࡁࡢ⥥Წ࡞࡝࡛༑ศ࡟ࣞࣥࢬ㠃ࢆᣔࡁྲྀࡿࠋ㏆ᖺࡢෆど㙾ᶵჾࡣᖖ᫬ほᐹ୰ࡢ⏬ീࢆ࣓࣮ࣔࣜ࡟⵳✚ࡋࠊࣇ࣮ࣜࢬࡢ㝿࡟ࡑࡢ୰࠿ࡽࣈࣞࡢᑡ࡞࠸⏬ീࢆᢳฟࡍࡿ
௙⤌ࡳࢆ᭷ࡋ࡚࠸ࡿࡀࠊࡇࢀ࡟㢗ࡿࡢ࡛ࡣ࡞ࡃࠊᚲせ࡟ᛂࡌ࡚ཷデ⪅࡟࿧྾೵Ṇࢆᣦ♧ࡋ࡚㩭᫂࡞⏬ീグ㘓࡟ດࡵࡿࠋ⢓⭷ୖࡸࣞࣥࢬ㠃ࡢởࢀࠊࣈࣞࡢ࠶ࡿࡼ࠺࡞୙㐺ṇ࡞グ㘓⏬ീࡀ㸯᳨ᰝ࡛ 5ࢥ࣐ࢆ㉸࠼ࡿࡇ࡜ࡀ࡞࠸ࡼ࠺࡟ດࡵࡿࠋ⫶ෆࢆࡃࡲ࡞ࡃ᧜ᙳࡋࠊ⑓ᕢࡀ࠶ࡿሙྜࡣࡑࡢᛶ≧ࡀุ᩿࡛ࡁࡿ⏬ീࢆグ㘓ࡋࠊㄞᙳጤဨ఍࡟グ㘓ࡋࡓ඲⏬ീࢆᥦฟࡍࡿࠋ⏬ീⰍㄪࠊ㟢ฟ࡞࡝ࡀ㐺ṇ࡛࠶ࡾࠊ⏬ീࢧ࢖ࢬࡢ኱ࡁࡉࡶࢲࣈࣝࢳ࢙ࢵࢡ࡛ࡢุᐃྍ⬟࡞ࡶࡢ࡛࠶ࡿࡇ࡜ࡀ㔜せ࡛࠶ࡿࠋ2㸧᧜ᙳ᪉ἲ
ཷデ⪅ࡀᕥഃ⮩఩࡛ࡢ᳨ᰝࢆཎ๎࡜ࡍࡿࠋ⫶ෆど㙾᳨デࡢほᐹ⠊ᅖࡣ㣗㐨࣭⫶࣭༑஧ᣦ⭠⌫㒊࡜ࡍࡿࠋᝏᛶ⑌ᝈࡢ㢖ᗘࡢᑡ࡞࠸༑஧ᣦ⭠ୗ⾜㒊ࡢほᐹࢆᚲ㡲࡜ࡣࡋ࡞࠸ ᅗ 1–6㸧ࠋ᧜ᙳࢥ࣐ᩘࡣ
㣗㐨࣭⫶࣭༑஧ᣦ⭠ࢆྵࡵ࡚ࠊ30㹼40 ࢥ࣐ࡀ㐺ᙜ࡛࠶ࡿ 1)ࠋᑡ࡞࠸࡜⥙⨶ᛶ࡟Ḟࡅࡸࡍࡃࠊ࠶ࡲ
ࡾ࡟ከ࠸࡜ࢲࣈࣝࢳ࢙ࢵࢡ࡟ᡭ㛫ྲྀࡿࠋဗ㢌࡟฿㐩ࡋ࡚ࠊဗ㢌ࢆᗈࡆࡓ≧ែ࡜ࡋ࡚ほᐹࢆ⾜ࡗࡓᚋ࡟㣗㐨࡟㐍ࡳࠊୖ㒊㣗㐨ࠊ୰㒊㣗㐨ࠊୗ㒊㣗㐨ࠊ㣗㐨⫶᥋ྜ㒊࡬࡜㐍ࡴࠋᖖ࡟㐍⾜᪉ྥࢆ⏬ീࡢ୰ᚰ࡟⨨ࡁࠊ๓ቨ࣭ྑቨ࣭ᚋቨ࣭ᕥቨࢆព㆑ࡋ࡚ほᐹࡍࡿ ᅗ 1 ࠋ⫶ෆࡢほᐹグ㘓᪉ἲ࡜ࡋ࡚ࠊ୺࡟஧ࡘࡢ᪉ᘧࡀᐇ᪋ࡉࢀ࡚࠸ࡿࠋA ἲࡣᄇ㛛࠿ࡽ㡰⾜ᛶ࡟ほᐹࡋ࡚ᗃ㛛㍯࡟㐩ࡋࠊࢱ࣮ࣥほᐹ࡛ᄇ㛛࡟ᡠࡗ࡚ࡃࡿ᪉ᘧ࡛࠶ࡾࠊB ἲࡣ⫶ෆ࡟ධࡗ࡚ࡍࡄ࡟ᗃ㛛㍯࡟㐍ࢇ࡛࠿ࡽࢱ࣮ࣥほᐹ࡛ᄇ㛛࡟ᡠࡾࠊࢱ࣮ࣥࢆእࡋ࡚ぢୗࢁࡋほᐹࡍࡿ᪉ᘧ࡛࠶ࡿࠋ࡝ࡕࡽ
ࡢ᪉ἲ࡟ࡶ㛗▷ࡀ࠶ࡿࡀࠊ᳨ᰝ་ࡀ㥆ᰁࢇ࡛㛗ࡅࡓ᪉ἲ࡛ほᐹグ㘓ࢆ⾜࠼ࡤࡼ࠸ࠋ
⫶య㒊ᚋቨࡣぢୗࢁࡋほᐹࡢሙྜ࡟ࡣ✵Ẽ㔞ࢆẚ㍑ⓗᑡ࡞ࡵ࡜ࡍࡿࠋ✵Ẽ㔞ࡀከ࠸ሙྜ࡟᥋⥺᪉ྥ࡜࡞ࡿ⢓⭷㠃ࡀ⦆ࡳࠊほᐹࡋࡸࡍࡃ࡞ࡿ ᅗ 2 ࠋ๓ᗞ㒊ࡣᗃ㛛㍯ࢆ㡬Ⅼ࡜ࡍࡿ෇㗹ᙧࢆ࡞ࡋ࡚
࠾ࡾࠊ๓ቨ࣭ᚋቨ࣭኱ᙙ࣭ᑠᙙࡢ 4 ⢓⭷㠃ࢆࡍ࡭࡚ほᐹグ㘓ࡍࡿࠋഇᗃ㛛㍯ࡀᏑᅾࡍࡿሙྜࡣࠊ
ࡦࡔࡢ⿬ഃ࡟ࡶὀពࢆᡶ࠺ ᅗ 3 ࠋయ㒊ᑠᙙ࡜ᚋቨࡢ J ࢱ࣮ࣥほᐹࡣෆど㙾ࡀྍ⬟࡞㝈ࡾ᥋⥺᪉ྥ࡜࡞ࡽ࡞࠸ࡼ࠺࡞ゅᗘ࡛⢓⭷㠃ࢆグ㘓ࡍࡿࡇ࡜ࡀᮃࡲࢀࡿ ᅗ 4 ࠋయ㒊኱ᙙ࡜๓ቨࡢぢୗࢁࡋほᐹ᫬࡟ࡣ✵Ẽ㔞ࢆẚ㍑ⓗከࡵ࡟ࡋ࡚ࠊࡦࡔ࡜ࡦࡔࡢ㛫ࢆᗈࡆࠊ⑓ኚࡀࡦࡔࡢ⿬ഃ࡟㞃ࡉࢀ࡞࠸ࡼ࠺
࡟ᚰࡀࡅࡿ ᅗ 5 ࠋ⫶ෆど㙾᳨ᰝ᫬࡟ពᅗⓗ࡟ὀ┠ࡋ࡞࠸࡜ほᐹ࠿ࡽ₃ࢀࠊグ㘓⏬ീࡀṧࡏ࡞࠸㡿ᇦࡀ⫶ෆ࡟ࡣᏑᅾࡍࡿ ᅗ 6 ࠋ➨ 1 ࡟ᄇ㛛┤ୗᑠᙙࡢ J ࢱ࣮ࣥほᐹ࡛࠶ࡿࠋ✵Ẽ㔞ࢆẚ㍑ⓗከࡵ࡜ࡋ࡚ࠊ᭱኱ࡢࢱ࣮ࣥࢆෆど㙾࡟࠿ࡅ࡚༑ศ࡟ᘬࡁᢤ࠸࡚ほᐹࡍࡿࠋᄇ㛛ࡢ㐍⾜ࡀࢇࡢぢⴠ࡜ࡋࡣ㑊ࡅ࡞ࡅࢀࡤ࡞̿  ̿

ࡽ࡞࠸ࠋ➨ 2 ࡟⫶ゅ㒊࠿ࡽయୗ㒊ࡢᑠᙙ࣭ᚋቨࡢ J ࢱ࣮ࣥぢୖࡆほᐹ࡛࠶ࡿࠋ✵Ẽ㔞ࢆከࡵ࡜ࡋ
࡚ࠊ⢓⭷㠃ࢆ༑ศグ㘓ࡍࡿࠋ➨ 3 ࡟యୗ㒊࠿ࡽ⫶ゅࡢᚋቨぢୗࢁࡋ⏬ീ࡛࠶ࡿࠋ✵Ẽ㔞ࢆẚ㍑ⓗᑡ࡞ࡵ࡜ࡋ࡚ࠊࣛࣥࢻ࣐࣮ࢡ࡜ࡋ࡚ࡢ⫶ゅ࠿ࡽࡢࡦࡔࢆ⏬ീෆ࡟ྲྀࡾ㎸ࡳࠊ༢⊂࡛ࡶ㡿ᇦࡀࢃ࠿ࡿࡇ࡜ࡀᮃࡲࡋ࠸ࠋ➨ 4 ࡟ᗃ㛛㍯ࢆṇ㠃࡟ᤊ࠼ࠊᗃ㛛㍯๓㒊ࢆྵࡴ⏬ീ࡛࠶ࡿࠋᐜ᫆࡟ほᐹࡉࢀࡿሙྜࡶከ࠸ࡀࠊ⑭ࡏࡓ㧗㱋⪅࡛ࡣᡭ๓࡟ࡦࡔࡀ࡛ࡁࠊほᐹࡋࡀࡓ࠸ሙྜࡀ࠶ࡾࠊពᅗⓗ࡟グ㘓ࡍࡿࠋ3㸧⏕᳨ࡢᑐ㇟
⏕᳨ࡣ་⒪ಖ㝤⤥௜ࡢᑐ㇟ ᖹᡂ 15 ᖺ 7 ᭶ 30 ᪥ཌ⏕ປാ┬ಖ㝤ᒁ་⒪ㄢ஦ົ㐃⤡ ࡜࡞ࡿࡢ࡛ࠊ
࠶ࡽ࠿ࡌࡵ᳨デࡢ⮬ᕫ㈇ᢸ㢠ࡢ࡯࠿࡟ࠊ⏕᳨ᐇ᪋࡟ᑐࡍࡿಖ㝤デ⒪ࡢ⮬ᕫ㈇ᢸ㢠ࡀ㏣ຍࡉࢀࡿྍ
⬟ᛶࡢ࠶ࡿࡇ࡜ࢆཷデ⪅࡟ㄝ᫂ࡋࠊ஢ᢎࢆᚓ࡚࠾ࡃࠋ⏕᳨ࡣ⭘⒆ᛶ⑓ኚࡀ᝿ᐃࡉࢀࡿሙྜ࡟ࡢࡳ
⾜࠸ࠊ௨ୗࡢ⑓ኚ࡟ᑐࡋ࡚ࡣࠊཎ๎⏕᳨ࡢᚲせࡣ࡞࠸ࠋ࡞࠾ࠊ㟼⬦⒗ࡢ⏕᳨ࡣ⚗ᚷ࡛࠶ࡿࠋ᳨デෆど㙾᳨ᰝࡢ⏕᳨⋡ࡣ᭱ᑠ㝈࡜࡞ࡿࡼ࠺࡟ࡍ࡭ࡁ࡛࠶ࡿࠋձ ඾ᆺⓗ࡞⫶ᗏ⭢࣏࣮ࣜࣉ ղ ࢱࢥ࢖࣎ࡧࡽࢇ ճ 㯤Ⰽ⭘  մ ⾑⟶ᣑᙇ⑕ vascular ectasia յ 5 ੈ௨ୗࡢ㐣ᙧᡂ࣏࣮ࣜࣉ ն ༑஧ᣦ⭠₽⒆᳨ᰝ⤊஢ᚋ࡟ࠊཷデ⪅࡟ࡣ᳨ᰝ་࠿ࡽㄝ᫂ࢆ⾜࠺ࡀࠊ᭱⤊ⓗ࡞⤖ᯝࡣ⏕᳨⑓⌮デ᩿ཬࡧࢲࣈࣝ
ࢳ࢙ࢵࢡࡀ⤊ࢃࡗ࡚࠿ࡽࠊᨵࡵ࡚ㄝ᫂ࡍࡿࡇ࡜࡟࡞ࡿࠋ
4㸧Ⰽ⣲ᩓᕸ
⑓ኚࡢᛶ≧ࢆࡼࡾヲࡋࡃほᐹࡍࡿࡓࡵ࡟ࡣࠊ᳨デ࡟ᘬࡁ⥆࠸࡚⏕᳨ࢆᐇ᪋ࡍࡿሙྜ࡟ࡣࠊⰍ⣲ᩓᕸ 0.4%࢖ࣥࢪࢦ࣑࢝ࣝࣥࢆ 2㹼5 ಸ࡟ᕼ㔘ࡋࡓࡶࡢࢆᩓᕸ ࢆ⾜ࡗ࡚ࡶࡼ࠸ࠋ
⾲㠃ᆺᡥᖹୖ⓶ࡀࢇࡢᣠ࠸ୖࡆ࡟⊃ᖏᇦගほᐹ NBI: narrow band imaging; BLI: blue lazer
imaging ࡞࡝ࡣᴟࡵ࡚᭷⏝࡛࠶ࡿࡀࠊグ㘓⏬ീ࡜࡞ࡿ࡜᝟ሗ㔞ࡀᑡ࡞࠸ࡓࡵ࡟᳨デ࡟ࡣ㥆ᰁࡲࡎࠊ⑓ᕢࡢ࡞࠸㡿ᇦࢆ⊃ᖏᇦග࡛グ㘓ࡍࡿᚲせࡣ࡞࠸ࠋ㣗㐨⢓⭷࡬ࡢࣝࢦ࣮ࣝᩓᕸࡣയᐖࡀⓎ⏕ࡍࡿྍ⬟ᛶࡀ࠶ࡾࠊ⫶ෆど㙾᳨デ࡛ࡣ㑊ࡅࡿ࡭ࡁ࡛࠶ࡿࠋཧ⪃ᩥ⊩1㸧ⴗཎᘅ᫂㸪ᒣୗ⏤㉳Ꮚ㸪ඵᮌⱱ㸪௚㸬ഇ㝜ᛶ⋡࠿ࡽࡳࡓከ᪋タෆど㙾⫶ࡀࢇಶ᳨ูデࡢ㐺ṇ࡞᧜ᙳᯛᩘࡢ᳨ウ㸬᪥ᾘࡀࢇ᳨デㄅ 2010; 48:355–361㸬̿  ̿

ୖ㒊㣗㐨
㣗㐨ࡣ⫶ࡀࢇ᳨デᑐ㇟⮚ჾ࡛ࡣ࡞࠸ࡀࠊ୹ᛕ࡞ほᐹࡀᮃࡲࢀࡿࠋୖ㒊㣗㐨࡛ࡣࣛࣥࢻ࣐࣮ࢡ࡛࠶ࡿᕥ୺
Ẽ⟶ᨭࠊ᳝య࡟ࡼࡿᅽ㏕࡟ὀពࢆᡶ࠸ࠊ࿘ᅾࢆྲྀࡾ㐪࠼࡞࠸ࡼ࠺࡟ࡍࡿࠋ



୰㒊㣗㐨
㣗㐨ࡣၚᾮ࡞࡝࡟ࡼࡿἻ
ࡀከ࠸ࡢ࡛༑ศ࡞Ὑίࢆ
⾜࠺ࠋ୰㒊㣗㐨࡛ࡣ๓ቨ࠿
ࡽࡢᚰᢿືࠊᚋቨ࠿ࡽࡢ᳝
యᅽ㏕࡟ࡼࡾ࿘ᅾࢆ☜ㄆࡋࠊ඲ᬒࡀධࡿࡼ࠺࡞ほᐹグ㘓ࢆ⾜࠺ࠋୗ㒊㣗㐨ୗ㒊㣗㐨࡛ࡣᕥቨ࡟ᾮయ
ࡀ㈓␃ࡍࡿሙྜࡀ࠶ࡾࠊὙ
ί྾ᘬࡋ࡚ࠊ⢓⭷㠃ࢆ㟢ࢃ࡟ࡋ࡚ほᐹグ㘓ࢆ⾜࠺ࠋ㣗㐨⫶᥋ྜ㒊㣗㐨⫶᥋ྜ㒊࡛῝྾Ẽࢆ⾜࠸ࠊෆ⭍ࢆᗈࡆ࡚グ㘓ࡍࡿࠋᓥ≧෇ᰕୖ⓶ࠊᰙ≧⾑⟶⥙ࠊⓎ㉥ࠊ⢓⭷യᐖ࡞࡝ࡢከᙬ࡞ᡤぢࢆ࿊ࡍࡿࡇ࡜
ࡀከ࠸ࡢ࡛ὀព῝ࡃほᐹ
ࡍࡿࠋ



ᅗ 1.㣗㐨ࡢほᐹ̿  ̿

⫶యୖ㒊ᚋቨぢୗࢁࡋ⫶య㒊ᚋቨࡣ┤どᆺෆど㙾ࢆ⏝࠸ࡿぢୗࢁࡋ࡛ࡣ
᥋⥺᪉ྥ࡜࡞ࡗ࡚ほᐹࡋ࡙ࡽ࠸ࠋయୖ㒊࡛ࡣศỈᕊ Ჴ ࡜࿧ࡤࢀࡿ┒ࡾୖࡀࡾࡀ࠶ࡾࠊ࢔ࣥࢢࣝ᧯
సࢆ⾜࠸ࠊ┒ࡾୖࡀࡾࡢ
ᡭ๓ഃࡶほᐹグ㘓ࡍࡿࠋ⫶య୰㒊ᚋቨぢୗࢁࡋయ㒊࡛ࡣཎ๎ⓗ࡟ᑠᙙࢆ
12 ᫬᪉ྥ࡟⨨ࡁࠊ኱ᙙࡢ
ࡦࡔ࡟␃ពࡋ࡞ࡀࡽࠊẚ㍑ⓗ✵Ẽ㔞ࢆᑡ࡞ࡃࡋ࡚ᚋቨࡢほᐹグ㘓ࢆ⾜࠺ࠋ⫶యୗ㒊ᚋቨぢୗࢁࡋయୗ㒊࠿ࡽ⫶ゅ㒊ࡢᚋቨࡣ࡜ࡾࢃࡅほᐹࡋ࡟ࡃ࠸
㡿ᇦ࡛࠶ࡿࠋෆど㙾࡟ᅇ㌿ࢆຍ࠼ࠊ࢔ࣥࢢࣝ᧯స
ࢆ⏝࠸࡚ᚋቨࢆほᐹࡍࡿࡼ࠺࡟ᕤኵࡍࡿࠋ

⫶ゅୖ㒊ᚋቨぢୗࢁࡋ⫶ゅ㒊࡟㏆࡙ࡃ࡜ᚋቨࡢど㔝ࡣࡉࡽ࡟᥋⥺᪉ྥ࡟࡞ࡿࡢ࡛ࠊ࢔ࣥࢢࣝ᧯స
ࢆᙉࡃࡋ࡞ࡅࢀࡤ࡞ࡽ࡞
࠸ࡇ࡜ࡀከ࠸ࠋ⫶ゅᚋቨࢆࣛࣥࢻ࣐࣮ࢡ࡜ࡋ࡚⏬
ീ࡟ྲྀࡾ㎸ࡴࡇ࡜ࡀᚲせ
࡛࠶ࡿࠋ



ᅗ 2.⫶య㒊ᚋቨࡢほᐹ̿  ̿๓ᗞ㒊ᑠᙙ
๓ᗞ㒊ࡣẚ㍑ ⓗほᐹࡋࡸࡍ࠸㡿ᇦ ࡛࠶ ࡿࡀࠊ⫶ゅୗᑠᙙࡣෆど㙾 ඛ➃࡜㏆᥋ ࡋ࡚ほᐹࡋ࡙ࡽ࠸ሙ ྜࡀ࠶ࡿࠋ⢓⭷㠃࡜୍ᐃࡢ㊥㞳 ࢆ ࡜ ࡗࡓほ ᐹグ㘓ࡀᚲせ࡛࠶ࡿࠋ

๓ᗞ㒊ᚋቨ
๓ᗞ㒊࡛ࡶᚋቨࡣ᥋
⥺᪉ྥ࡜࡞ࡾࠊほᐹࡋ࡙ࡽ࠸ሙྜࡀ࠶ࡿࠋෆ
ど㙾࡟ᅇ㌿ࢆຍ࠼࡚ࠊほᐹグ㘓ࢆ⾜ ࠺ᚲせ
ࡀ࠶ࡿࠋ



๓ᗞ㒊኱ᙙ኱ ᙙ ࡣ ⢓ᾮ࡞ ࡝ࡀ௜╔ࡋࡸࡍ࠸ࡢ࡛ࠊ༑ศ
࡟Ὑίࢆ⾜ࡗ ࡚࠿ࡽ
ほ ᐹ グ 㘓 ࢆ⾜ ࢃ࡞ࡅࢀࡤ࡞ࡽ࡞࠸ࠋ

๓ᗞ㒊๓ቨ


㙠 ② ⸆ ࢆ౑⏝ ࡋ࡞࠸⿕᳨⪅࡟࠾࠸ ࡚⫶ゅ㒊࠿ࡽᗃ㛛Ὕ ࡟ྥࡅ࡚ ࡢ ⽸ ື Ἴ ࡀ ㉳ࡇࡿࡇ࡜ࡀ࠶ࡿࡢ࡛ࠊ㐠ືఇ Ṇ ᮇ ࢆᚅࡗ ࡚ほᐹグ㘓ࢆ⾜࠺ࠋ


ᅗ 3.ᗃ㛛๓ᗞ㒊ࡢほᐹ̿  ̿

⫶ゅ㒊ࡢ㹈ࢱ࣮ࣥ
⫶య㒊ᑠᙙ࡜ᚋቨࡢ㹈ࢱ࣮ࣥほᐹࡣ㔜せ࡛࠶ࡾࠊ┬ࡃࡇ࡜ࡀ࠶ࡗ࡚ࡣ
࡞ࡽ࡞࠸ࠋ⫶ゅ㒊࠿ࡽᄇ㛛ࢆ㐲ᮃࡍࡿ⏬ീࡣయ㒊ࡢᘼ≧ኚᙧࡢᣠ࠸ୖࡆ࡟㔜せ࡛࠶ࡾࠊⴎ⦰ᗘ
ࡢุᐃ࡟Ḟ࠿ࡏ࡞࠸ࠋయୗ㒊ࡢ㹈ࢱ࣮ࣥ
⢓⭷㠃ࢆ⯍ࡵࡿࡼ࠺࡟ࠊ
⫶ゅ㒊┤ୖࡢయୗ㒊࠿ࡽᄇ㛛┤ୗࡲ࡛ᑠᙙ࡜
ᚋቨࢆ୰ᚰ࡟ࠊྍ⬟࡞ࡽࡤ๓ቨࡲ࡛ෆど㙾ࢆᅇ㌿ࡉࡏ࡚ほᐹグ㘓ࡍࡿࠋయ୰㒊ࡢ㹈ࢱ࣮ࣥ
యୖ㒊࠿ࡽయ୰㒊ᑠᙙࢆ୰ᚰ࡜ࡋࡓ⑓ኚࡀぢⴠ࡜ࡉࢀࡿ᭱኱ࡢཎᅉ
ࡣࡇࡢ㹈ࢱ࣮ࣥほᐹࢆ┬ࡃࡇ࡜࡟࠶ࡿࠋ୹ᛕ࡞ほᐹグ㘓ࡀ㔜せ࡛࠶ࡿࠋᄇ㛛┤ୗࡢ㹈ࢱ࣮ࣥᄇ㛛┤ୗࡢయୖ㒊ᑠᙙࡢほᐹࡣ┬␎ࡋ࡚ࡣ࡞
ࡽ࡞࠸ࠋෆど㙾ࢆᅇ㌿ࡉࡏ࡚ࠊ๓ᚋቨࡶほᐹグ㘓ࡋࠊෆど㙾㍈ࡢᚋ᪉࡟㞃ࡉࢀࡓ⑓ኚࡢᏑᅾ࡟ࡶ
␃ពࡋ࡞ࡅࢀࡤ࡞ࡽ࡞࠸ࠋ
ᅗ 4. ⫶య㒊ᑠᙙࡢ - ࢱ࣮ࣥほᐹ̿  ̿

యୗ㒊๓ቨぢୗࢁࡋ⫶య㒊๓ቨ࡜኱ᙙ࡛ࡣ
௜╔ࡍࡿ⢓ᾮࡸ⫶ᾮࠊἻࢆὙί㝖ཤࡋࠊ✵Ẽ㔞ࢆẚ㍑ⓗከࡵ࡜ࡋ࡚ࠊほᐹグ㘓ࡍࡿࠋ

యୗ㒊኱ᙙぢୗࢁࡋ✵Ẽ㔞ࡀᑡ࡞࠸ሙྜࡸ
⫶ᾮࠊ⢓ᾮࡀ㝖ཤࡉࢀ࡚࠸࡞࠸࡜⑓ኚࡀ㞃ࡉࢀࡿࡇ࡜ࡀ㉳ࡇࡾ࠺ࡿࠋ

య୰㒊๓ቨ኱ᙙぢୗࢁࡋࡦࡔ࡜ࡦࡔࡢ㛫࡟⑓ኚࡀ㞃ࡉࢀ࡚࠸࡞࠸ࡇ࡜
ࢆ☜ㄆ࡛ࡁࡿぢୗࢁࡋ⏬ീࢆグ㘓ࡍࡿࠋ✵Ẽ㔞ࢆከࡃࡋ࡚ࡶࡦࡔ㛫ࡀᗈࡀࡽ࡞࠸ሙྜ࡟ࡣ῝྾Ẽࠊࡉࡽ࡟⫼⮩఩ㄏᑟࢆᐇ᪋ࡍࡿࠋయୖ㒊኱ᙙぢୗࢁࡋࡦࡔࡢ㉮⾜ࡀࡣࡌࡲࡿ
యୖ㒊ࡲ࡛࢔ࣥࢢࣝ᧯
సࢆ⏝࠸࡚༑ศ࡟ほᐹグ㘓ࡍࡿࠋ⢓ᾮ†ࡢ⢓⭷㠃࡟྾ᘬ⑞ࢆ௜ࡅ࡞࠸
ࡼ࠺࡟␃ពࡋ࡞ࡅࢀࡤ
࡞ࡽ࡞࠸ࠋ


ᅗ 5. ⫶య㒊඲ቨ࡜኱ᙙࡢほᐹ̿  ̿

ពᅗⓗ࡟グ㘓ࡋ࡞ࡅࢀࡤ
࡞ࡽ࡞࠸ಶᡤ
ձᄇ㛛┤ୗࡢᑠᙙ Jࢱ࣮ࣥ

┤どᆺෆど㙾ࢆ⏝࠸ࡓሙྜࠊほᐹࡋ࡟ࡃ࠸⟠ᡤࡀ⫶ෆ࡟ࡣᏑᅾࡍࡿࡀࠊ➨୍ࡀࡇࡢ㒊఩࡛࠶ࡿࠋᙉ
࠸࢔ࣥࢢࣝ᧯సࡀᚲせ࡜࡞ࡿࠋពᅗⓗ࡟グ㘓ࡋ࡞ࡅࢀࡤ
࡞ࡽ࡞࠸ಶᡤ
ղ⫶ゅ㒊࠶ࡿ࠸ࡣయୗ㒊࠿ࡽࡢᑠᙙᚋቨ Jࢱ࣮ࣥ┬␎ࡋࡓሙྜࠊ⫶య㒊ᑠᙙࢆ୰ᚰ࡜ࡋࡓᘼ≧ኚᙧࡸ⢓⭷ⴎ⦰ࡀぢⴠ࡜ࡉࢀࡿࠋ- ࢱ࣮ࣥほᐹ⏬ീࡣከࡵ࡟᧜ᙳࡍࡿࠋពᅗⓗ࡟グ㘓ࡋ࡞ࡅࢀࡤ
࡞ࡽ࡞࠸ಶᡤ
ճ⫶ゅ㒊ᚋቨぢୗࢁࡋⓗ☜࡞࢔ࣥࢢࣝ᧯స࡜ෆ
ど㙾ࡢᅇ㌿ࢆ⾜ࢃ࡞࠸࡜ࠊ᥋⥺᪉ྥࡢほᐹ࡜࡞ࡗ࡚ࡋࡲ࠺ࡢ࡛ὀពࡍ
ࡿࠋ




ពᅗⓗ࡟グ㘓ࡋ࡞ࡅࢀࡤ
࡞ࡽ࡞࠸ಶᡤ
մᗃ㛛㍯๓㒊࠿ࡽᗃ㛛㍯



ᗃ㛛㍯๓㒊࡟ᶓ㉮ࡍࡿഇᗃ㛛㍯ࡀ࠶ࡿሙྜࡸᗃ㛛㍯ࡀᚋቨഃ࡟㛤ࡃሙྜ࡟ほᐹࡋ࡙ࡽࡃ࡞ࡿࡀࠊᗃ
㛛㍯ࢆ☜ᐇ࡟ᤊ࠼ࡓほᐹグ㘓ࡀᚲ㡲࡛࠶ࡿࠋ


ᅗ 6. ព㆑ࡋ࡚ほᐹࡋ࡞ࡅࢀࡤ࡞ࡽ࡞࠸⫶ෆࡢ 4 㡿ᇦ㸦⣽ᕝ἞㸧̿  ̿



5. ᶵჾ⟶⌮1㸧ᶵჾ⟶⌮ࡢཎ๎་⒪ჾලᾘẘࡢỈ‽࡜᪉ἲࡣࠊឤᰁ⑕౛࡟ᑐࡋ࡚⏝࠸ࡓჾල࡛࠶ࡿ࠿࡛ࡣ࡞ࡃࠊḟ࡟෌౑⏝ࡍࡿࡇ࡜ࢆᇶ‽࡜ࡍࡿࠋᾘẘỈ‽ࢆ༊ศࡋࡓ E. H. Spaulding ศ㢮࡟ᇶ࡙ࡅࡤࠊᾘ໬ჾෆど㙾ᶵჾࡣࢭ࣑ࢡࣜࢸ࢕࢝ࣝ࡟ヱᙜࡍࡿ 1)ࠋᡭ⾡ჾලࡸ࢝ࢸ࣮ࢸࣝ࡞࡝ࡢࢡࣜࢸ࢕࢝ࣝ࡟⥆ࡃ㧗࠸Ỉ‽࡟࠶ࡾࠊ⁛⳦࡟ḟࡄẁ㝵࡛࠶ࡿ㧗Ỉ‽ᾘẘฎ⌮ἲࡀ㐺ྜࡍࡿ 2)ࠋ㧗Ỉ‽ᾘẘ࡛ࡣࠊⱆ⬊ࡀከᩘᏑᅾࡍࡿሙྜ
ࢆ㝖ࡁࠊࡍ࡭࡚ࡢᚤ⏕≀ࢆṚ⁛ࡉࡏࡿࡇ࡜ࡀせồࡉࢀࡿࠋ᳨デࡣ↓⑕≧⪅ࢆᑐ㇟࡜ࡋ࡚࠸ࡿ་⒪⾜Ⅽ࡛࠶ࡿࠋឤᰁ⑕ࢆྵࡵ࡚೺ᗣ⿕ᐖࡢⓎ⏕ࡣⓙ↓࡛࠶ࡿࡇ࡜ࢆ┠ᣦࡉ࡞ࡅࢀࡤ࡞ࡽ࡞࠸ࠋ
⾑ᾮࢆ௓ࡍࡿ᧯సࢆ⾜࠺ჾල 㖀Ꮚࡸࣈࣛࢩ࡞࡝ ࡟ᑐࡋ࡚ࡣࠊ࣮࢜ࢺࢡ࣮ࣞࣈ࡞࡝ࡢ⁛⳦ࡀᚲせ࡛࠶ࡾࠊෆど㙾ࡢࡼ࠺࡟⢓⭷࡟᥋ࡍࡿჾල࡟㛵ࡋ࡚ࡣࠊ๓㏙ࡢࡈ࡜ࡃ㧗Ỉ‽ᾘẘฎ⌮ࢆᐇ᪋ࡍࡿࠋ㧗Ỉ‽ᾘẘ๣࡜ࡋ࡚ࡣࠊձ ࢢࣝࢱ࣮ࣝ࢔ࣝࢹࣄࢻࠊղ ࣇࣛࢱ࣮ࣝ〇๣ࠊճ 㐣㓑㓟ࡢ 3 ✀ࡀ࠶ࡆࡽࢀࠊࡇࢀࡽࡢᾘẘ๣ࡢྲྀᢅ࠸ㄝ᫂᭩ࢆ⇍ㄞࡋ࡚≉ᛶࢆ⌮ゎࡋࠊ༑ศ࡞㓄៖ࢆ⾜࠺ࠋᙉ㓟ᛶ㟁ゎỈࡸ࢜ࢰࣥỈ࡞࡝ࡢᶵ⬟Ỉࢆ౑⏝ࡋࡓෆど㙾ჾල࡬ࡢᾘẘຠᯝࡣ᫂☜࡛ࡣ࡞࠸ࠋ
⮬ືὙίᾘẘᶵ࡟࠿ࡅࡿ๓ࡢෆど㙾ࡢ⏝ᡭὙίࡀ୙༑ศ࡞ሙྜ࡟ࡣࠊ࡝ࡢ⸆๣ࢆ౑⏝ࡋ࡚ࡶᾘẘຠᯝࡀⴭࡋࡃపୗࡍࡿࠋ᳨ᰝ⤊஢ᚋ┤ࡕ࡟⾜ࢃࢀࡿෆど㙾ෆእࡢὙί࣭ᾘẘࡣࠊឤᰁ㜵Ṇ࡟ࡣ᭱㔜せ࡛࠶ࡿࠋ
2㸧Ὑί࣭ᾘẘࡢ᪉ἲෆど㙾ࡢὙί࣭ᾘẘࡣࠊ᪥ᮏᾘ໬ჾෆど㙾Ꮫ఍ࡢ㺀ᾘ໬ჾෆど㙾ࡢឤᰁไᚚ࡟㛵ࡍࡿ࣐ࣝࢳࢯࢧ
࢚ࢸ࢕ᐇ㊶࢞࢖ࢻ㺁࡟‽ࡌࡿ 2)ࠋὙίᢸᙜ⪅ࡣࠊ㐺ษ࡞ PPE personal protective equipment: ಶே㜵ㆤල ࢆ⿦╔ࡍࡿࡇ࡜ࡀᮃࡲࡋ࠸ࠋෆど㙾ࡣࡣࡌࡵ࡟⏝ᡭ࡛Ὑίࡍࡿ ᅗ 1 ࠋ᳨ᰝ⤊஢ᚋෆど㙾ࢆࢩࢫࢸ࣒࠿ࡽྲྀࡾእࡉࡎࠊෆど㙾ࡢእ⾲࡟௜╔ࡍࡿ⾑ᾮࡸ⢓ᾮࢆ㝖ཤࡍࡿ┠ⓗ࡛ࠊὙίᾮࢆྵࡲࡏࡓ࣮࢞ࢮ࡛ෆど㙾⾲㠃ࢆ༑ศ࡟ᣔࡁྲྀࡿࠋ⥆࠸࡚ࠊ྾ᘬ࣎ࢱࣥࢆ᧯సࡋ࡚ෆど㙾ඛ➃࠿ࡽὙίᾮ 200mL ௨ୖࢆ྾ᘬࡋࠊࡉࡽ࡟㏦
Ẽ࣭㏦Ỉࢳࣕࣥࢿࣝ࡟Ỉ࡜✵Ẽࢆ஺஫࡟㏦ࡾΎᤲࡍࡿࠋὙ࠸ሙ࡟⛣ືࡋࠊෆど㙾඲యࢆỈ࡟ᾐࡅࡿࡓࡵ㜵Ỉ࢟ࣕࢵࣉࢆ⿦╔ࡋࠊỈ₃ࢀࢸࢫࢺࢆᐇ᪋ࡍࡿࠋỈ₃ࢀࢸࢫࢺ⤊஢ᚋࡣࠊ྾ᘬ࣭㖀Ꮚࢳࣕࣥࢿࣝෆࢆࣈࣛࢵࢩࣥࢢࡋ࡚ởࢀࢆⴠ࡜ࡍࠋࣈࣛࢵࢩࣥࢢࡣࠊ㸯ᅇẖ࡟ࣈࣛࢩඛ➃ࡢởࢀࡢ᭷↓ࢆ☜ㄆࡋ࡞ࡀࡽࠊ⧞ࡾ㏉ࡋ ᚟ࡋ࡚⾜࠺ࠋࣈࣛࢵࢩࣥࢢ᪉ྥࡣࠊෆど㙾࣓࣮࣮࢝ࡸᶵ✀ࡢ㐪࠸࡟ࡼࡾ␗࡞ࡿࡇ࡜ࡀ࠶ࡾࠊྲྀᢅ࠸ㄝ᫂᭩ࢆ☜ㄆࡍࡿࠋὙίᚋࠊෆど㙾እ⾲ࡸࢳࣕࣥࢿࣝෆࡣࠊỈ㐨Ỉࢆ⏝࠸ࡓࡍࡍࡂࢆ༑ศ࡟⾜࠺ࠋࡇࡢࡼ࠺࡞సᴗ㐣⛬ࡢ୰࡛ࠊෆど㙾እ⾲࡜ࢳࣕࣥࢿࣝෆࡢ௜
╔⢓ᾮཬࡧ⾑ᾮࡀ࡯ࡰ㝖ཤࡉࢀࡿࡇ࡜࠿ࡽࠊᴟࡵ࡚㔜せ࡞ฎ⌮࡛࠶ࡿࡇ࡜ࢆ⌮ゎࡋࠊྛᕤ⛬ࡢ┬␎ࡸᡭᢤࡁࡣៅࡲ࡞ࡅࢀࡤ࡞ࡽ࡞࠸ࠋ
㏦Ẽ࣭㏦Ỉ࣎ࢱࣥࠊ྾ᘬ࣎ࢱࣥࠊ㖀Ꮚᰦࠊ๪㏦Ỉ࢟ࣕࢵࣉࠊ྾ᘬษࡾ᥮࠼ࣞࣂ࣮ࠊ㏫ὶ㜵Ṇᘚ࡞࡝ࡣ㜵Ỉ࢟ࣕࢵࣉࢆ௜ࡅࡓࡲࡲྲྀࡾእࡋࠊู㏵Ὑί࡜ᾘẘࢆ⾜࠺ࠋࡇࡢᚋ࡟ࠊὙί࣭ᾘẘࡢᆒ୍໬ཬࡧᚑ஦⪅ࡢ㌟య࡬ࡢᾘẘ⸆᭚㟢㜵Ṇ࡟㓄៖ࡋ࡚ࠊ⮬ືὙίᾘẘᶵࢆ౑⏝ࡍࡿࠋ㧗Ỉ‽ᾘẘᾮࢆ౑⏝ࡋࠊᾘẘᾮࡢ౑⏝ᅇᩘࠊ᭷ຠ᪥᫬ࠊ⃰ᗘཬࡧᚲせ࡟ᛂࡌᗘ⟶⌮࡞࡝࡬ࡢ㓄៖ࡀᚲせ࡛࠶ࡿࠋ ྛᾘẘ⸆ࡢྲྀᢅ࠸ㄝ᫂᭩࡟ᚑࡗ࡚ᑐฎࡍࡿࠋ
㸯᪥ࡢ᳨ᰝࡀ⤊஢ᚋ࡟ᾘẘࢆ⤊࠼ࡓෆど㙾࡟㛵ࡋ࡚ࡣࠊྛ⟶㊰ෆ࡟ᾘẘ⏝࢚ࢱࣀ࣮ࣝࢆὀධᚋࠊ̿  ̿

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㏦Ẽ㏦Ỉࢆ⾜ࡗ࡚஝⇱ࡉࡏࡿࠋ஝⇱ຠᯝ࡜ྠ᫬࡟ࠊࢢࣝࢱ࣮ࣝ࢔ࣝࢹࣄࢻ⪏ᛶᢠ㓟⳦࡞࡝࡟ᑐࡋ
࡚ࡶᾘẘຠᯝࢆ᭷ࡍࡿ࡜⪃࠼ࡽࢀࡿࠋ

ᅗ 1. Ὑί࣭ᾘẘࡢ㐣⛬     

3㸧ෆど㙾ࡢಖ⟶ෆど㙾ࢆ༑ศ࡟஝⇱ࡉࡏࡓᚋࠊಖ⟶ᗜ࡟ྞࡾୗࡆࡿࠋෆど㙾ᐊࡣᖖ࡟Ύ₩࡟ࡋ࡚ࠊᾘẘࢆ⾜ࡗࡓᶵჾࡢ෌ởᰁࢆ㉳ࡇࡉ࡞࠸ࡼ࠺࡟␃ពࡍ࡭ࡁ࡛࠶ࡿࠋ≉࡟ࠊෆど㙾ಖ⟶ᗜࡣෆど㙾ᶵჾ࡜ྠᵝࠊᖖ࡟Ύ₩ࢆಖࡘᚲせࡀ࠶ࡾࠊ㞧⳦ࡀ⦾Ṫࡋ࡞࠸ࡼ࠺࡟ὀពࡀᚲせ࡛࠶ࡿࠋ4㸧ෆど㙾ฎ⨨ලෆど㙾ฎ⨨ලࡢ୰࡟ࡣࠊᒁᡤὀᑕ㔪࡞࡝ở≀ࡢ㝖ཤࡀᅔ㞴࡛ࠊ෌⏕฼⏝ࢆ⾜ࡗࡓሙྜ࡟ឤᰁࡢ
༴㝤ࢆᣢࡘฎ⨨ල࡜ࠊ⁛⳦ࡍࢀࡤ෌⏕฼⏝ྍ⬟࡞ฎ⨨ලࡀ࠶ࡿࠋୡ⏺ෆど㙾Ꮫ఍࡛ࡢࢥࣥࢭࣥࢧࢫ࡛ࡣࠊձ ᒁᡤὀᑕ㔪ࠊղ ࢸࣇࣟࣥࢥ࣮ࢸ࢕ࣥࢢࡢ࢞࢖ࢻ࣡࢖
࣮ࣖࡢ෌⏕฼⏝ࡣ⚗ࡌࡽࢀ࡚࠸ࡿ 3)ࠋࡑࡢ௚ࡢฎ⨨ල࡛ࡶࢹ࢕ࢫ࣏࣮ࢨࣈࣝ⏝࡟స〇ࡉࢀࡓࡶࡢࡢ
෌⏕฼⏝ࡣ༴㝤࡛࠶ࡿࠋ෌⏕฼⏝ྍ⬟࡞ฎ⨨ලࡣࠊὙίᾮ࡜ࣈࣛࢩ࡛༑ศ࡟௜╔⢓ᾮ࡞࡝ࢆⴠ࡜
ࡋࠊ⏝ᡭὙίࡢࡳ࡛ࡣở≀㝖ཤࡀ୙༑ศ࡞ࡓࡵ࡟ࠊ㉸㡢ἼὙίࢆຍ࠼ࡿࠋ㉸㡢ἼὙίᚋࠊ₶⁥๣ࢆሬᕸࡋࡓฎ⨨ලࡣ࣮࢜ࢺࢡ࣮ࣞࣈ࡛⁛⳦ࢆ⾜࠺ࠋ⣲ᮦ࡟ࡼࡾ࣮࢜ࢺࢡ࣮ࣞࣈ࡟ࡼࡿຍ⇕࡟ሓ࠼࡞࠸ჾල࡟ᑐࡋ࡚ࡣࠊ࢚ࢳࣞࣥ࢜࢟ࢧ࢖ࢻ࢞ࢫ EO ࢞ࢫ ࡞࡝࡛ࡢ⁛⳦ࢆᐇ᪋ࡍࡿࠋ

ཧ⪃ᩥ⊩
1㸧 Spaulding EH. Chemical disinfection of medical and surgical materials. Lawrence CA, Block SS, eds.
Disinfection, sterilization and preservation. Lea & Febiger, Philadelphia, 1968, 517–531.
2㸧 ㉥ᯇὈḟ㸪▼ཎ❧㸪బ⸨බ㸪௚ ᪥ᮏᾘ໬ჾෆど㙾Ꮫ఍ 㸬ᾘ໬ჾෆど㙾ࡢឤᰁไᚚ࡟㛵ࡍࡿ࣐ࣝࢳࢯࢧ࢚ࢸ࢕ᐇ㊶࢞࢖ࢻ㸬Gastroenterol Endosc 2014; 56:89–107㸬̿  ̿

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3㸧 World Gastroenterology Organization / World Endoscopy Organization. Global Guidelines: Endoscope
disinfectionʊa resource-sensitive approach (February 2011). WGO/WEO, 2011.
http://www.worldgastroenterology.org/guidelines/global-guidelines/endoscope-disinfection/endoscopedisinfection-english [2016.01.22]㸦⣽ᕝ἞㸧̿  ̿

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6. ⤖ᯝሗ࿌
1㸧᳨ᰝᚋࡢㄝ᫂⫶ෆど㙾᳨デࡢ᳨ᰝ་ࡣࠊ᳨ᰝ⤊஢᫬࡟ࠊ᳨ᰝࡢᴫせࠊ⏕᳨ࡢ᭷↓࡟ࡘ࠸࡚ㄝ᫂ࢆ⾜࠺ࠋࡇࡢ㝿ࠊ᳨ᰝ᫬ࡢ⤖ᯝࡣࢲࣈࣝࢳ࢙ࢵࢡ࡟ࡼࡾ᭱⤊ⓗ࡞ุᐃࡀỴᐃࡍࡿࡇ࡜࠿ࡽࠊ᳨ᰝ᫬ࡢ⤖ᯝࡣኚ᭦ࡉࢀࡿྍ⬟ᛶࡀ࠶ࡾࠊ᭱⤊ⓗ࡞ุᐃ⤖ᯝࢆ☜ㄆࡍࡿᚲせᛶࢆㄝ᫂ࡍࡿࠋ᳨ᰝ᫬࡜᭱⤊ⓗ࡞ุᐃ⤖ᯝࡀ␗࡞ࡗࡓሙྜ࡟ࡣࠊ᳨ᰝ་ࡀ᳨ᰝ⏬ീࢆᥦ♧ࡋ࡞ࡀࡽࠊᑐ㠃࡛ヲ⣽࡞ㄝ᫂ࢆ⾜࠺࡭ࡁ࡛࠶
ࡿࠋ2㸧ཷデ⪅࡬ࡢ⤖ᯝሗ࿌⫶ෆど㙾᳨デཷデ⪅࡟ࡣࠊㄞᙳጤဨ఍࡟ࡼࡿ᭱⤊ุᐃ࡟ᇶ࡙ࡁࠊ㺀ุᐃ㺁ࡢ᝟ሗࢆ㏻▱ࡍࡿࠋࡲࡓࠊ㺀ุᐃ㺁࡟ᑐᛂࡋࡓ஦ᚋᣦᑟࢆ௜ຍࡍࡿࠋデ᩿ྡࡣᚲせ࡟ᛂࡌ࡚グ㍕ࡍࡿࠋ⾲ 1 ࡟ලయ᱌ࢆᥦ
♧ࡋࡓࠋ⤖ᯝ㏻▱ࡣ᳨ᰝཷデᚋ 2 㐌㛫௨ෆࡀᮃࡲࡋ࠸ࡀࠊᅔ㞴࡞ሙྜ࡛ࡶ 1 ࠿᭶௨ෆ࡟☜ᐇ࡟ఏ㐩ࡍࡿࠋ⫶ෆど㙾᳨デࡢ᪋⾜ࡣከࡃࡣಶูࡢ་⒪ᶵ㛵࡛ᐇ᪋ࡉࢀࡿࡇ࡜࠿ࡽࠊ᳨ᰝ་ࡀᑐ㠃᳨࡛ᰝグ㘓ࢆᥦ♧ࡋ࡞ࡀࡽࠊࡑࡢㄝ᫂ࢆ⾜࠺ࠋᅔ㞴࡞ሙྜ࡟ࡣࠊ㒑㏦࡟ࡼࡿఏ㐩ࡶྍ⬟࡛࠶ࡿࡀࠊ㺀⫶ࡀࢇ࠶ࡾ㺁㺀⫶ࡀࢇ␲࠸㺁㺀⫶ࡀࢇ௨እࡢᝏᛶ⑓ኚ㺁౛࡟ࡘ࠸࡚ࡣࠊᑐ㠃࡟ࡼࡿཷデ⪅࡬ࡢಶูㄝ᫂ࡀᚲせ࡛
࠶ࡿࠋᚲせ࡟ᛂࡌ࡚ᑓ㛛ࡢ་⒪ᶵ㛵ࢆ⤂௓ࡋࠊ㐺ษ࡞἞⒪ࢆཷࡅࡽࢀࡿࡼ࠺࡟ᨭ᥼ࡍࡿࠋ㺀⫶ࡀࢇ࡞ࡋ㺁ࡢሙྜࡣࠊ2 ᖺᚋࡢḟᅇ᳨デࢆ່ࡵࡿࠋ⫶ෆど㙾᳨デᐇ᪋་⒪ᶵ㛵ࡣࠊ⤖ᯝุᐃ⚊ P.42ཧ↷ ࡢࢲࣈࣝࢳ࢙ࢵࢡࢆᢸᙜࡍࡿ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࡟ᥦฟࡍࡿࠋ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࡣࢲࣈࣝࢳ࢙ࢵࢡᚋࡢ⤖ᯝࢆᐇ᪋་⒪ᶵ㛵࡟ࣇ࢕࣮ࢻࣂࢵࢡࡍࡿ࡜࡜ࡶ࡟ࠊุᐃ⤖ᯝࡢ࡜ࡾࡲ࡜ࡵࢆ⾜࠺ࠋ௨㝆ࡢ㏣㊧ㄪᰝ࡟ࡘ࠸
࡚ࡣࠊ๓㏙グ㍕ࢆཧ↷ࡍࡿ P.43 ࠋⓎぢࡀࢇࡢࡀࢇⓏ㘓࡬ࡢᒆฟࡣࠊཎ๎࡜ࡋ࡚⫶ෆど㙾᳨ᰝࢆᐇ᪋ࡋࡓ᳨ᰝ་⒪ᶵ㛵ࡀ⾜࠺ࠋ̿  ̿

⾲ 1. ᳨デ⤖ᯝሗ࿌ᵝᘧ㸦౛㸧⫶ෆど㙾᳨デ⤖ᯝࡢ࠾▱ࡽࡏẶ  ྡ                                ᛶ  ู     ⏨      ዪ⏕ᖺ᭶᪥     ኱ṇ࣭᫛࿴      ᖺ    ᭶    ᪥⏕ఫ  ᡤ      ᖺ  ᭶  ᪥࡟ࠊ㸦⫶ෆど㙾᳨デᐇ᪋་⒪ᶵ㛵ྡ㸧࡛ᐇ᪋࠸ࡓࡋࡲࡋࡓ
᳨ᰝࡢ⤖ᯝࡣࠊୗグࡢ࡜࠾ࡾ࡛ࡋࡓࡢ࡛ࠊ࠾▱ࡽࡏࡋࡲࡍࠋ
グ1.

௒ᅇࡢ᳨ᰝ࡛ࡣࠊ⫶ࡀࢇࡣㄆࡵࡽࢀࡲࡏࢇ࡛ࡋࡓࠋ
⌧ᅾࠊ⫶ࡀࢇ࠶ࡿ࠸ࡣ⫶ࡀࢇࢆ␲࠺⑓ኚࡣ࠶ࡾࡲࡏࢇࠋ
௒ᚋࡶࠊ⥅⥆ࡋ࡚ࠊᐃᮇⓗ࡟᳨デࢆཷࡅࡿࡇ࡜ࢆ࠾່ࡵࡋࡲࡍࠋ
⑕≧ࡢ࠶ࡿሙྜ࡟ࡣࠊḟᅇࡢ᳨デࢆᚅࡓࡎ࡟ࠊ᭱ᐤࡾࡢ་⒪ᶵ㛵ࡢཷデࢆ࠾່ࡵࡋ
ࡲࡍࠋ

2.

௒ᅇࡢ᳨ᰝࡢ⤖ᯝࠊ෌᳨ᰝࡀᚲせ࡛ࡍࠋ௒ᅇࡢ᳨ᰝ࡛ࡣࠊ㸦デ᩿ྡ࡞࡝㸧    ࡀ␲ࢃࢀࡲࡍࠋ෌ᗘࠊ⫶ෆど㙾᳨ᰝࡀᚲせ࡜࡞ࡾࡲࡍࡢ࡛ࠊ་⒪ᶵ㛵ࢆཷデࡋ࡚ࡃࡔࡉ࠸ࠋ

3.

௒ᅇࡢ᳨ᰝ࡛ࡣࠊୗグࡢ⑓ኚࡀㄆࡵࡽࢀࡲࡋࡓࠋ
㸦デ᩿ྡ࡞࡝㸧    ࡀㄆࡵࡽࢀࡲࡍࠋ἞⒪ࡀᚲせ࡜࡞ࡾࡲࡍࡢ࡛ࠊ་⒪ᶵ㛵ࢆཷデࡋ࡚ࡃࡔࡉ࠸ࠋ௨ୖ⫶ෆど㙾᳨デᐇ᪋་⒪ᶵ㛵㸸㐃⤡ඛ⫶ࡀࢇ᳨デᐇ᪋୺య㸦ᕷ༊⏫ᮧᢸᙜ㒊⨫㸧㐃⤡ඛ㸦℈ᓥࡕࡉ࡜㸧̿  ̿

ϯ. ୙฼┈࡬ࡢᑐ⟇
1. ഇ㝧ᛶ⫶ෆど㙾᳨デ࡛ࡣࠊഇ㝧ᛶ⋡ࡢ௦᭰ᣦᶆ࡜ࡋ࡚ࠊ⏕᳨⋡ࡀ⏝࠸ࡽࢀࡿࡇ࡜ࡀከ࠸ࠋ⫶ෆど㙾᳨デࡢ⢭ᐦ᳨ᰝ࡟┦ᙜࡍࡿ⏕᳨ࡣࠊ㺀⫶ࡀࢇ㺁࠶ࡿ࠸ࡣ㺀⫶ࡀࢇ␲࠸㺁ࡢ⑓ኚ࡟㝈ᐃࡋ࡚⾜࠸ࠊ୙ᚲせ࡞⏕᳨ࡣᴟຊ㑊ࡅࡿ࡭ࡁ࡛࠶ࡿࠋ༑ศ࡞ほᐹࢆ⾜࠺ࡇ࡜࡛ࠊ㺀⫶ࡀࢇ␲࠸㺁ࡢ⑓ኚ࡜᫂ࡽ࠿࡞Ⰻᛶ
⑓ኚࡢ㆑ูࡣྍ⬟࡛࠶ࡿࠋ୙ᚲせ࡞⏕᳨ࡣࠊฟ⾑࡞࡝ࡢഅⓎ⑕ࢆㄏⓎࡍࡿࠋࡲࡓࠊཷデ⪅࡟ࡼࡗ࡚ࡣ㺀ࡀࢇ␲࠸㺁ࡢ⑓ኚ ഇ㝧ᛶ ࢆ♧၀ࡍࡿࡇ࡜࡛ࠊ୙Ᏻࢆ୚࠼ࡿሙྜࡶ࠶ࡿ 1)ࠋ
 ࡍ࡛࡟⫶ෆど㙾᳨デࢆᑟධࡋ࡚࠸ࡿᆅᇦࡢ⏕᳨⋡ࡣࠊ10㹼15%࡛࠶ࡿ 2-4)ࠋᑟධᚋ࡟⢭ᗘ⟶⌮ࡀ
ᾐ㏱ࡍࡿࡇ࡜࡟ࡼࡾ⏕᳨⋡ࡶῶᑡࡋࠊ10%௨ୗ࡜࡞ࡗ࡚࠸ࡿ 4)ࠋᚑࡗ࡚ᑟධ᫬ࡣࠊ⫶ෆど㙾᳨デࡢ⏕᳨⋡ࡣ 15%௨ୗ࡟␃ࡵࡿ࡭ࡁ࡛࠶ࡿࠋࡉࡽ࡟ࠊ⢭ᗘ⟶⌮యไࢆᩚഛࡍࡿࡇ࡜࡟ࡼࡾせ⏕᳨⋡ࢆ
10%௨ୗ࡟ࡍࡿࡇ࡜ࢆ┠ᶆ࡜ࡍࡿࠋ
2. 㐣๫デ᩿㺀᭷ຠᛶホ౯࡟ᇶ࡙ࡃ⫶ࡀࢇ᳨デ࢞࢖ࢻࣛ࢖ࣥ 2014 ᖺᗘ∧㺁5)࡛ࡣࠊ ⫶ෆど㙾᳨デࡢ᳨デ㛫㝸ࢆ
2㹼3 ᖺ࡜ࡍࡿࡇ࡜ࡀᮃࡲࡋ࠸࡜ࡋ࡚࠸ࡿࠋ⫶ෆど㙾᳨デࢆ㢖ᅇ࡟⾜࠺ࡇ࡜࡛᪩ᮇࡀࢇࡀࡼࡾከࡃぢࡘ࠿ࡿࡀࠊࡑࡢ୰࡟ࡣࠊ⏕࿨ணᚋ࡟┤᥋ᙳ㡪ࡢ࡞࠸㐣๫デ᩿ࡀྵࡲࢀ࡚࠸ࡿྍ⬟ᛶࡀ࠶ࡿࠋ㢖ᅇ࡟᳨デࢆ⾜࠺ࡇ࡜࡛㐣๫デ᩿ࡀቑຍࡋࠊ
㐣๫ཷデࢆㄏⓎࡍࡿ 6)ࠋࡀࢇ᳨デ࡟ࡼࡿ㐣๫デ᩿ࢆྍ⬟࡞㝈ࡾῶᑡࡉࡏࡿࡓࡵ࡟ࡣࠊ᳨デᅇᩘࢆ᭱ᑠ㝈࡜ࡍࡿࡇ࡜ࡀᮃࡲࡋ࠸ 7)ࠋᚑࡗ࡚ࠊ⫶ෆど㙾᳨デࡣẖᖺ࡛ࡣ࡞ࡃࠊ2 ᖺ࡟ 1 ᅇ࡟␃ࡵࡿ࡭ࡁ࡛
࠶ࡿࠋ
3. ឤᰁ
ᾘ໬ჾෆど㙾ࡢ㧗Ỉ‽ᾘẘࡢᴫᛕࡀᬑཬࡋࡓ⌧ᅾࠊឤᰁࣜࢫࢡࢆᣍࡃ኱ࡁ࡞せᅉࡣࠊෆど㙾ࡸ௜ᒓရ࣭ฎ⨨ලࡢ୙㐺ษ࡞Ὑίࡸᾘẘ࡟㛵୚ࡋ࡚࠸ࡿྍ⬟ᛶࡀ㧗࠸ࠋ๓㏙ࡢᶵჾ⟶⌮ P.64 ࢆཧ↷ࡋࠊෆど㙾ࡢὙί࣭ᾘẘࡣ㐺ษ࡟⾜ࢃࢀࡿ࡭ࡁ࡛࠶ࡿࠋࡲࡓࠊෆど㙾ࡢὙίࡣ⏝ᡭὙίࡢࡳ࡛ࡣ୙
༑ศ࡛࠶ࡾࠊᚲࡎ⮬ືὙίᾘẘᶵࢆే⏝ࡍ࡭ࡁ࡛࠶ࡿࠋཧ⪃ᩥ⊩1㸧 ᅜ❧ࡀࢇ◊✲ࢭࣥࢱ࣮ ࡀࢇண㜵᳨࣭デ◊✲ࢭࣥࢱ࣮㸬᭷ຠᛶホ౯࡟ᇶ࡙ࡃஙࡀࢇ᳨デ࢞࢖ࢻ
ࣛ࢖ࣥ 2013 ᖺᗘ∧㸬ᮾி㸪2014㸬
2㸧 Hamashima C, Okamoto M, Shabana M, et al. Sensitivity of endoscopic screening for gastric cancer
by the incidence method. Int J Cancer 2013; 133:653–659.
3㸧 ኱㔝೺ḟ㸪㧗␊୍㑻㸪᱒ᒣṇே㸪௚㸬㝧ᛶ཯ᛂ㐺୰ᗘ࡜⒴Ⓨぢ⋡࠿ࡽࡳࡓ⫶ෆど㙾ከ᪋タ᳨
デ࡟࠾ࡅࡿ⮳㐺⏕᳨⋡࡟ࡘ࠸࡚ࡢ᳨ウ㸬᪥ᾘࡀࢇ᳨デㄅ 2011; 49:613–617.

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4㸧 ᪂₲ᕷ࣭᪂₲ᕷ་ᖌ఍㸬᪂₲ᕷ⫶ࡀࢇ᪋タ᳨デᐇ᪋せ㡿㸬᪂₲ᕷ⫶ࡀࢇෆど㙾᳨デ 10 ᖺࡢ࠶ࡺࡳ㸪୍⯡♫ᅋἲே᪂₲ᕷ་ᖌ఍㸪᪂₲ᕷ㸪2014.
5㸧 ᅜ❧ࡀࢇ◊✲ࢭࣥࢱ࣮ ࡀࢇண㜵᳨࣭デ◊✲ࢭࣥࢱ࣮㸬᭷ຠᛶホ౯࡟ᇶ࡙ࡃ⫶ࡀࢇ᳨デ࢞࢖ࢻ
ࣛ࢖ࣥ 2014 ᖺᗘ∧㸬ᮾி㸪2015㸬6㸧 Harris RP, Wilt TJ, Qaseem A. A value framework for cancer screening: advice for high-value carefrom the American College of Physicians. Ann Intern Med 2015; 162:712–717.
7㸧 Wilt TJ, Harris RP, Qaseem A. Screening for cancer: advice for high-value care from the American
College of Physicians. Ann Intern Med 2015; 162:718–725.

℈ᓥࡕࡉ࡜

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അⓎ⑕ ⫶ෆど㙾᳨デࡢᐇ᪋࣭ᣑ኱࡟ࡼࡿഅⓎ⑕ࡣᚲࡎ㉳ࡇࡾ࠺ࡿࡶࡢ࡛࠶ࡿࠋࡋ࠿ࡋ࡞ࡀࡽࠊᖖ᪥㡭
࠿ࡽࡢഅⓎ⑕ᑐ⟇࡟ࡼࡾࠊࡑࡢ೺ᗣ⿕ᐖࢆ᭱ᑠ໬ࡍࡿࡇ࡜ࡀ࡛ࡁࡿࠋ௚ࡢ୙฼┈ࡢᑐ⟇࡜␗࡞ࡿ
ࡢࡣࠊഅⓎ⑕ࡣ⫶ෆど㙾᳨デ࡟ᦠࢃࡿ་⒪ᶵ㛵࡛ࡣ࡝ࡇ࡛ࡶ㉳ࡇࡾ࠺ࡿࡶࡢ࡜ࡋ࡚ࠊ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࢆ୰ᚰ࡟⤌⧊࡜ࡋ࡚ࡑࡢ᝟ሗࢆ཰㞟ࡋࠊ௨㝆ࡢᏳ඲ᑐ⟇࡟ഛ࠼ࡿࡇ࡜࡛࠶ࡿࠋ
1㸧അⓎ⑕ᑐᛂ࡬ࡢ‽ഛ
㸦1㸧᳨ᰝྠព᭩ࡢྲྀᚓ㸸അⓎ⑕ࡀ㉳ࡇࡾ࠺ࡿࡇ࡜ࢆ᫂グࡋ࡚࠾ࡃࠋ
㸦2㸧അⓎ⑕ࢆព㆑ࡋࡓၥデ㸸᪤ Ṕࠊ᳨ᰝṔࠊ᭹⏝⸆ ≉࡟ᢠ⾑ᰦ⸆ ࠊ࢔ࣞࣝࢠ࣮ࡢ᭷↓ࠊṑ⛉἞⒪࡟࠾ࡅࡿ㯞㓉᫬ࡢ≧ἣ࡞࡝ࠋ
㸦3㸧⫶ෆど㙾᳨ᰝ᫬ࡣ㙠②⸆࡞࡝ࡢ౑⏝ࡣࡦ࠿࠼ࡿࡢࡀᮃࡲࡋ࠸ࡀࠊ౑⏝ࡍࡿሙྜ࡟ࡣࠊ౑⏝ୖࡢὀព஦㡯ࢆ⇍▱ࡋࠊᛮࢃࡠ๪స⏝࡞࡝࡟ഛ࠼ࡿᚲせࡀ࠶ࡿࠋ
㸦4㸧㙠③⸆࣭㙠㟼⸆ࡣཎ๎౑⏝ࡋ࡞࠸ࠋ
㸦5㸧࿧྾೵Ṇࠊᚰ೵Ṇ࡬ࡢഛ࠼ࡣᖖ࡟ᚲせ࡛࠶ࡾࠊ㓟⣲ࠊࣂࢵࢢࣂࣝࣈ࣐ࢫࢡ BVM ࠊẼ⟶ᤄ⟶ࢭࢵࢺࠊᚰ㟁ᅗࣔࢽࢱ࣮ࠊ㝖⣽ືჾ AED ࡞࡝ᩆ࿨ᩆᛴタഛࡣഛ࠼࡚࠾ࡃᚲせࡀ࠶ࡿࠋ
㸦6㸧ᩆᛴ࣮࢝ࢺࢆ㏆ࡃ࡟⨨ࡁࠊ㍺ᾮࠊᙉᚰ๣࡞࡝ᚲせ࡞་⸆ရࢆᖖഛࡍࡿ ὀ 1㸧ࠋ
㸦7㸧᳨ᰝ᫬㛫࡟వ⿱ࢆࡶࡓࡏࠊᖖ࡟‽ഛࢆᛰࡽ࡞࠸ࡇ࡜ࡀᚲせ࡛࠶ࡿ 1)ࠋ
㸦8㸧ᩆᛴ࣮࢝ࢺࢆⅬ᳨ࡋࠊᐃᮇⓗ࡟⥭ᛴᑐᛂࡢカ⦎ࢆ⾜࠺ࠋὀ 1㸸⾑⟶☜ಖࡢࡓࡵࡢⅬ⁲ࢭࢵࢺࠊὀᑕ㔪ࠊὀᑕ⟄ࠊ㍺ᾮ ⏕⌮㣗ሷᾮࠊࣈࢻ࢘⢾ᾮ>5%ࠊ20%@ࠊࣜࣥࢤࣝᾮ࡞࡝ྛ✀㍺ᾮ〇๣ ࠊᙉᚰ๣࣭᪼ᅽ๣ ࢔ࢻࣞࢼࣜࣥࠊࢻࣃ࣑ࣥ࡞࡝ ࠊࢢࣝ࢝ࢦ
ࣥࠊᢠ୙ᩚ⬦๣ ࣜࢻ࢝࢖ࣥ࡞࡝ ࠊෙᣑᙇ๣ ࢽࢺࣟࢢࣜࢭࣜࣥ࡞࡝ ࠊࢫࢸࣟ࢖ࢻ๣ࠊẼ⟶ᨭᣑᙇ๣ ࢿ࢜ࣇ࢕ࣜࣥ࡞࡝ ࠊ࣋ࣥࢰࢪ࢔ࢮࣆࣥཷᐜయᣕᢠ๣ ࣇ࣐ࣝࢮࢽࣝ ࠊ㝆ᅽ๣ ࢔ࢲ࣮ࣛࢺ㘄ࠊ࣌ࣝࢪࣆࣥὀ ࠊ㙠㟼๣ ࢪ࢔ࢮࣃ࣒࡞࡝ ࠊH1 ཷᐜయᣕᢠ๣࡞࡝ࠋ
2㸧അⓎ⑕࡬ࡢᑐᛂ

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㸦1㸧㢖ᗘࡢ㧗࠸അⓎ⑕ձ㰯ฟ⾑
㢖ᗘࡣ㧗࠸ࡶࡢࡢ㍍ᚤ࡞ฟ⾑ࡀ኱㒊ศ࡛࠶ࡿࠋ࠶ࡽ࠿ࡌࡵᑐᛂ࣐ࢽࣗ࢔ࣝࢆసᡂࡋ࡚࠾ࡃ࡜ᑐ
ฎࡀᐜ࡛᫆࠶ࡿࠋ⾲ 1 ࡣᐑᇛ┴ᑐࡀࢇ༠఍࡛౑⏝ࡋ࡚࠸ࡿ㰯ฟ⾑ࡢᑐᛂ࣐ࢽࣗ࢔࡛ࣝ࠶ࡿࠋ࡯࡜
ࢇ࡝ࡢ㰯ฟ⾑ࡣ㺀ᣦ♧ձ㺁࡛ᑐᛂྍ⬟࡞㍍ᚤ࡞ฟ⾑࡛࠶ࡾࠊ⪥㰯⛉ᑓ㛛་࡟⤂௓ࡍࡿࡼ࠺࡞኱㔞ฟ⾑ࡣᴟࡵ࡚ࡲࢀ࡛࠶ࡿࠋࡇࢀࡀ᭱Ⰻࡢᑐᛂ࡜࠸࠺ࢃࡅ࡛ࡣ࡞ࡃࠊྛ᳨デ᪋タࡀᐇ᝟࡟ྜࢃࡏ࡚ࠊ
㐺ษ࡞ᑐᛂ࣐ࢽࣗ࢔ࣝࢆᩚഛࡍࡿᚲせࡀ࠶ࡿࠋ
ղ⏕᳨ࡸ⢓⭷⿣๰࡟ࡼࡿฟ⾑⏕᳨࡛ࡣࠊᢠ⾑ᰦ⸆᭹⏝ࡢ᭷↓࡟࠿࠿ࢃࡽࡎࠊ୍ᐃ㢖ᗘࡢฟ⾑ࡀ࠶ࡿ 2, 3)ࠋ⫶ෆど㙾᳨ᰝ࡛ၥ㢟࡟࡞ࡿฟ⾑ࡣࠊ⏕᳨ࡸ㰯⭍⢓⭷ 㰯ฟ⾑ ௨እࡢ⢓⭷⿣๰ ࣐࣮ࣟࣜ࣡࢖ࢫ⑕ೃ⩌࡞࡝ ࡟ࡼࡿฟ⾑࡛࠶ࡿࠋࡲࢀ࡛ࡣ࠶ࡿࡀධ㝔ࢆせࡍࡿࡼ࠺࡞኱ฟ⾑ࢆࡁࡓࡋࡓࡾࠊࢩࣙࢵࢡࢆేⓎࡍࡿࠋ⏕᳨ࢆ⾜ࡗࡓሙྜ࡟ࡣࠊᚲࡎṆ⾑ࢆ☜ㄆࡋࡓୖ࡛ෆど㙾ࢆᢤཤࡍࡿ 4)ࠋࡲࡓࠊ᳨ᰝ་ࡣෆど㙾ⓗṆ⾑⾡࡟⩦⇍ࡋࠊᶵᮦ࡞࡝ࡢ‽ഛࢆᩚ࠼࡚࠾ࡃࡇ࡜ࡀᮃࡲࡋ࠸ࠋ୺࡞Ṇ⾑⾡࡜ࡋ࡚ࡣ⸆๣ᩓᕸἲࠊ
ᒁὀἲࠊจᅛἲࠊࢡࣜࢵࣉἲ࡞࡝ࡀ࠶ࡿ 5)ࠋṆ⾑ᅔ㞴࡞ሙྜࡣࠊ㏿ࡸ࠿࡟ᑐᛂྍ⬟࡞་⒪ᶵ㛵࡟ᦙ̿  ̿

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㏦ࡍࡿࡇ࡜ࡣ࠸࠺ࡲ࡛ࡶ࡞࠸ࠋ
⾲ 1. ⤒㰯ෆど㙾᳨ᰝ᫬ࡢฟ⾑ฎ⨨࣐ࢽࣗ࢔ࣝ 㸦බ┈㈈ᅋἲேᐑᇛ┴ᑐࡀࢇ༠఍㸸ࡀࢇ᳨デࢭࣥࢱ࣮࡟࠾ࡅࡿ⤒㰯ෆど㙾᳨ᰝ᫬ࡢฟ⾑ฎ⨨࣐ࢽࣗ࢔ࣝࡼࡾᨵኚ㸧

㸦2㸧㔜⑕౛ࡢഅⓎ⑕ձ࢔ࢼࣇ࢕ࣛ࢟ࢩ࣮ࢩࣙࢵࢡ
⾲ 2 ࡣཌ⏕ປാ┬ࡢ࣮࣒࣮࣍࣌ࢪ࡟ᥖ㍕ࡉࢀ࡚࠸ࡿ࢔ࢼࣇ࢕ࣛ࢟ࢩ࣮ࢩࣙࢵࢡࡢᑐᛂ࣐ࢽ
ࣗ࢔࡛ࣝ࠶ࡿ6)ࠋ๓ฎ⨨⸆࡟ࡼࡿ࢔ࢼࣇ࢕ࣛ࢟ࢩ࣮ࡀ␲ࢃࢀࡓࡽࠊ┤ࡕ࡟࣐ࢽࣗ࢔ࣝ࡝࠾ࡾ࡟
ABCDE ࢔ࣉ࣮ࣟࢳࢆ⾜࠸ A: Ẽ㐨ࠊB: ࿧྾ࠊC: ᚠ⎔ࠊD: ព㆑ࠊE: ⬺⾰ ࠊ࣐ࢽࣗ࢔ࣝࡢ἞⒪ᡭ㡰࡟ࡼࡗ࡚἞⒪ࡍࡿࠋ㏆ࡃ࡟ᚲせ࡞་⒪ᶵჾ࡜⸆๣ࢆᖖഛࡋࡓᩆᛴ࣮࢝ࢺࢆ⏝ពࡋ࡚࠾ࡃᚲせࡀ࠶ࡿࠋ

⾲ 2 ࢔ࢼࣇ࢕ࣛ࢟ࢩ࣮ࡢ἞⒪ᡭ㡰 㸦ཌ⏕ປാ┬㸬㔜⠜๪స⏝⑌ᝈูᑐᛂ࣐ࢽࣗ࢔ࣝ㸫࢔ࢼࣇ࢕ࣛ࢟ࢩ࣮㸪ᖹᡂ 20 ᖺ 3 ᭶ P.23㸧ᩥ⊩ 6 ᨵኚ̿  ̿

ղ࿧྾ᢚไ
ୖ㒊ᾘ໬⟶࡟࠾ࡅࡿ๓ฎ⨨࡟ࡼࡿṚஸ౛ࡣࠊ㙠③⸆࣭㙠㟼⸆౑⏝࡟ࡼࡿࡇ࡜ࡀከ࠸ࠋᚑࡗ࡚ࠊ⫶ෆど㙾᳨デ࡟࠾࠸࡚ࠊ㙠③⸆࣭㙠㟼⸆ࡣཎ๎౑⏝ࡋ࡞࠸ࠋ
3㸧അⓎ⑕ࡢሗ࿌⫶ෆど㙾᳨デࡢ⢭ᗘ⟶⌮࡜ࡋ࡚ࡣᶵჾ࣭యไࡢᩚഛࠊྛ✀ࡢࣉࣟࢭࢫᣦᶆ࡟ຍ࠼࡚അⓎ⑕ࡢᢕᥱࡀ㔜せ࡛࠶ࡾࠊࡑࡢࡓࡵ࡟ࡣഅⓎ⑕ࡢሗ࿌ࡀḞ࠿ࡏ࡞࠸ࠋᑐ⟇ᆺ᳨デ࡛ࡣഅⓎ⑕ሗ࿌ࡢ㈐ົࡣࠊ
୍⩏ⓗ࡟ࡣ᳨デᐇ᪋୺య࡛࠶ࡿᕷ༊⏫ᮧ࡟࠶ࡿࡀࠊྛᕷ༊⏫ᮧ࠿ࡽ᳨デࢆጤクࡉࢀ࡚࠸ࡿ་⒪ᶵ㛵ࡸ་ᖌ఍࠶ࡿ࠸ࡣ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࡬ࠊ⫶ෆど㙾᳨デ࡟క࠺അⓎ⑕ࡢሗ࿌ࢆࡍࡿ
࡭ࡁ࡛࠶ࡿࠋ
᳨ᰝࡢ୰᩿ࡸฎ⨨ ᢞ⸆ࠊⅬ⁲ࠊ㰯ฟ⾑ฎ⨨࡞࡝ ࠊ⑓㝔⤂௓࡞࡝ఱࡽ࠿ࡢᑐᛂࡀᚲせ࡛࠶ࡗࡓഅⓎ⑕ࡣࡍ࡭࡚ሗ࿌ࡍࡿࠋデ⒪࡟࠾ࡅࡿഅⓎ⑕ㄪᰝࡣࠊධ㝔ࡀᚲせ࡞㔜⠜౛ࡢ᝟ሗ཰㞟ࡀ୺య࡜࡞ࡿࡀࠊ↓⑕≧⪅ࢆᑐ㇟࡜ࡍࡿ᳨デ࡛ࡣࠊࡼࡾ㍍ᚤ࡞അⓎ⑕ࢆࡶᢕᥱࡍࡿᚲせࡀ࠶ࡿࡢࡣᙜ↛࡛࠶ࡾࠊධ㝔ࢆせࡋ࡞࠸ࡲ࡛ࡶఱࡽ࠿ࡢฎ⨨ ᑐᛂ ࢆせࡋࡓࡶࡢࡍ࡭࡚ࢆᑐ㇟࡜ࡍ࡭ࡁ࡛࠶ࡿࠋᅗ 1ࡢࣇ࣮ࣟࢳ࣮ࣕࢺ࡟ᚑࡗ࡚അⓎ⑕ሗ࿌ࢆ⾜࠺ࡢࡀࡼ࠸࡛࠶ࢁ࠺ࠋሗ࿌ᵝᘧ ౛ ࡟ࡘ࠸࡚ࡣ⾲3 ࡟♧ࡋࡓࠋ㔜⑕ᗘࡢุᐃࡣࠊᅜ❧኱Ꮫ㝃ᒓ⑓㝔་⒪Ᏻ඲⟶⌮༠㆟఍ࡢ࢖ࣥࢩࢹࣥࢺࣞ࣋ࣝ 7)ࢆཧ↷ࡋࠊ᳨デ᫬ࡢഅⓎ⑕ሗ࿌࡟⏝࠸ࡿࡓࡵ࡟⡆␎໬ࡉࢀࡓࡶࡢ࡛࠶ࡿࠋ
᪥ᮏᾘ໬ჾࡀࢇ᳨デᏛ఍ ௨ୗࠊᏛ఍ ࡛ࡣࠊ඲ᅜ㞟ィ༠ຊ᪋タ࡟ᑐࡋ࡚അⓎ⑕࡟㛵ࡍࡿ࢔ࣥࢣ
࣮ࢺㄪᰝࢆ⾜ࡗ࡚࠸ࡿ 8-10)ࠋࡇࡢ࢔ࣥࢣ࣮ࢺㄪᰝࡣࠊഅⓎ⑕ࡢ✀㢮ࠊ㒊఩ࠊᶵჾ ⤒ཱྀ࣭⤒㰯ෆど㙾 ࡸ⸆๣ࡢ✀㢮ࡔࡅ࡛ࡣ࡞ࡃࠊ㔜⑕ᗘࡸணᚋࡲ࡛ࡶㄪᰝࡋ࡚࠸ࡿࠋഅⓎ⑕ࡢ㔜⑕ᗘࡣࠊᖐᏯ ᳨ᰝ᪋タᑐᛂ㸧
ࠊእ᮶ཷデ ௚་⒪᪋タ⤂௓ ࠊධ㝔 ᳨ᰝ᪋タࠊ௚㝔 ࡢ 3 ࡘ࡟༊ศࡉࢀࠊࡉࡽ࡟ฟ⾑౛࡛ࡣࢩࣙࢵࢡࡢ᭷↓ࡢグ㍕ࡶ࠶ࡿ ᪥ᮏᾘ໬ჾࡀࢇ᳨デᏛ఍࡟ࡼࡿ 2013 ᖹᡂ 25 ᖺᗘഅⓎ⑕ㄪᰝࡼࡾணᐃ㸧
ࠋṚஸ౛ࠊッゴ౛ࡶᢕᥱࡋࠊഅⓎ⑕࡬ࡢᑐᛂࡢཧ⪃࡜࡞ࡿࡼ࠺࡟ᕤኵࡋ࡚࠸ࡿࠋ

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ᅗ 1. ⫶ෆど㙾᳨デഅⓎ⑕ሗ࿌ࡢࣇ࣮ࣟࢳ࣮ࣕࢺ̿  ̿

⾲ 3. ⫶ෆど㙾᳨デഅⓎ⑕ሗ࿌ᵝᘧ 㸦౛㸧ሗ࿌་⒪ᶵ㛵᳨デ᪥        ᖺ    ᭶   ᪥ཷデ⪅Ặྡᛶ ู ⏨      ዪ⏕ᖺ᭶᪥        ᖺ    ᭶   ᪥㸦   ṓ㸧࠶ࡾ㸦                        㸧ᇶ♏⑌ᝈ࡞ࡋ
ෆど㙾ࡢ✀㢮⤒ཱྀ ⤒㰯✸Ꮝ
㰯ฟ⾑⢓⭷⿣๰
Ẽ⭘ ✸Ꮝ࡜ࡢ㔜」ࡶྵࡴ അⓎ⑕ࡢ✀㢮⏕᳨㒊఩࠿ࡽࡢᚋฟ⾑๓ฎ⨨⸆࡟ࡼࡿ࢔ࢼࣇ࢕ࣛ࢟ࢩ࣮ࢩࣙࢵࢡ
ࡑࡢ௚ࡢഅⓎ⑕㒊 ఩ 㰯⭍  ဗႃ㢌  㣗㐨  ⫶࣭༑஧ᣦ⭠  ࡑࡢ௚
㍍⑕ ฎ⨨࡞ࡋ  ୰➼ᗘ ฎ⨨࠶ࡾ  㔜⑕ᗘ㔜⑕ ධ㝔 Ṛஸ   ධ㝔 ᳨ᰝ᪋タࠊ௚㝔 እ᮶ཷデ ௚་⒪᪋タ⤂௓ ㌿ ᖐᖐᏯ ᳨ᰝ᪋タᑐᛂ ධ㝔་⒪ᶵ㛵

അⓎ⑕Ⓨ⏕᫬ࡢ≧ἣ̿  ̿ཧ⪃ᩥ⊩1㸧 ᮏ⏣ᾈோ㸬IV ❶.അⓎ⑕࡜ᑐ⟇㸫6.അⓎ⑕࡬ࡢഛ࠼㸬⫶ෆど㙾᳨デᶆ‽໬◊✲఍⦅㸪⫶ෆど㙾᳨デ࣐ࢽࣗ࢔ࣝ㸪་Ꮫ᭩㝔㸪ᮾி㸪2010㸪55–57.
2㸧 Sieg A, Hachmoeller-Eisenbach U, Eisenbach T. Prospective evaluation of complications in outpatient
GI endoscopy: a survey among German gastroenterologists. Gastrointest Endosc 2001; 53:620–627.
3㸧 Parra-Blanco A, Kaminaga N, Kojima T, et al. Hemoclipping for postpolypectomy and postbiopsy
colonic bleeding. Gastrointest Endosc 2000; 51:37–41.
4㸧⸨ᮏ୍┾㸪⸨ᇛගᘯ㸪ຍ⸨ඖႹ㸪௚㸬ᢠ⾑ᰦ⸆᭹⏝⪅࡟ᑐࡍࡿᾘ໬ჾෆど㙾デ⒪࢞࢖ࢻࣛ࢖
ࣥ㸬Gastroenterol Endosc 2012; 54:2075–2102.
5㸧 ᮏ⏣ᾈோ㸬IV ❶.അⓎ⑕࡜ᑐ⟇㸫5.അⓎ⑕Ⓨ⏕᫬ࡢᑐฎἲ㸬⫶ෆど㙾᳨デᶆ‽໬◊✲఍⦅㸪⫶ෆど㙾᳨デ࣐ࢽࣗ࢔ࣝ㸪་Ꮫ᭩㝔㸪ᮾி㸪2010㸪54–55㸬
6㸧 ཌ⏕ປാ┬㸬㔜⠜๪స⏝⑌ᝈูᑐᛂ࣐ࢽࣗ࢔ࣝ̿࢔ࢼࣇ࢕ࣛ࢟ࢩ࣮㸬2008㸪23㸬
URL: http://www.mhlw.go.jp/topics/2006/11/dl/tp1122-1h01.pdf㹙2015.7.17㹛
7㸧 ᅜ❧኱Ꮫ㝃ᒓ⑓㝔་⒪Ᏻ඲⟶⌮༠㆟఍㸬ᅜ❧኱Ꮫ㝃ᒓ⑓㝔་⒪Ᏻ඲⟶⌮༠㆟఍࡟ࡘ࠸࡚㸬
URL: http://square.umin.ac.jp/anzenhc/medical/index.html㹙2016.1.25㹛
8㸧 ῰㇂኱ຓ㸪▼ᕝຮ㸪୍℩㞞ኵ㸪௚㸬ᖹᡂ 22 ᖺᗘ⫶ࡀࢇ᳨デഅⓎ⑕࢔ࣥࢣ࣮ࢺㄪᰝሗ࿌㸬᪥ᾘࡀࢇ᳨デㄅ 2013; 51:250–255㸬
9㸧 ῰㇂኱ຓ㸪▼ᕝຮ㸪୍℩㞞ኵ㸪௚㸬ᖹᡂ 23 ᖺᗘ⫶ࡀࢇ᳨デഅⓎ⑕࢔ࣥࢣ࣮ࢺㄪᰝሗ࿌㸬᪥ᾘࡀࢇ᳨デㄅ 2014; 52:253–258㸬
10㸧῰㇂኱ຓ㸪▼ᕝຮ㸪୍℩㞞ኵ㸪௚㸬ᖹᡂ 24 ᖺᗘ⫶ࡀࢇ᳨デഅⓎ⑕࢔ࣥࢣ࣮ࢺㄪᰝሗ࿌㸬᪥ᾘࡀࢇ᳨デㄅ 2015; 53:233–238㸬㸦῰㇂኱ຓࠊ℈ᓥࡕࡉ࡜㸧̿  ̿

ϰ.ࡲ࡜ࡵ⫶ෆど㙾᳨デࡣᚑ᮶⾜ࢃࢀ࡚ࡁࡓ⫶ X ⥺᳨デ࡜ࡣ␗࡞ࡾࠊ᪂ࡓ࡞యไ࡙ࡃࡾࡀồࡵࡽࢀࡿࠋ
ࡍ࡛࡟⫶ෆど㙾᳨デࢆᑟධࡋࡓᆅᇦࡢከࡃࡣࠊᆅᇦ་ᖌ఍ࢆ୺య࡜ࡋࡓಶ᳨ูデ᪉ᘧࢆ࡜ࡗ࡚࠸
ࡿࠋࡇࡢሙྜࠊ⾜ᨻ࡜ᆅᇦ་ᖌ఍ࡀඹྠ࡛ࠊ⫶ෆど㙾᳨デࡢࡓࡵࡢయไ࣭࣮࡙ࣝࣝࡃࡾࢆ⾜ࡗ࡚࠸ࡿࠋࡑࡢ㐃ᦠ᪉ἲࡣࠊᆅᇦࡢ≧ἣ࡟ࡼࡾ␗࡞ࡿࡀࠊ⫶ෆど㙾᳨デࡢᐇ᪋୺య࡛࠶ࡿᕷ༊⏫ᮧࡀ‽ഛࡍ࡭ࡁ㡯┠ࢆ⾲ 1 ࡟♧ࡋࡓࠋ⫶ෆど㙾᳨デࡢᐇ᪋࡟㝿ࡋ࡚ࡣࠊ22 㡯┠୰௚ࡢࡀࢇ᳨デ࡟ࡶඹ㏻ࡍࡿ
II–3 ࢆ㝖ࡃࠊᑡ࡞ࡃ࡜ࡶ 21 㡯┠ࢆᩚഛࡍࡿᚲせࡀ࠶ࡿࠋ୍᪉ࠊᐇ㝿ࡢ᳨デࢆᢸᙜࡍࡿ་⒪ᶵ㛵࡟࠾࠸࡚ࡣࠊ⾲ 2 ࡢ 23 㡯┠ࢆࡍ࡭࡚ᐇ᪋ࡋࠊཷデ⪅࡟Ᏻ඲࡛㉁ࡢ㧗࠸᳨ᰝࢆᥦ౪ࡍࡿ࡜࡜ࡶ࡟ࠊ⫶ෆど㙾᳨ᰝࡢࢫ࢟ࣝ࢔ࢵࣉ࡟ດࡵࡿ࡭ࡁ࡛࠶ࡿࠋ̿  ̿ 

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⾲ 1.

⫶ෆど㙾᳨デᐇ᪋ࡢࡓࡵࡢ⮬ᕫⅬ᳨⾲࠙ᕷ༊⏫ᮧ∧ࠚ

I. ┠ⓗ
1. ⫶ෆど㙾᳨デࡢ┠ⓗࢆ⌮ゎࡋࡓ࠿ࠋII. ᑐ㇟
2. ⫶ෆど㙾᳨デࡢᑐ㇟⪅ࡢ㐺ᛂ࣭㝖እ᮲௳ࢆつᐃࡋࡓ࠿ࠋ
3. ⫶ෆど㙾᳨デࡢᑐ㇟⪅ྡ⡙ࢆసᡂࡋࡓ࠿ࠋ
III. ᪉ἲ
4. ⫶ෆど㙾᳨デࡢ᳨デ㛫㝸ࢆつᐃࡋࡓ࠿ࠋ         
5. ⫶ෆど㙾᳨デࢆᢸᙜࡍࡿ᳨デᐇ᪋୺య ᆅ༊་ᖌ఍ࠊ᳨デᶵ㛵࡞࡝ ࢆつᐃࡋࡓ࠿ࠋ
6. ⫶ෆど㙾᳨デࡢ᳨ᰝ་ࡢ᮲௳ࢆつᐃࡋࡓ࠿ࠋ
7. ⫶ෆど㙾᳨ᰝࡢ๓ฎ⨨ࡢ᪉ἲࢆ⌮ゎࡋࡓ࠿ࠋ
8. ⫶ෆど㙾᳨ᰝࡢ᧜ᙳ᪉ἲ 㒊఩ࠊࢥ࣐ᩘ࡞࡝ ࢆつᐃࡋࡓ࠿ࠋ
9. ⫶ෆど㙾᳨デࡢࢲࣈࣝࢳ࢙ࢵࢡࡢࡓࡵࡢㄞᙳ఍ࢆᐃᮇ㛤ദࡋ࡚࠸ࡿ࠿ࠋ
10. ⫶ෆど㙾᳨デࡢࢲࣈࣝࢳ࢙ࢵࢡࡣࠊෆど㙾ࢆᑓ㛛࡜ࡍࡿ་ᖌ ᚲࡎࡋࡶࠊᑓ㛛་࡛࡞ࡃ࡚ࡶࡼ࠸ ࡀ⾜ࡗ࡚࠸ࡿ࠿ࠋ
11. ᐃᮇⓗ࡟⫶ෆど㙾᳨デࡢ⏬ീࢆⅬ᳨ࡋ࡚࠸ࡿ࠿ࠋ
IV. ㏣㊧ㄪᰝ
12. ⫶ෆど㙾᳨デࡢ⤖ᯝࢆᩚ⌮ࡍࡿࡓࡵࡢࢹ࣮ࢱ࣮࣋ࢫ ྎᖒࠊ㟁Ꮚ፹య࡞࡝ ࢆసᡂࡋࡓ࠿ࠋ
13. ⫶ෆど㙾᳨デᐇ᪋ᶵ㛵࠿ࡽࠊ᳨ᰝࡢ⤖ᯝࢆ཰㞟ࡋ࡚࠸ࡿ࠿ࠋ
14. ⫶ෆど㙾᳨デᐇ᪋ᶵ㛵ࡢ⏕᳨ᐇ᪋ᩘࢆᢕᥱࡋ࡚࠸ࡿ࠿ࠋ
15. 㺀෌᳨ᰝ㺁ࡢᮍཷデ⪅࡟ࡘ࠸࡚ࠊ⢭᳨ཷデ່ዡࢆ⾜ࡗ࡚࠸ࡿ࠿ࠋ
16. 㺀⫶ࡀࢇ࠶ࡾ㺁㺀⫶ࡀࢇ␲࠸㺁࡟ࡘ࠸࡚ࠊ᭱⤊⤖ᯝࢆᢕᥱࡋ࡚࠸ࡿ࠿ࠋ
17. ⫶ෆど㙾᳨デࡢ⤖ᯝ࡟ࡘ࠸࡚ࠊᐇ᪋ᖺᗘࡢ㺀ཷデ⋡㺁㺀ࡀࢇⓎぢ⋡㺁㺀せ⢭᳨⋡㺁㺀⢭᳨ཷデ⋡㺁㺀㝧ᛶ཯ᛂ㐺୰ᗘ㺁ࢆ⟬ฟ࡛ࡁࡿ࠿ࠋ
18. ⫶ෆど㙾᳨デࡢ඲ཷデ⪅࡟⤖ᯝࢆ㏻▱ࡋࡓ࠿ࠋ
V. Ᏻ඲⟶⌮
19. അⓎ⑕ࡢሗ࿌ࡢ᪉ἲ࣭⤒㊰࣭㐃⤡ඛ࡟ࡘ࠸࡚ࠊࣇ࣮ࣟࢳ࣮ࣕࢺࢆసᡂࡋࡓ࠿ࠋ
 20. Ᏻ඲⟶⌮యไࢆ☜ㄆࡍࡿࡓࡵ࡟ࠊഅⓎ⑕ሗ࿌᭩ࡢⅬ᳨ࡸ་⒪ᶵ㛵࡬ࡢゼၥㄪᰝࢆ⾜ࡗ࡚࠸ࡿ࠿ࠋVI. ◊ಟ఍
21. ⫶ෆど㙾᳨デࡢࢫ࢟ࣝ࢔ࢵࣉࡢࡓࡵ࡟ࠊᑡ࡞ࡃ࡜ࡶᖺ 1 ᅇࡢ◊ಟ఍ࢆ㛤ദࡋ࡚࠸ࡿ࠿ࠋ
22. ⫶ෆど㙾᳨デ࡟ᚑ஦ࡍࡿ࣓ࢹ࢕࢝ࣝࢫࢱࢵࣇ ┳ㆤᖌࠊ⮫ᗋ᳨ᰝᢏᖌ࡞࡝ ࡟ࠊ᳨ᰝ࡟㛵ࡍࡿᩍ⫱ᶵ఍ࢆᥦ౪ࡋ࡚࠸ࡿ࠿ࠋ̿  ̿ 



⾲ 2.

⫶ෆど㙾᳨デᐇ᪋ࡢࡓࡵࡢ⮬ᕫⅬ᳨⾲࠙་⒪ᶵ㛵∧ࠚ

I. ┠ⓗ
1. ⫶ෆど㙾᳨デࡢ┠ⓗࢆ⌮ゎࡋࡓ࠿ࠋ           
II. ‽ഛ
2. ⫶ෆど㙾᳨デᐇ᪋་⒪ᶵ㛵࡟࠾ࡅࡿᶵჾⅬ᳨ ෆど㙾ࠊ⮬ືὙίᾘẘᶵ࡞࡝ ࢆ⾜ࡗࡓ࠿ࠋ3. ⫶ෆど㙾᳨デ࡟ᚑ஦ࡍࡿ࣓ࢹ࢕࢝ࣝࢫࢱࢵࣇ ┳ㆤᖌࠊ⮫ᗋ᳨ᰝᢏᖌ࡞࡝ ࡟ࠊ๓ฎ⨨ࠊ᳨ᰝࠊᚋฎ⨨࡟࠾ࡅࡿᙺ๭ࢆᩍ⫱ࡋࡓ࠿ࠋ
4. അⓎ⑕ᑐ⟇࡜ࡋ࡚ࠊᩆᛴ࣮࢝ࢺࢆ‽ഛ࣭Ⅼ᳨ࡋࠊᐃᮇⓗ࡟⥭ᛴ᫬ᑐᛂࡢカ⦎ࢆࡋ࡚࠸ࡿ࠿ࠋ
5. അⓎ⑕ࡀⓎ⏕ࡋࡓሙྜࠊᕷ༊⏫ᮧ࡬ࡢሗ࿌᪉ἲࢆ⌮ゎࡋ࡚࠸ࡿ࠿ࠋ
III. ཷデ⪅࡬ࡢㄝ᫂
6. ᳨ᰝᐇ᪋๓࡟ࠊ⫶ෆど㙾᳨デࡢ᳨ᰝ᪉ἲࢆㄝ᫂ࡋࡓ࠿ࠋ
7. ᳨ᰝᐇ᪋๓࡟ࠊ⫶ෆど㙾᳨デࡢ฼┈࣭୙฼┈࡟ࡘ࠸࡚ㄝ᫂ࡋࡓ࠿ࠋ
8. ᳨ᰝᐇ᪋๓࡟ࠊཷデ⪅ࡢ᪤ Ṕ࣭⌧⑓Ṕࢆ☜ㄆࡋࡓ࠿ࠋ
9. ᳨ᰝᐇ᪋๓࡟ࠊཷデ⪅ࡢ᭹⸆ࡢෆᐜࢆ☜ㄆࡋࡓ࠿ࠋ
10. ᳨ᰝᐇ᪋๓࡟ࠊ᳨ᰝཷデࡢྠពࢆ☜ㄆࡋࡓ࠿ࠋ
11. ᳨ᰝ⤊஢ᚋ࡟ࠊ᳨ᰝࡢᴫせ ⏕᳨ᐇ᪋ࢆྵࡴ ࢆཷデ⪅࡟ㄝ᫂ࡋࡓ࠿ࠋ
12. ุᐃ⤖ᯝࡀ㺀⫶ࡀࢇ࡞ࡋ㺁ࡢሙྜ࡟ࠊḟᅇࡢ᳨デ࡟ࡘ࠸࡚ㄝ᫂ࡋࡓ࠿ࠋ
13. ෌᳨ᰝࡸ἞⒪ࡀᚲせ࡞ሙྜࠊ㐺ษ࡞་⒪ᶵ㛵ࢆ⤂௓࡛ࡁࡿ࠿ࠋ
14. ࢲࣈࣝࢳ࢙ࢵࢡࡢุᐃࡀึᅇ᳨ᰝ⤖ᯝ࡜␗࡞ࡗࡓሙྜࠊࡑࡢ⌮⏤ࢆཷデ⪅࡟ㄝ᫂ࡋࡓ࠿ࠋ
IV. ᳨ᰝ᪉ἲ
15. ⫶ෆど㙾᳨ᰝࡢ๓ฎ⨨ࢆ㐺ษ࡟⾜ࡗ࡚࠸ࡿ࠿ࠋ
16. ⫶ෆࢆ⥙⨶ⓗ࡟ほᐹࡍࡿࡓࡵ࡟ᚲせ࡞᧜ᙳ㒊఩࡜᧜ᙳࢥ࣐ᩘࢆ⌮ゎࡋ࡚࠸ࡿ࠿ࠋ
17. ⏕᳨ࡣ㺀⫶ࡀࢇ㺁࠶ࡿ࠸ࡣ㺀⫶ࡀࢇ␲࠸㺁⑓ኚ࡟㝈ᐃࡋ࡚࠸ࡿ࠿ࠋ
18. ⫶ෆど㙾᳨ᰝ⤊஢ᚋ࡟ࠊ㐺ษ࡞ᡭ㡰࡟ࡼࡾෆど㙾ࢆὙί࣭ᾘẘ࡛ࡁࡿ࠿ࠋ
V. ㄞᙳ఍ࠊ◊ಟ఍19. ⫶ෆど㙾᳨デࡢ᳨ᰝ⤖ᯝ 㟁Ꮚ፹య࡞࡝ ࢆࠊ඲౛ࠊࢲࣈࣝࢳ࢙ࢵࢡࡢࡓࡵࡢㄞᙳጤဨ఍
࡟ᥦฟࡋ࡚࠸ࡿ࠿ࠋ
20. ⫶ෆど㙾᳨デࡢࢲࣈࣝࢳ࢙ࢵࢡࢆ⾜࠺ㄞᙳ఍࡟ฟᖍࡋ࡚࠸ࡿ࠿ࠋ
21. ⫶ෆど㙾᳨デࡢㄞᙳጤဨ఍࡟ࡼࡿ⏬ീⅬ᳨࡛ᣦ᦬ࡉࢀࡓⅬ࡟ࡘ࠸࡚ࠊ᧜ᙳ᪉ἲࡢᨵၿ࡟
ດࡵࡓ࠿ࠋ22. ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࡢ୺ദࡍࡿ◊ಟ఍࡟ฟᖍࡋ࡚࠸ࡿ࠿ࠋ
23. ⫶ෆど㙾᳨デ࡟ᚑ஦ࡍࡿ࣓ࢹ࢕࢝ࣝࢫࢱࢵࣇ ┳ㆤᖌࠊ⮫ᗋ᳨ᰝᢏᖌ࡞࡝ ࢆ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࡢ୺ദࡍࡿ◊ಟ఍࡟ฟᖍࡉࡏ࡚ࠊ⫶ෆど㙾ࡢὙί࣭ᾘẘ᪉ἲࢆᏛ⩦ࡍࡿᶵ఍ࢆ୚࠼࡚࠸ࡿ࠿ࠋ
㸦℈ᓥࡕࡉ࡜㸧̿  ̿                  ϱ.௒ᚋࡢㄢ㢟
1. ࣜࢫࢡᒙู໬
1㸧ཷデᑐ㇟ࣜࢫࢡᒙู໬࡬ࡢ⫼ᬒ⫶ෆど㙾᳨デࡢᬑཬᒎ㛤ୖ࡛᭱኱ࡢࣁ࣮ࢻࣝࡣࠊ᳨ᰝ་ࡢ☜ಖ࡟࠶ࡿࠋ⌧≧࡛ࡣࠊ⫶ෆど㙾᳨デࡢᒎ㛤ࢆᴦほど࡛ࡁࡿᆅᇦࡣ㝈ࡽࢀ࡚࠾ࡾࠊࡑࡢฎ⌮⬟࡟ࡣ㝈⏺ࡀ࠶ࡿࠋ୍᪉ࠊ⣽ᚄ໬࡞࡝ෆど㙾ᶵჾࡢ㐍Ṍ࡟ࡣ┠ぬࡲࡋ࠸ࡶࡢࡀ࠶ࡿࡀࠊෆど㙾᳨ᰝࡣᇶᮏⓗ࡟౵くᛶࡀ㧗ࡃࠊཷデ⪅࡟࡜ࡗ࡚㈇ᢸࡢከ࠸᳨ᰝ࡛࠶ࡿࠋᚑࡗ࡚ࠊ↓⑕≧⪅ࢆᑐ㇟࡜ࡍࡿ᳨デ࡟࠾࠸࡚ࡣࠊഅⓎ⑕࡟᱁ูࡢὀពࢆᡶ࠺ᚲせࡀ࠶ࡿࠋ௨ୖࡼࡾࠊ⫶ෆど㙾᳨デ࡟㛵ࡋ࡚ࡣࠊᑐ㇟⪅ࡍ࡭࡚ࢆ୍ᚊ࡟᳨デᑐ㇟࡜ࡍࡿࡢ࡛ࡣ࡞ࡃࠊ࠶ࡿ
⛬ᗘ㑅ูࡋࡓᑐ㇟ࢆᶆⓗ࡟ࡍࡿࡇ࡜ࡀ⌮࡟㐺ࡗ࡚࠸ࡿࠋࡇࡢほⅬ࠿ࡽࠊ⫶ࡀࢇࣜࢫࢡ࡟ᇶ࡙࠸࡚
᳨デᑐ㇟ࡢᒙู໬࣭㞟⣙ࢆ⾜࠺ヨࡳࡀࠊࡇࢀࡲ࡛ヨ㦂ⓗ࡟࡞ࡉࢀ࡚ࡁ࡚࠸ࡿࠋ
2㸧⫶ࡀࢇࡢࣜࢫࢡࣇ࢓ࢡࢱ࣮࡜Ⓨࡀࢇ࡟㛵ࡍࡿᇶᮏ஦㡯⫶ࡢⓎࡀࢇ࡟ࡣ」ᩘࡢせᅉࡀ㛵୚ࡋࠊ⏨ᛶࠊ㧗ᖺ㱋ࠊႚ↮ࠊ㧗ሷ㣗ᦤྲྀࠊ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆ
ࣟࣜឤᰁ࡞࡝ࡀࣜࢫࢡࣇ࢓ࢡࢱ࣮࡛࠶ࡿࠋ
࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁࡣࠊⓎࡀࢇࡢ୺せ⤒㊰ࢆጞື࣭᥎㐍ࡉࡏࡿ᭱኱ࡢᅉᏊ࡜ࡋ࡚఩⨨࡙ࡅࡽࢀ࡚࠸ࡿࠋከࡃࡢ⫶ࡀࢇⓎ⏕ࡣ⫶⅖ᣢ⥆ࡢ⤖ᯝ࡜ࡋ࡚⏕ࡌࡿⴎ⦰ᛶ⫶⅖࣭⭠ୖ⓶໬⏕ࢆᇶ┙࡜ࡋ࡚Ⓨ⏕ࡍࡿࠋࡇࢀࡀ⫶ࡀࢇⓎ⏕ࡢ୺せ⤒㊰࡜⪃࠼ࡽࢀ࡚࠸ࡿࠋࡍ࡞ࢃࡕࠊ㺀⫶⅖ࠊ⭠ୖ⓶໬⏕ࠊ␗ᙧᡂࠊ⫶ࡀࢇ࡜㐍ᒎࡍࡿ࣮ࣝࢺ㺁1)࡛࠶ࡾࠊᮏ࣮ࣝࢺ㐍ᒎ࡜࡜ࡶ࡟⫶ࡀࢇࣜࢫࢡୖ᪼ࢆㄆࡵࠊ
ⴎ⦰ᛶ⫶⅖࣭⭠ୖ⓶໬⏕ࡣ๓ࡀࢇ≧ែ 㧗༴㝤⩌ ࡜ࡋ࡚ᤊ࠼ࡽࢀ࡚࠸ࡿࠋ
3㸧⫶ࡀࢇࣜࢫࢡ࡟ᇶ࡙ࡃ᳨デᑐ㇟ᒙู໬
࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁࡀ⫶ࡀࢇⓎ⏕࡟㛵ࡍࡿ᭱኱ࡢࣜࢫࢡࣇ࢓ࢡࢱ࣮࡛࠶ࡾࠊ࣊ࣜࢥࣂ
ࢡࢱ࣮࣭ࣆࣟࣜឤᰁ࡟㉳ᅉࡍࡿ⫶ࡀࢇࡀ኱㒊ศ࡛࠶ࡿ 2–4)ࠋ௚ࡢࣜࢫࢡࣇ࢓ࢡࢱ࣮ࡣࠊ࣊ࣜࢥࣂࢡ
ࢱ࣮࣭ࣆࣟࣜឤᰁࢆᇶ┙࡜ࡍࡿ⫶ࡢⓎࡀࢇ㐣⛬࡟௓ධࡍࡿࡇ࡜࡟ࡼࡾࠊࡑࡢస⏝ࢆⓎ᥹ࡍࡿࠋ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⫶⅖ࡢ᭷↓ࠊࡑࡋ࡚ࠊࡑࡢ⑓ᮇࢆデ᩿ࡍࡿࡇ࡜ࡀࠊಶேࡢ⫶ࡀࢇࣜࢫࢡ࡟㛵ࡍࡿ㔜せ࡞ᣦᶆࢆ୚࠼ࡿࡇ࡜࡟࡞ࡿࡀࠊࡇࢀࡽࡢデ᩿ࡣ⑓⌮⤌⧊᳨ᰝ࡟ᇶ࡙ࡃࡶࡢ࡛ࠊ
↓⑕≧⪅ࢆᑐ㇟࡜ࡍࡿ⫶ࡀࢇ᳨デ࡟౑⏝ࡍࡿୖ࡛↓⌮ࡀ࠶ࡿࠋࡇࡢ௦⏝࡜ࡋ࡚ࠊཷデ⪅ࡢ㈇ᢸࡀ
㍍ࡃࠊ⡆౽࠿ࡘ㧗⢭ᗘ࡛ᐈほᛶࠊ෌⌧ᛶ࡟ඃࢀࡓ᳨య᳨ᰝࢆ౑ࡗ࡚ࡢデ᩿ࡀ᳨ウࡉࢀ࡚ࡁࡓࠋ
㸦1㸧࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁデ᩿࡟ᇶ࡙ࡃ᳨ウձ ᇶᮏⓗ஦㡯 ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁデ᩿ἲ࡜ࡋ᳨࡚デ࡟ᑟධྍ⬟࡞ࡶࡢ࡜ࡋ࡚ࡣࠊ⾑Ύ࠶ࡿ࠸ࡣᒀ୰
ࡢ≉␗ᢠయ౯ࠊ౽୰ᢠཎ࡞࡝ࡀ࠶ࡆࡽࢀࡿࠋղ ⌧≧࡜ㄢ㢟࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⪅ࡣ㠀ឤᰁ⪅࡟ẚ࡭࡚⫶ࡀࢇࣜࢫࢡࡀ㧗ࡃ 5-10)ࠊ⾑Ύᢠయ౯ࡀ㧗࠸࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⪅࡛ࡣ⫶ࡀࢇࣜࢫࢡࡀ㧗࠸ 9, 10)ࠋࢃࡀᅜ࡛ࡣࠊ⫶ࡀࢇ᳨デᑐ㇟⪅ࡢ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⋡ࡀᮍࡔ㧗࠸ࡓࡵࠊ⾑Ύ≉␗ᢠయ࡞࡝ࡢ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ̿  ̿                  デ᩿ࢆ⫶ࡀࢇ᳨デ࡟ᑟධࡍࡿࡇ࡜ࡣࠊ≉␗ᗘࡢୖ࠿ࡽၥ㢟ࡀ࠶ࡿࠋࡲࡓࠊᢠయ⣔ࢆᶆⓗ࡜ࡋࡓ⌧≧ࡢデ᩿ࢸࢫࢺ࡛ࡣ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆ᳨ࣟࣜᰝ㝜ᛶ౛ࡢデ᩿࡟㝈⏺ࡀ࠶ࡾࠊ⮬↛㝖⳦ࡢ≧ែ࡟࠶ࡿ㧗ᗘ㐍ᒎⴎ⦰ᛶ⫶⅖౛ࡸ⌧ᅾቑຍࡢ୍㏵ࢆ㎺ࡗ࡚࠸ࡿ㝖⳦౛ࡣࠊ᳨ᰝ㝜ᛶࡀᚲࡎࡋࡶ࣊ࣜࢥ
ࣂࢡࢱ࣮࣭ࣆࣟࣜᮍឤᰁࢆ♧ࡍࡶࡢ࡛ࡣ࡞࠸ 11-15)ࠋ௨ୖࡼࡾࠊ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁデ᩿༢⊂࡛ࡢ᳨デᑟධࡣ⌧ᐇⓗ࡛ࡣ࡞࠸ࠋ
㸦2㸧⾑Ύ࣌ࣉࢩࣀࢤࣥ PG ࡟ᇶ࡙ࡃ᳨ウ ձ ᇶᮏⓗ஦㡯⫶࡛⏘⏕ࡉࢀࡿᾘ໬㓝⣲࣌ࣉࢩࣥࡢ๓㥑య࡛࠶ࡿ࣌ࣉࢩࣀࢤࣥ PG ࡣࠊࣄࢺ࡛ࡣ 2 ࡘࡢ࢔࢖ࢯ
ࢨ࢖࣒ PGI ཬࡧ PGII ࡛ᵓᡂࡉࢀࠊPGI ࡣ⫶ᗏ⭢ࠊPGII ࡣ⫶඲ᇦ࡜༑஧ᣦ⭠࡛⏘⏕ࡉࢀࡿࠋ࣌ࣉࢩࣀࢤࣥࡢ኱㒊ศࡣ⫶ෆ⭍࡟እศἪࡉࢀࠊ⣙ 1%ࡀ⾑ᾮ୰࡟ฟ⌧ࡍࡿࠋ⾑Ύ࣌ࣉࢩࣀࢤ್ࣥࠊ
≉࡟ PGII ್ࡣ⫶⅖࡟ࡼࡗ࡚ୖ᪼ࡋࠊࡑࡢ್ࡣ⫶⅖άືᗘࢆ཯ᫎࡍࡿ 16-18)ࠋࡑࡋ࡚ࠊ៏ᛶ⫶⅖ᣢ⥆ࡢ⤖ᯝ⏕ࡌࡿⴎ⦰ᛶ⫶⅖࣭⭠ୖ⓶໬⏕㐍ᒎࢆ཯ᫎࡋ࡚ῶᑡࡍࡿ 16, 19, 20)ࠋ≉࡟ࠊ⾑Ύ PGI ್ཬࡧ
PGI / II ẚࡣࠊ୺࡟ⴎ⦰ᛶ⫶⅖࣭⭠ୖ⓶໬⏕㐍ᒎࢆ♧ࡍᣦᶆ࡜ࡋ࡚౑ࢃࢀ࡚ࡁࡓࠋ
⾑Ύ࣌ࣉࢩࣀࢤ್ࣥࡣࠊ⫶ษ㝖౛ࠊ⭈ᶵ⬟పୗࠊPPI proton pump inhibitor ࡞࡝ࡢᙉຊ࡞㓟ศἪᢚไ⸆࠶ࡿ࠸ࡣ⫶⢓⭷ࢆയᐖࡍࡿ NSAIDs non-steroidal anti-inflammatory drugs ࡞࡝ࡢ᭹⏝ࠊ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜ㝖⳦࡞࡝࡟ࡼࡾኚືࡍࡿࠋࡇࢀࡽ࡟ヱᙜࡍࡿሙྜࠊṇࡋ࠸ุᐃࡣᅔ㞴࡛࠶ࡾࠊ᳨ᰝᑐ㇟࠿ࡽ㝖እࡍ࡭ࡁ࡛࠶ࡿࠋղ ࣌ࣉࢩࣀࢤ᳨ࣥᰝ࡟ࡼࡿ⫶ࡀࢇ᳨デ⾑Ύ࣌ࣉࢩࣀࢤ᳨ࣥᰝ࡟ࡼࡾྠᐃࡋࠊ㐍ᒎࡋࡓⴎ⦰ᛶ⫶⅖ ⫶ࡀࢇ㧗༴㝤⩌ ࡢཷデ⪅ࢆᑐ㇟࡟ࠊෆど㙾࡟࡚⢭ᐦ᳨ᰝࢆ⾜࠺⫶ࡀࢇ᳨デ ࣌ࣉࢩࣀࢤ᳨ࣥᰝ ࡀ ヨ㦂ⓗ࡟ ᳨ウࡉࢀ࡚ࡁࡓ 21, 22)ࠋ࣌ࣉࢩࣀࢤ᳨ࣥᰝ࡛ࡣࠊ⾑Ύ PGI ್ ӌ 70ȝg /L ࠿ࡘ I / II ẚ ӌ 3.0 㝧ᛶ ࡢ cut-off ್ࡀ㺀ᇶ‽್㺁࡜ࡋ࡚ࠊ㐍ᒎࡋࡓⴎ⦰ᛶ⫶⅖࣭⭠ୖ⓶໬⏕⑕౛ྠᐃࢆ┠ⓗ࡟ᗈࡃ⏝࠸ࡽࢀ࡚ࡁࡓࠋຍ࠼࡚ࠊ⾑Ύ
PGI ್ӌ50g /L ࠿ࡘ I / II ẚ ӌ 3.0 ୰➼ᗘ㝧ᛶ ཬࡧ⾑Ύ PGI ್ӌ30ȝg /L ࠿ࡘ I / II ẚӌ2.0 ᙉ㝧ᛶࡢ 2 ✀㢮ࡢ cut-off ್ࡀࠊࡼࡾ㐍ᒎࡋࡓ⑕౛ࢆྠᐃࡍࡿ┠ⓗ࡛౑ࢃࢀ࡚࠸ࡿࠋ
࣌ࣉࢩࣀࢤ᳨ࣥᰝࡢ⛉Ꮫⓗ᳨ドࡣࠊ㛗ᮇほᐹ◊✲ࡀᑡ࡞࠸࡞࡝ከࡃࡢㄢ㢟ࡀ࠶ࡿࠋ࣌ࣉࢩࣀࢤ
᳨ࣥᰝࡢၥ㢟Ⅼࡣࠊ㝧ᛶ⋡ࡀ㧗ࡃ ᇶ‽್࡛⣙ 20㹼30% ࠊ㝜ᛶ⫶ࡀࢇࡀ↓ど࡛ࡁ࡞࠸⛬ᗘ ᇶ‽್࡛ 20㹼40% ࡟Ꮡᅾࡍࡿࡇ࡜ࠊࡀࢇ᳨デ࡟⏝࠸ࡿୖ࡛≉␗ᗘࡀప࠸ࡇ࡜࡞࡝ࡀ࠶ࡆࡽࢀࡿࠋ๓㏙ࡢᇶ‽್ࢆ cut-off ್࡜ࡋࡓሙྜࠊឤᗘ 77.3%ࠊ≉␗ᗘ 73.2%࡜ሗ࿌ࡉࢀ࡚࠸ࡿ 23)ࠋᚑࡗ࡚ࠊ⾑Ύ࣌ࣉࢩࣀࢤ᳨ࣥᰝ༢⊂࡛ࡢ⫶ࡀࢇ᳨デ࡟ࡣ㝈⏺ࡀ࠶ࡾࠊ㝜ᛶ⫶ࡀࢇᑐ⟇ࢆྵࡴࢩࢫࢸ࣒ᵓ⠏ࡀᚲ㡲࡛࠶ࡿࠋճ ⫶ࡀࢇࣜࢫࢡ࣐࣮࣮࢝࡜ࡋ࡚ࡢ⾑Ύ࣌ࣉࢩࣀࢤࣥ
୍᪉ࠊ⾑Ύ࣌ࣉࢩࣀࢤ್ࣥ⮬యࡣࣜࢫࢡ࣐࣮࣮࢝࡜ࡋ࡚㈗㔜࡞᝟ሗࢆᥦ౪ࡍࡿࠋࡍ࡞ࢃࡕࠊPG I
ཬࡧ PG I / II ࡛ࡣప್ࢆ♧ࡍ࡯࡝ ᅗ㸯ࠊA & B ࠊ୍᪉ PG II ࡛ࡣ㧗್ࢆ♧ࡍ࡯࡝ࠊ⫶ࡀࢇⓎ⏕ࣜࢫࢡࡢୖ᪼ࢆㄆࡵࠊ≉࡟ PGI ӌ30ng /mL ࡛ࣁࢨ࣮ࢻẚ㸻3.5ࠊPGI / II ӌ3.0 ࡛ࣁࢨ࣮ࢻẚ㸻3.7ࠊ
PGII >30ng /mL ࡛ࣁࢨ࣮ࢻẚ㸻3.6 ࡜᭷ព࡞ࣜࢫࢡୖ᪼ࡀほᐹࡉࢀ࡚࠸ࡿ 10)ࠋ                       ̿  ̿                  A

PG I ൒ 50
50 ൒ PG I ൐ 30
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Log-rank test p < 0.0001*⫶ࡀࢇⓎ⏕ᖺ⋡⫶ࡀࢇⓎⓎ⏕ᖺ⋡⫶ࡀࢇⓎ⏕ᖺ⋡
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ᅗ 1. ⾑Ύ࣌ࣉࢩࣀࢤ್ࣥ࡜⫶ࡀࢇⓎ⏕        ⾑Ύ࣌ࣉࢩࣀࢤ್ࣥࢆ

ᐃࡋࡓ 5,209 ྡࡢ↓⑕≧⪅ ⏨ᛶ ࢆ⾑Ύ࣌ࣉࢩࣀࢤ್ࣥ A: PG I, B: PG I/II ࡟࡚㝵ᒙ໬ࡋࠊྛࢢࣝ̿ࣉࡢ⫶ࡀࢇⓎ⏕ࢆ᳨ウࡋࡓࠋ Yanaoka K, et al. Int J Cancer. 2008, P.920 ᩥ⊩ 10 ࡼࡾᘬ⏝ᨵኚ௨ୖࡢ⤖ᯝࠊPGI ཬࡧ PGI / II ࡀඹ࡟ప್ࢆ♧ࡍ࣌ࣉࢩࣀࢤ᳨ࣥᰝ㝧ᛶ⪅ࡣࠊ☜ᐇ࡞⫶ࡀࢇ㧗༴㝤⩌࡛࠶ࡾࠊ⟶⌮ୗ࡟⨨࠸࡚ៅ㔜࡟⤒㐣ほᐹࡍࡿᚲせࡀ࠶ࡿ㞟ᅋࢆᵓᡂࡍࡿࡇ࡜ࡀ⌮ゎ࡛ࡁࡿࠋ
஦ᐇࠊ40㹼59 ṓࡢ᳨デୡ௦ࢆᑐ㇟࡟ࡋࡓሙྜࠊᇶ‽್㝜ᛶ⩌࡛ࡣ⫶ࡀࢇⓎ⏕ᖺ⋡ࡀ 0.07% ࣁࢨ࣮ࢻẚ㸻1.0 ࠊᇶ‽್㝧ᛶ⩌࡛ࡣᖺ⋡ 0.28% ࣁࢨ࣮ࢻẚ㸻3.6 ࠊ୰➼ᗘ㝧ᛶ⩌࡛ᖺ⋡ 0.32% ࣁࢨ࣮ࢻẚ㸻4.6 ࠊᙉ㝧ᛶ⩌࡛ࡣᖺ⋡ 0.42% ࣁࢨ࣮ࢻẚ㸻5.2 ࡜ሗ࿌ࡉࢀ࡚࠸ࡿ 24) ᅗ 2 ࠋ୍᪉ࠊ࣌ࣉࢩࣀࢤ᳨ࣥᰝ㝜ᛶ࡟ࡣࠊPGI ཬࡧ PGI / II ࡢ࠸ࡎࢀ࠿ࡀప್ࢆ♧ࡍ㧗༴㝤⩌ࡀΰධࡍࡿࡓࡵࠊ⌧ᅾࡢ࣌ࣉࢩࣀࢤ᳨ࣥᰝࡢุᐃᇶ‽ࢆࣜࢫࢡデ᩿࡟⏝࠸ࡿ࡟ࡣၥ㢟ࡀ࠶ࡿࠋ̿  ̿

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㸦Yanaoka K, et al. Cancer Epidemiol Biomarkers Prev, 2008㸧ᩥ⊩ 24 ࡼࡾᘬ⏝ᨵኚ

ᅗ 2. ⾑Ύ࣌ࣉࢩࣀࢤ᳨ࣥᰝࡢྛ FXWRII ್࡟ࡼࡿ⫶ࡀࢇⓎ⏕⾑Ύ࣌ࣉࢩࣀࢤ್ࣥࢆ ᐃࡋࡓ 5,209 ྡࡢ↓⑕≧⪅ ⏨ᛶ ࢆྛ cut-off ್ࡈ࡜ࡢ subgroup ࡟ศࡅ࡚
10 ᖺ㛫⤒㐣ほᐹࡋࠊྛ group ࡢ⫶ࡀࢇⓎ⏕ࢆ᳨ウࡋࡓࠋ㸦3㸧࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⫶⅖⑓ᮇศ㢮࡟ᇶ࡙ࡃࣜࢫࢡᒙู໬ձ ᇶᮏⓗ஦㡯࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⫶⅖ࡀ⫶ࡀࢇⓎ⏕ࡢ୺せ⤒㊰ࢆᵓᡂࡋࠊ⫶⅖㐍ᒎ࡟క࠸኱㒊ศࡢ⫶ࡀࢇࡀⓎ⏕ࡍࡿࠋ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⫶⅖ࡢ⑓ᮇࡣࠊ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜᢠయ౯
࡜⾑Ύ࣌ࣉࢩࣀࢤ್ࣥ࡟ᇶ࡙ࡁ 4 ⩌࡟ศ㢮࡛ࡁࡿ 25, 26)ࠋࡍ࡞ࢃࡕࠊA ⩌ ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜ
ᢠయ᳨ᰝࠊ࣌ࣉࢩࣀࢤ᳨ࣥᰝඹ࡟㝜ᛶ ࠊB ⩌ ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜᢠయ᳨ᰝ㝧ᛶࠊ࣌ࣉࢩࣀ
ࢤ᳨ࣥᰝ㝜ᛶ ࠊ C ⩌ ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜᢠయ᳨ᰝࠊ࣌ࣉࢩࣀࢤ᳨ࣥᰝඹ࡟㝧ᛶ ࠊD ⩌ ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜᢠయ᳨ᰝ㝜ᛶࠊ࣌ࣉࢩࣀࢤ᳨ࣥᰝ㝧ᛶ ࡛࠶ࡿ ᅗ 3 ࠋA ⩌ࡣ࣊ࣜࢥࣂࢡࢱ
࣮࣭ࣆࣟࣜᮍឤᰁ೺ᖖ⩌ࠊB ⩌ࡀ㍍ᗘⴎ⦰ᛶ⫶⅖⩌ࠊC ⩌ࡣ㧗ᗘⴎ⦰ᛶ⫶⅖⩌ࠊD ⩌ࡣ໬⏕ᛶ⫶⅖
⩌ ⭠ୖ⓶໬⏕㐍ᒎ࡟ࡼࡿ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜ⮬↛㝖⳦⩌ ࡟┦ᙜࡋࠊឤᰁᡂ❧࠿ࡽ໬⏕ᛶ⫶
⅖࡟⮳ࡿ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⫶⅖ࡢ⮬↛ྐࡀࠊB ⩌࠿ࡽ D ⩌࡬ࡢ㐍⾜࡜ࡋ࡚♧ࡉࢀࡿࠋ
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㸦ᩥ⊩ 25, 28 ࡼࡾᘬ⏝ᨵኚ㸧

ᅗ 3. ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⫶⅖⑓ᮇศ㢮
Hp: ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜࠊPG:࣌ࣉࢩࣀࢤࣥ
㸦ࡓࡔࡋࠊ㝖⳦౛࡞࡝ࡣᮏศ㢮ࡢᑐ㇟እ㸧㸡B ⩌ࡢ୰࡟ࡣᮍศ໬ࡀࢇࡢࣁ࢖ࣜࢫࢡࡀྵࡲࢀࡿࡢ࡛ὀព
ࡀᚲせࠋ㸦ᩥ⊩ 24, 28, 43㸧̿  ̿                  㛗ᮇほᐹ◊✲ࡢ⤖ᯝࠊA ⩌࠿ࡽ D ⩌ࡲ࡛ࡢྛ⑓ᮇ࠾ࡅࡿ⫶ࡀࢇⓎ⏕⋡ཬࡧࣜࢫࢡࡀ♧ࡉࢀ࡚࠸ࡿ 27–31)ࠋᅗ 4 ࡛ࡣࠊ40㹼59 ṓࡢ⫶ࡀࢇ᳨デᑐ㇟⪅ࡢ⫶ࡀࢇⓎ⏕ᖺ⋡ࡣࠊA ⩌ 0.02%࡜ప⋡࡛࠶ࡿࡀࠊ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁᡂ❧࡟ࡼࡾ⫶ࡀࢇⓎ⏕ᖺ⋡ࡣ᭷ព࡟ୖ᪼ࠊB ⩌ 0.14% ࣁࢨ࣮ࢻẚ㸻7.1 ࠊC ⩌ 0.30% ࣁࢨ࣮ࢻẚ㸻14.5 ࠊD ⩌ 1.1% ࣁࢨ࣮ࢻẚ㸻61.9 ࡜ሗ࿌ࡉࢀ࡚࠸ࡿ 27, 28)ࠋ ↓⑕≧⪅⏨ᛶ ෥ṓ ྡᖹᆒほᐹᮇ㛫 6'   ᖺ/RJUDQNWHVW
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   ほᐹᮇ㛫㸦ᖺ㸧㸦ᩥ⊩ 27, 28 ࡼࡾᘬ⏝ᨵኚ㸧

ᅗ 4. ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⫶⅖ࡢ⑓ᮇ࡜⫶ࡀࢇⓎ⏕࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⫶⅖ࡢ⑓ᮇ࡜⫶ࡀࢇⓎ⏕ ஧ࡘࡢ⾑ᾮ᳨ᰝ ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜᢠయ᳨ᰝࠊ࣌ࣉࢩࣀࢤ᳨ࣥᰝ ࡟࡚࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⫶⅖ࡢ⑓ᮇ A-D ⩌ࢆデ᩿ࡋࡓ↓⑕≧ࡢ୰ᖺ⏨ᛶ 4,655 ேࢆ 16 ᖺ㛫⤒㐣ほᐹࡋࠊྛ⑓ᮇࡢ⫶ࡀࢇⓎ⏕ࢆ᳨ウࡋࡓࠋ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜᮍឤᰁ⩌ A ⩌ ࡣ⫶ࡀࢇప༴㝤⩌࡛࠶ࡾࠊ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤ
ᰁ⫶⅖㐍ᒎ࡟ࡼࡾ⫶ࡀࢇࣜࢫࢡࡀẁ㝵ⓗ࡟ቑຍࡍࡿࠋᚑࡗ࡚ࠊ⫶ࡀࢇ㧗༴㝤⩌ C ཬࡧ D ⩌ ࢆ⟶⌮ᑐ㇟࡜ࡋࠊప༴㝤⩌ A ⩌ ࢆ᳨デ࠿ࡽ㝖እࡍࡿ⪃࠼᪉ࡶ࠶ࡿࠋᮏศ㢮ࢆ⏝࠸ࣜࢫࢡᒙู໬࡟ࡼ
ࡾ᳨デຠ⋡໬ࢆᅗࡿࡢࡀ㺀ABC ᳨デ㺁࡟௦⾲ࡉࢀࡿ⫶ࡀࢇࣜࢫࢡ᳨デ࡛࠶ࡿ 32, 33)ࠋղ ⌧≧࡛ࡢㄢ㢟࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⫶⅖⑓ᮇศ㢮ࡣࠊ஧ࡘࡢ⾑ᾮ᳨ᰝ࡟ᇶ࡙ࡁ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟ
ࣜឤᰁ⫶⅖ࡢ⑓ᮇ࡜⫶ࡀࢇࣜࢫࢡホ౯ࢆ⾜࠺ࡀࠊᇶ┙࡜࡞ࡿ⛉Ꮫⓗ᳨ウࡣ༑ศ࡛ࡣ࡞ࡃࠊヨ㦂ẁ㝵࡟␃ࡲࡾࠊከࡃࡢ᳨ウㄢ㢟ࢆᢪ࠼࡚࠸ࡿࠋ
a㸧࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁデ᩿ࡢಙ㢗ᛶࡢၥ㢟⌧ᅾ ABC ᳨デ࡟౑⏝ࡉࢀ࡚࠸ࡿ ᐃ⣔ࡣࣜࢫࢡᒙู໬ࢆ᝿ᐃࡋ᳨࡚ウࡉࢀ࡚࠸࡞࠸ࠋ
ࡇࡢࡓࡵࠊ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜᮍឤᰁ࡛ప༴㝤⩌࡜ศ㢮ࡋࡓ㞟ᅋ࡟ࠊ↓どࡋࡀࡓ࠸๭ྜࡢ࣊ࣜࢥࣂࢡࢱ
࣮࣭ࣆࣟࣜ⌧ឤᰁཬࡧ᪤ឤᰁ⪅ࡀΰධࡋ࡚࠸ࡿ࡚࠸ࡿ 11-15)ࠋཷデ⪅ࡢ୙฼┈ࢆᅇ㑊ࡍࡿୖ࡛ࠊ᳨
デᑟධ௨๓࡟౑⏝ࡍࡿ ᐃ⣔ࡢ≉ᛶࠊcut-off ್࡞࡝ࡢ༑ศ࡞᳨ウࡀ୙ྍḞ࡛࠶ࡿࠋ             b㸧࣌ࣉࢩࣀࢤࣥ࡟ࡼࡿⴎ⦰ᛶ⫶⅖デ᩿ࡢಙ㢗ᛶ࡟㛵ࡍࡿၥ㢟ABC ᳨デ࡛౑ࢃࢀ࡚࠸ࡿ⾑Ύ࣌ࣉࢩࣀࢤ್ࣥࡢ cut-off ್ࡣࠊPGIӌ70 ࠿ࡘ PGI / IIẚӌ3.0 ᇶ‽್ ࡛࠶ࡿࠋࡋ࠿ࡋࠊᇶ‽್ࡣࣜࢫࢡᒙู໬ࢆ┠ⓗ࡟タᐃࡉࢀࡓࡶࡢ࡛ࡣ࡞࠸ࠋࡍ࡞ࢃࡕࠊᇶ‽್㝧ᛶ⩌ࡣ㧗༴㝤⩌࡛࠶ࡿࡀࠊ㝜ᛶ⩌࡟ࡣ PGI ࠶ࡿ࠸ࡣ PG I / II ẚࡢ࠸ࡎࢀ࠿ࡀప್ࢆ♧ࡍ㧗༴㝤⩌ࡀΰᅾࡋࠊ࣌ࣉࢩࣀࢤ᳨ࣥᰝ㝜ᛶ⩌ࡣᚲࡎࡋࡶప༴㝤⩌࡜ࡣ㝈ࡽ࡞࠸㞟ᅋ࡛࠶ࡿ 24)ࠋ
̿  ̿                  ௨ୖࡢ⤖ᯝࠊA ⩌ ప༴㝤⩌ ࡟↓どࡋࡀࡓ࠸๭ྜࡢࡀࢇⓎ⏕ࡀ⏕ࡌࠊẚ㍑ⓗపࣜࢫࢡ࡛࠶ࡿ B⩌࡟ᮍศ໬ࡀࢇ㧗༴㝤⩌ ᚋ㏙ ࡀᏑᅾࡋࠊࡉࡽ࡟ࡣࠊቑຍࡢ୍㏵ࢆ㎺ࡿ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜ
㝖⳦⩌ࡀపࣜࢫࢡ࡜ࡋ࡚ྠᐃࡉࢀࡿ࡞࡝ࠊ୍㐃ࡢၥ㢟ࡀⓎ⏕ࡍࡿཎᅉ࡜࡞ࡗ࡚࠸ࡿ 13, 14, 34)ࠋc㸧⑓ᮇศ㢮࡟ࡼࡿࣜࢫࢡᒙู໬ࢆᕠࡗ࡚ࡢၥ㢟ࡇࢀࡲ࡛ࡢሗ࿌࠿ࡽࠊ౑⏝ࡍࡿᐃ⣔ࡢ≉ᛶࠊcut-off ್ࡢタᐃ࡞࡝࡟ࡼࡗ࡚ࡣࠊA–D ࡢྛ⩌㛫ࡢ᭷ព࡞㝵ᒙ໬ࡀ㐩ᡂ࡛ࡁ࡞࠸ࡇ࡜ࡀ᝿ᐃࡉࢀࡿ 35)ࠋ᳨デᑟධ࡟ࡼࡾ㐺ษ࡞ࣜࢫࢡᒙู໬ࡀ㐩ᡂྍ⬟࠿࡟㛵ࡋ࡚ࡣࠊ౑⏝ࡍࡿ ᐃ⣔ࡢ⢭ᗘࠊcut-off ್࡟ࡘ࠸࡚஦๓ࡢ༑ศ࡞᳨ウࡀᚲ㡲࡛࠶ࡿࠋd㸧ഇ㝧ᛶ㸸ㄗࡗࡓࣛ࣋ࣜࣥࢢ
⫶ࡀࢇⓎ⑕ࣜࢫࢡࡀ࠶ࡿ BࠊCࠊD ⩌ࡢ඲ဨࡀ⫶ࡀࢇࢆⓎ⑕ࡍࡿࢃࡅ࡛ࡣ࡞ࡃࠊ኱༙ࡣ⫶ࡀࢇࢆ
Ⓨ⑕ࡋ࡞࠸ࠋᚑࡗ࡚ࠊ┦ᙜᩘࡀ㺀⫶ࡀࢇⓎ⑕ࣜࢫࢡ࠶ࡾ㺁࡜࠸࠺ㄗࡗࡓࣛ࣋ࣜࣥࢢࢆཷࡅࡿࠋ㛵㐃ࡢㄪᰝࡣ࡞࠸ࡀࠊஙࡀࢇ᳨デ࡛ࡣഇ㝧ᛶࢆక࠺୙Ᏻ࡞࡝ᚰ⌮ⓗ㈇ᢸࡀሗ࿌ࡉࢀ࡚࠸ࡿ 36, 37)ࠋe㸧⌮ㄽⓗᇶ┙࡜࡞ࡿ⫶Ⓨࡀࢇ௬ㄝࡢ㝈⏺࡟⏤᮶ࡍࡿၥ㢟ABC ᳨デࡢ⌮ㄽⓗᇶ┙ࡣⴎ⦰ᛶ⫶⅖࣭⭠ୖ⓶໬⏕ࢆ๓ࡀࢇ≧ែ࡜ࡍࡿⓎࡀࢇ௬ㄝ࡟࠶ࡿࠋࡇࢀ
ࡣࠊศ໬ᆺ⫶ࡀࢇ୺యࡢⓎࡀࢇ௬ㄝ࡛࠶ࡾࠊࢫ࢟ࣝࢫ⫶ࡀࢇ࡟௦⾲ࡉࢀࡿᮍศ໬ࡀࢇ࡟ࡣ㐺⏝࡛
ࡁ࡞࠸ 38, 39)ࠋࡇࢀࡲ࡛ࡢሗ࿌࡛ࡣࠊ㧗ᗘⴎ⦰ᛶ⫶⅖࣭⭠ୖ⓶໬⏕ࢆకࢃ࡞࠸⫶ࡀࢇ⑕౛ࡀ 20㹼40%࡟ୖࡿࡇ࡜ 40, 41)ࠊ㧗ᗘⴎ⦰ᛶ⫶⅖ࡢ๓ẁ㝵࡛⫶⅖άືᗘࡢ㧗࠸᫬ᮇ࡛ࡢⓎࡀࢇࣜࢫࢡࡀ㧗࠸ࡇ࡜
24, 28, 42, 43)ࠊ≉࡟ࠊẚ㍑ⓗపࣜࢫࢡࡢ B ⩌࡟㧗ᝏᛶᗘࡢ⫶ࡀࢇ㧗༴㝤⩌ࡢᏑᅾࡀᣦ᦬ࡉࢀ࡚࠸ࡿࠋ

f㸧᳨デ㐠⏝ୖࡢㄢ㢟̿⟶⌮యไᵓ⠏ࡢ㔜せᛶABC ᳨デ࡛ࡣ⾑Ύ࣌ࣉࢩࣀࢤ᳨ࣥᰝ࡟㛵ࡋ࡚㐺⏝እࡢཷデ⪅ ๓㏙ ࡀᏑᅾࡍࡿࠋ㐺⏝እࡢཷデ⪅ࡢ๭ྜࡣ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜ㝖⳦἞⒪ࡢᬑཬᒎ㛤ࠊ㧗㱋⪅ࡢቑຍ࡟క࠺᭹⸆ቑຍ࡞࡝࡟ࡼ
ࡾ☜ᐇ࡞ቑຍഴྥ࡟࠶ࡾࠊ」ᩘࡢ᳨デࢩࢫࢸ࣒ࢆື࠿ࡍ⌧ሙࡢ㈇ᢸࡣ↓どࡋࡀࡓ࠸ࡶࡢࡀ࠶ࡿࠋ
㺀ABC ᳨デ㺁ࡣ㐠⏝ୖࡢࣁ࣮ࢻࣝࡀᴟࡵ࡚㧗ࡃࠊࣜࢫࢡᒙู໬ࢆ⾜ࡗࡓཷデ⪅ࡢࢹ࣮ࢱࢆ⟶⌮ࡋࠊࣜࢫࢡ᳨デࡢᐇຠᛶࢆ࠶ࡆࡿࡓࡵࡢ⟶⌮యไࡢ᳨ウࡀ༑ศ࡛ࡣ࡞࠸ࠋྠᐃࡋࡓ㧗༴㝤⩌࡟ᑐࡋ࡚⟶⌮⢭᳨ࡢ⥅⥆ࡣࣜࢫࢡ᳨デࡢᇶᮏ࡛࠶ࡾࠊᐇࡣ᝿ീ௨ୖ࡟ከࡃࡢປຊ࡜⤒㈝ࡀせồࡉࢀࡿ㐣⛬࡛࠶ࡿࠋ኱㜰ᗓ྿⏣ᕷࡢ࣌ࣉࢩࣀࢤ᳨ࣥᰝ⫶ࡀࢇ᳨デࡢ 12 ᖺ࡟ࢃࡓࡿ⤒㦂࠿ࡽࡣࠊ㧗༴㝤⩌ᑐ㇟⪅ࡢ⥅⥆ⓗ⟶⌮ࡀᅔ㞴࡛࠶ࡿ࠿ࢆ❚࠸▱ࡿࡇ࡜ࡀ࡛ࡁࡿ 44)ࠋ⟶⌮యไᵓ⠏࡞ࡋ࡟⌧ᅾࡢ᳨デయไୗ࡛㐠⏝ࡍࡿࡢ࡛ࡣࠊ㺀ࡸࡾࡗᨺࡋ᳨デ㺁࡟㝗ࡿྍ⬟ᛶࡀ㧗࠸ࡇ࡜ࡀ኱࠸࡟༴᝹ࡉࢀࡿࠋ
4㸧ࡲ࡜ࡵ ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁࢆᇶ㍈࡟ࡋࡓ⫶ࡀࢇⓎ⏕ࡢヲ⣽ࡀ᫂ࡽ࠿࡟࡞ࡾࠊ⫶ࡀࢇ㧗༴㝤⩌ࢆ࠶ࡿ⛬ᗘᢕᥱࡍࡿࡇ࡜ࡀྍ⬟࡜࡞ࡗࡓࠋࡑࡢ⤖ᯝࠊ⫶ࡀࢇ᳨デຠ⋡໬ࢆど㔝࡟ࠊ⾑ᾮ᳨ᰝ࡟ࡼ
ࡿ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⫶⅖⑓ᮇศ㢮࡟ᇶ࡙ࡃࣜࢫࢡᒙู໬ࡀ᳨ウࡉࢀ࡚࠸ࡿࠋ⌧≧࡛ࡣ࠶ࡿ⛬ᗘࡢࣜࢫࢡᒙู໬ࡀྍ⬟࡜⪃࠼ࡽࢀࡿࡀࠊ⌮ㄽⓗ࡞ẁ㝵࡟␃ࡲࡿࠋ௒ᚋࡢ᳨ウ࡟ࡼࡾࠊಙ
㢗࡟㊊ࡿ ᐃ⣔ࢆ⏝࠸ࡓᏳᐃࡋࡓࢩࢫࢸ࣒ࡢⓏሙࡀᮇᚅࡉࢀࡿࠋ
ཷデ⪅ࡢ୙฼┈ࢆᅇ㑊ࡍࡿ࡟ࡣࠊ㺀ABC ᳨デ㺁ࡢᑟධ࡟ៅ㔜ࢆᮇࡍ࡭ࡁ࡛࠶ࡿࠋ௒ᚋࡣࠊᐇ᪋ྍ
⬟ᛶࡢ࠶ࡿ㈐௵యไࢆᵓ⠏ࡋࠊࡉࡽ࡞ࡿ᳨ウࡀᚲせ࡛࠶ࡿࠋࣜࢫࢡᒙู໬ࢆ᳨デ࡟ᑟධࡍࡿሙྜࠊ㺀᭷ຠᛶホ౯࡟ᇶ࡙ࡃ⫶ࡀࢇ᳨デ࢞࢖ࢻࣛ࢖ࣥ㺁45)ࡢ່࿌ࢆ㑂Ᏺࡋࠊ㐺ṇ࠿ࡘៅ㔜࡟㐠⏝ࡍࡿࡇ࡜ࡀ㔜せ࡛࠶ࡿࠋ≉࡟ࠊཷデ⪅࡟ᑐࡋᮏ᳨デࡀヨ㦂ẁ㝵࡟࠶ࡿ⌧≧࡟ࡘ࠸࡚ṇ☜࡟࿘▱ࢆᅗࡿ࡭ࡁ
࡛࠶ࡿࠋ̿  ̿                  ཧ⪃ᩥ⊩1㸧 Correa P. Human gastric carcinogenesis: a multistep and multifactorial process̿First American
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21㸧 ୕ᮌ୍ṇ. ⾑Ύ࣌ࣉࢩࣀࢤ್ࣥ࡟ࡼࡿ⫶⒴ࢫࢡ࣮ࣜࢽࣥࢢ࡟㛵ࡍࡿ◊✲㸬 ୺௵◊✲⪅୕ᮌ୍ṇ ཌ⏕ປാ┬ࡀࢇ◊✲ຓᡂ㔠ᖹᡂ 9 ᖺᗘሗ࿌㞟 9–8 㸪1997㸪288–292.
22㸧 ໭ෆಙኴ㑻㸪୍℩㞞ኵ㸬࣌ࣉࢩࣀࢤࣥἲ࡜ࡣ㸬ཌ⏕┬ࡀࢇ◊✲ຓᡂ㔠࡟ࡼࡿ㺀⾑Ύ࣌ࣉࢩࣀࢤ
್ࣥ࡟ࡼࡿࢫࢡ࣮ࣜࢽࣥࢢ࡟㛵ࡍࡿ◊✲㺁⌜ ୺௵◊✲⪅ ୕ᮌ୍ṇ ࣌ࣉࢩࣀࢤࣥἲࣁࣥࢻ
ࣈࢵࢡ㸪࣓ࢪ࢝ࣝࣅ࣮ࣗ♫㸪ᮾி㸪2001, 10–13.
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26㸧 ୍℩㞞ኵ. H. pylori 㛵㐃⫶⅖ࡢ⮬↛ྐ࡟ᇶ࡙ࡃ⫶⒴Ⓨ⏕ண㜵࣭᪩ᮇⓎぢ. ᪥ᾘࡀࢇ᳨デㄅ
2008; 46:355–364.
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30㸧 Mizuno S, Miki I, Ishida T, et al. Prescreening of a high-risk group for gastric cancer by serologicallydetermined Helicobacter pylori infection and atrophic gastritis. Dig Dis Sci 2010; 55:3132–3137.
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Chinese community. Int J Cancer 2012; 130:1614–1619.

̿  ̿                  
32㸧 NPO ἲே᪥ᮏ⫶ࡀࢇண▱࣭デ᩿࣭἞⒪◊✲ᶵᵓ㸬⫶ࡀࢇࣜࢫࢡ᳨デ ABC ᳨デ ࣐ࢽࣗ࢔ࣝؐ
⫶ࡀࢇ᧞⁛ࡢࡓࡵࡢᡭᘬࡁ. ༡ᒣᇽ㸪ᮾி㸪2009.
33㸧 ஝⣧࿴㸪ྜྷᕝᏲஓ㸪㜿㒊⣧㸪௚㸬ఫẸ᳨デ࡟࠾࠸࡚ Helicobacter pylori ᳨ᰝࡣ࡝ࡢࡼ࠺࡟ά⏝ࡉࢀࡿ࠿㸽ؐ⾑Ύ H. pylori ᢠయ౯㸪⾑Ύ࣌ࣉࢩࣀࢤ್ࣥྠ᫬ ᐃ࡟ࡼࡿ⫶ࡀࢇ᳨デ ABC ᳨
デ ࡢヨࡳ㸬Helicobacter Res 2007; 11:554–561㸬
34㸧 ๓໭㝯㞝㸪ຍ⸨㡰㸪୍℩㞞ኵ㸪௚㸬ABC ศ㢮ࡢ⌧≧࡟࠾ࡅࡿㄢ㢟㸸⾑Ύ࣌ࣉࢩࣀࢤࣥ࡟ࡼࡿ
ⴎ⦰ᛶ⫶⅖デ᩿ࡢၥ㢟Ⅼ㸬୍℩㞞ኵ㸪ᒸᨻᚿ㸪ᩪ⸨༤⦅㸪⫶⒴ࣜࢫࢡࣇ࢓ࢡࢱ࣮࡜ࣜࢫࢡデ᩿㸪᪥ᮏ࣓ࢹ࢕࢝ࣝࢭࣥࢱ࣮㸪ᮾி㸪2014, 121–127.
35㸧 Terasawa T, Nishida H, Kato K, et al. Prediction of gastric cancer development by serum pepsinogentest and Helicobacter pylori seropositivity in Eastern Asians: a systematic review and meta-analysis.
PLoS ONE 2014; 9:e109783.
36㸧 ᅜ❧ࡀࢇ◊✲ࢭࣥࢱ࣮ ࡀࢇண㜵᳨࣭デ◊✲ࢭࣥࢱ࣮㸬᭷ຠᛶホ౯࡟ᇶ࡙ࡃஙࡀࢇ᳨デ࢞࢖ࢻ
ࣛ࢖ࣥ 2013 ᖺᗘ∧㸬ᮾி㸪2014㸬
37㸧 Nelson HD, Pappas M, Cantor A, et al. Harms of breast cancer screening: systematic review to update
the 2009 U.S. Preventive Services Task Force recommendation. Ann Intern Med 2016; 2016 Jan 12.
doi: 10.7326/M15-0970.
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Pract Res Clin Gastroenterol 2006; 20:651–674.
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gastric lesions. Aliment Pharmacol Ther 2004; 20:261–270.
40㸧 ᯇᮏ⣧୍, Ⲩ஭Ὀ㐨, ▮స࿴ஓ, ௚㸬⾑Ύ࣌ࣉࢩࣀࢤࣥἲ㝜ᛶ⫶⒴ࡢ᳨ウ㸬᪥ᾘ㞟᳨ㄅ 2002;
40:20–27.
41㸧 ▼⏣୍ᙪ, ⸨⏣┤Ꮥ, ⤖ᇛ㇏ᙪ, ௚㸬࣌ࣉࢩࣀࢤุࣥᐃ㝜ᛶ⫶⒴౛ࡢ᳨ウ㸬᪥ᾘ㞟᳨ㄅ 1999;
37:543–547.
42㸧 Inoue M, Tajima K, Matsuura A, et al. S. Severity of chronic atrophic gastritis and subsequent gastriccancer occurrence: a 10-year prospective cohort study in Japan. Cancer Lett 2000; 161:105–112.
43㸧 Watanabe M, Kato J, Inoue I, et al. Development of gastric cancer in nonatrophic stomach with highly
active inflammation identified by serum levels of pepsinogen and Helicobacter pylori antibody
together with endoscopic rugal hyperplastic gastritis. Int J Cancer 2012; 131:2632–2642.
44㸧 ┦㤿Ꮥ㸬ᑐ⟇ᆺ᳨デ࠿ࡽぢࡓ⫶⒴ࣜࢫࢡデ᩿ࡢၥ㢟Ⅼ̿ࣜࢫࢡ᳨デࡢඛ㥑ࡅ࡜ࡋ࡚ࡢ࣌ࣉࢩ
ࣀࢤࣥἲࡀ♧ࡍㄢ㢟㸸྿⏣ᕷ࡟࠾ࡅࡿᑟධᚋ 12 ᖺ㛫ࡢṔྐؐ㸬୍℩㞞ኵ㸪ᒸᨻᚿ㸪ᩪ⸨༤⦅㸪⫶⒴ࣜࢫࢡࣇ࢓ࢡࢱ࣮࡜ࣜࢫࢡデ᩿ؐ࡜ࡃ࡟ ABC ᳨デࡢ⌧≧࡜ၥ㢟Ⅼࡢṇࡋ࠸⌮ゎࡢࡓࡵ࡟㸪᪥ᮏ࣓ࢹ࢕࢝ࣝࢭࣥࢱ࣮㸪ᮾி㸪2014㸪153–161.
45㸧 ᅜ❧ࡀࢇ◊✲ࢭࣥࢱ࣮ ࡀࢇண㜵᳨࣭デ◊✲ࢭࣥࢱ࣮㸬᭷ຠᛶホ౯࡟ᇶ࡙ࡃ⫶ࡀࢇ᳨デ࢞࢖ࢻ
ࣛ࢖ࣥ 2014 ᖺᗘ∧㸬ᮾி㸪2015㸬୍℩㞞ኵ ̿  ̿ 

2. ⫶ෆど㙾࡟ࡼࡿ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁデ᩿
1㸧⫼ᬒ៏ᛶ⫶⅖ࡢ୺せ࡞⑓ᅉࡀ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ࡛࠶ࡾࠊ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⫶⅖ࡀ⫶ࡀࢇⓎ⏕ࡢ୺せ⤒㊰ࢆᵓᡂࡍࡿࡇ࡜ࡀ᫂ࡽ࠿࡟ࡉࢀࡓࡇ࡜࠿ࡽࠊ៏ᛶ⫶⅖ࡢデ⒪ࡣ኱ࡁ࡞ኚㇺࢆ㐙ࡆࡓࠋ≉࡟ 2013 ᖺࠊ⫶ෆど㙾᳨ᰝ࡛☜ㄆࡉࢀࡓ⫶⅖⑕౛࡟ࡘ࠸࡚ࠊ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆ
ࣟࣜឤᰁデ᩿࡜㝖⳦἞⒪ࡢಖ㝤㐺⏝ࡀᢎㄆࡉࢀࡓࡇ࡜࡟ࡼࡾࠊ⫶ෆど㙾࡟ࡼࡿᮏ⫶⅖ࡢデ᩿ࡀᨵࡵ࡚ၥࢃࢀ࡚࠸ࡿࠋ⫶ෆど㙾࡟ࡼࡿ⫶⅖デ᩿ࢆᕠࡿ⤒⦋ࡣḟ㡯࡟グࡍ࡜࠾ࡾ࡛࠶ࡿࡀࠊ୍᪉ࠊⓎ⏕⫶ࡀࢇࡢ࡯࡜ࢇ࡝ࡀ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⫶⅖࡟⏤᮶ࡍࡿࡇ࡜ࠊ⫶⅖ᣢ⥆࡟ࡼࡾ⏕ࡌࡿⴎ⦰ᛶ⫶⅖࣭⭠ୖ⓶໬⏕㐍ᒎ࡜⫶ࡀࢇࣜࢫࢡ࡟┦㛵ࢆㄆࡵࡿࡇ࡜࡞࡝࠿ࡽࠊ⫶ࡀࢇ᳨デࡢ㡿ᇦ࡟࠾࠸࡚ࡶ᭱኱ࡢࣜࢫࢡࣇ࢓ࢡࢱ࣮࡛࠶ࡿ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⫶⅖ࡢ᭷↓ࠊ⑓ᮇ࡞࡝ࢆ⏬
ീ᳨ᰝ࡟ࡼࡾデ᩿ࡍࡿࡇ࡜࡛ࠊಶࠎࡢཷデ⪅ࡢ⫶ࡀࢇࣜࢫࢡࢆホ౯ࡍࡿヨࡳࡀάⓎ໬ࡍࡿ඙ࡋࡀ
ࡳࡽࢀ࡚࠸ࡿࠋຍ࠼࡚ࠊ๓❶࡛㏙࡭ࡓ㺀ABC ᳨デ㺁࡟㛵ࡍࡿ᳨ウࡀ㐍ࡴ࡟ࡘࢀ࡚ࠊྠ᳨デࡢᇶ┙ࢆ࡞ࡍ⾑Ύᢠయ౯࡟ࡼࡿ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁデ᩿ཬࡧ⾑Ύ࣌ࣉࢩࣀࢤࣥ PG ᳨ᰝ࡟ࡼࡿⴎ
⦰ᛶ⫶⅖デ᩿ࡢಙ㢗ᛶ࡟ၥ㢟ࡀ࠶ࡿࡇ࡜ࡀㄆ㆑ࡉࢀࡿ࡟⮳ࡾࠊࡇࢀࡽࢆ⿵᏶ࡍࡿ┠ⓗ࡛ࠊཷデ⪅ࡢ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⫶⅖࡟㛵ࡍࡿࣜࢫࢡホ౯ࢆ⏬ീ᳨ᰝ࡛⾜࠺ືࡁࡀฟ࡚࠸ࡿࠋ௨ୖ
ࡢ⤒⦋࡟ࡼࡾࠊ⫶ෆど㙾࡟ࡼࡿ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⫶⅖デ᩿ࢆ෌᳨ウࡍࡿᶵ㐠࡟࠶ࡿࠋ2㸧ෆど㙾ⓗ⫶⅖ศ㢮ࡢṔྐⓗ⤒⦋1922 ᖺࠊ⫶ෆど㙾ᡤぢ࡜⑓⌮ᡤぢࢆᑐᛂࡉࡏࡓ៏ᛶ⫶⅖࡟㛵ࡍࡿ᭱ึࡢศ㢮 1)ࡀ Schindler ࡟ࡼࡾሗ࿌ࡉࢀ࡚௨᮶ࠊ៏ᛶ⫶⅖ࡢ⫶ෆど㙾デ᩿☜❧࡟ྥࡅ࡚ࡢດຊࡀ㔜ࡡࡽࢀ࡚ࡁࡓࠋ࡞࠿࡛ࡶ 1969ᖺ࡟ᮌᮧ࣭➉ᮏࡽ࡟ࡼࡾᥦၐࡉࢀࡓෆど㙾ⓗⴎ⦰ᛶ⫶⅖ࡢ㐍ᒎᗘศ㢮 2) ࡸ 1973 ᖺ࡟ Strickland ࡽ࡟ࡼࡾᥦၐࡉࢀࡓⴎ⦰ᇦࡢศᕸࠊ⾑Ύ⮬ᕫᢠయ౯ࡸ࢞ࢫࢺ್ࣜࣥ࡟ᇶ࡙ࡃ Type A ཬࡧ Type B
gastritis ࡢศ㢮 3)ࡣ௒᪥ࡢデ⒪࡟ᙳ㡪ࢆ୚࠼⥆ࡅ࡚࠸ࡿࡶࡢ࡛࠶ࡿࠋࡑࡋ࡚ࠊ1990 ᖺࠊWhiteheadࡢ⫶⅖ศ㢮 4)࡟ᨵⰋࢆຍ࠼ࠊ୺せ࡞⑓ᅉ࡛࠶ࡿ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜࢆ┒ࡾ㎸ࢇࡔ Sydney Systemࡀᥦ᱌ࡉࢀࠊ⑓ᅉࠊᒁᅾࠊ⑓⌮⤌⧊Ꮫⓗᡤぢࠊෆど㙾ᡤぢࡢࡍ࡭࡚ࢆ⥙⨶ࡋࡓୡ⏺ᶆ‽ࡢศ㢮ࡀ
Ⓩሙࡋࡓ 5)ࠋ⌧ᅾࡣᨵゞ∧ Houston-updated version 6)ࡀ౑ࢃࢀ࡚࠸ࡿࡀࠊᮏศ㢮࡟ࡣࠊෆど㙾ⓗ⫶⅖ࡀᚲࡎࡋࡶ gold standard ࡛࠶ࡿ⤌⧊Ꮫⓗ⫶⅖ࢆ཯ᫎࡋ࡚࠸࡞࠸࡜࠸࠺ၥ㢟ࡀ࠶ࡿ 7)ࠋࡇࡢ⤖ᯝࠊ」㞧࡞ศ㢮࡟ࡶ࠿࠿ࢃࡽࡎࠊෆど㙾࡜⑓⌮ࡢ୧デ᩿ࡢ஋㞳࡟ࡼࡾࠊணᚋࡸ἞⒪࡞࡝⮫ᗋୖ᭷┈࡞
᝟ሗ࡜ࡣ㊥㞳ࡢ࠶ࡿศ㢮࡟␃ࡲࡿ࡜࠸࠺୙㒔ྜ࡞≧ἣࡀ⥆࠸࡚࠸ࡿࠋ
3㸧⫶ෆど㙾࡟ࡼࡿ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⫶⅖デ᩿ࡢ⌧≧ୡ⏺ᶆ‽࡛࠶ࡿ Sydney System ࡟ᇶ࡙ࡃෆど㙾デ᩿࡜࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁࡀច㉳ࡍࡿ⤌⧊Ꮫⓗ⫶⅖࡜ࡣᚲࡎࡋࡶ୍⮴ࡋ࡞࠸࡜࠸࠺⌧≧࡟ᑐࡋࠊࢃࡀᅜ࡛ࡣࠊ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤ
ᰁ⫶⅖ࡢෆど㙾ᡤぢࢆᩚ⌮ࡋ࡚ࠊឤᰁデ᩿ࢆྵࡵデ⒪࡟ᙺ❧ࡘྜ⌮ⓗ࡞ෆど㙾デ᩿Ꮫ☜❧ࡢࡓࡵࡢດຊࡀ⥆ࡅࡽࢀ࡚ࡁࡓ 8, 9)ࠋ
 Ḣ⡿࡟ẚ࡭࡚ෆど㙾デ᩿Ꮫࡀ㐍Ṍࡋ࡚࠸ࡿ࡜࠸ࢃࢀࡿࢃࡀᅜ࡟࠾࠸࡚ࡶࠊෆど㙾࡟ࡼࡿ⫶⅖デ᩿☜❧ࡀᅔ㞴࡞సᴗ࡜࡞ࡗࡓ⫼ᬒࡣࠊ᱁ู࡟㧗࠸࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⫶⅖᭷⑓⋡࡟࠶ࡿࠋࡍ࡞ࢃࡕࠊࢃࡀᅜ࡟࠾࠸࡚ࡣࠊ៏ᛶ⫶⅖ࡀ⪁໬⌧㇟࡛࠶ࡿ࡜ࡢㄝࡀㄝᚓຊࢆᣢࡘ࡯࡝ࠊ᭷⑓⋡ࡀ㧗ࡃࠊデ᩿ࡢᇶᮏ࡜࡞ࡿ೺ᖖ࡞⫶ࡢෆど㙾ᡤぢࡢᢕᥱࡀ㞴ࡋ࠿ࡗࡓࡇ࡜࡟ࡼࡿ࡜⪃࠼ࡽࢀࡿࠋࡋ̿  ̿ ࠿ࡋࠊ៏ᛶ⫶⅖ࡢཎᅉ࡜ࡋ࡚ࡢ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁࡢᏑᅾࡀ᫂☜࡜࡞ࡾࠊឤᰁ⪅࡜ᮍឤᰁ⪅ࠊࡉࡽ࡟ࡣ㝖⳦ࡉࢀࡓ᪤ឤᰁ⪅ࡢᡤぢࢆࡑࢀࡒࢀヲ⣽࡟ẚ㍑᳨ウࡍࡿࡇ࡜࡛ࠊ࣊ࣜࢥࣂࢡࢱ
࣮࣭ࣆࣟࣜឤᰁ⫶⅖࡟㉳ᅉࡍࡿෆど㙾ᡤぢࡢ඾ᆺ౛࡟㛵ࡋ୍࡚ᐃࡢぢゎࡀᚓࡽࢀࡘࡘ࠶ࡿ 10-15)ࠋ
4㸧࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⫶⅖ࡢෆど㙾ᡤぢ ๓㏙ࡢࡈ࡜ࡃ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜࡢឤᰁ≧ែࡀ␗࡞ࡿ3⩌ࠊࡍ࡞ࢃࡕࠊᮍឤᰁࠊ⌧ឤᰁࠊ᪤ឤᰁ 㝖⳦ᚋ ࡢྛ⩌ࡢẚ㍑᳨ウ࡟ࡼࡾෆど㙾ᡤぢࡀᩚ⌮ࡉࢀࡘࡘ࠶ࡾࠊከ᪋タඹྠ◊✲ࡢ⤖ᯝ10-14)ࡸࢥࣥࢭࣥࢧࢫ఍㆟ࡢ⤖ᯝ 15)࡜ࡋ࡚ሗ࿌ࡉࢀ࡚࠸ࡿࠋࡇࢀࡽ࡟㛵ࡍࡿ⌧᫬Ⅼ࡛ࡢぢゎࡢᴫ␎ࢆ௨
ୗ࡟ᥦ♧ࡍࡿࠋ
㸦1㸧࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜᮍឤᰁ౛ࡢෆど㙾ᡤぢ㸦ᅗ 1㸧ձ RAC regular arrangement of collecting venulesղ ⛸⥺ୖⓎ㉥ ࠸ࢃࡺࡿ kammrötungճ ࣐࣊ࢳࣥࡢ௜╔մ ⫶ᗏ⭢࣏࣮ࣜࣉ
࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜᮍឤᰁ࡛⤌⧊Ꮫⓗ⅖⑕ࡢ࡞࠸య㒊⫶⢓⭷ୖ⓶⾲㠃࡛ࡣ ձ ࡀほᐹࡉࢀࡿࠋղ ࠿ࡽ մ ࡶ ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁࡢ࡞࠸⫶⢓⭷ୖ⓶࡟ࡳࡽࢀࡿᡤぢ࡛࠶ࡿࠋࡇࢀࡽࡢᡤぢࡢᏑᅾ࡜ඹ࡟ࠊάືᛶ⅖⑕ࢆ♧ࡍᡤぢ࠶ࡿ࠸ࡣ⅖⑕ᣢ⥆ࡢ⤖ᯝ࡛࠶ࡿⴎ⦰࣭⭠ୖ⓶໬⏕࡞࡝ࡢᡤぢࡀㄆࡵࡽࢀ࡞࠸⑕౛࡛ࡣࠊ࡯ࡰ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜᮍឤᰁ࡜デ᩿࡛ࡁࡿࠋ
㸦2㸧࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜ⌧ឤᰁ౛ࡢෆど㙾ᡤぢ㸦ᅗ 2ࠊA̾N㸧ձ ÅₔᛶⓎ㉥ղ ⓾ぁ⭘኱ճ ᾋ⭘≧⢓⭷
մ Ⅼ≧Ⓨ㉥յ ⢓ᾮ௜╔ն ⴎ⦰շ ⭠ୖ⓶໬⏕࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ࡟ࡼࡿάືᛶ⅖⑕ࢆ཯ᫎࡋࡓᡤぢ ձ࠿ࡽ յࡢ࠸ࡎࢀ࠿ࡢᏑᅾࡀ⌧ឤᰁ౛ࡢデ᩿࡟ࡣᚲ㡲࡛࠶ࡿࠋࡲࡓࠊ⫶ࡀࢇ᳨デᑐ㇟ᖺ㱋࡟㐩ࡋࡓឤᰁ౛࡛ࡣ⛬ᗘࡢᕪࡣ࠶ࡿࡀࠊ
㛗ᮇ㛫ࡢឤᰁᣢ⥆ࡢ⤖ᯝࠊ ᗃ㛛⭢ཬࡧᄇ㛛⭢ഃ࠿ࡽ⫶ᗏ⭢ഃ࡟㐍ᒎࡍࡿ⭠ୖ⓶໬⏕ࢆྵࡴ ⴎ⦰ᛶኚ໬ ն շ ࢆㄆࡵࡿࠋ
㸦3㸧࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜ᪤ឤᰁ౛ 㝖⳦ᚋ ࡢෆど㙾ᡤぢ㸦ᅗ 2ࠊK̾P㸧ձ ⴎ⦰ղ ⭠ୖ⓶໬⏕ճ ᆅᅗ≧Ⓨ㉥ࡇࢀࡽࡢᡤぢࡢᏑᅾ࡜࡜ࡶ࡟ࠊ⌧ឤᰁ࡟ࡼࡿ⫶⅖ࡢάືᛶࢆ♧ࡍ๓㡯 ձ࠿ࡽ յࡢᡤぢࡀㄆࡵࡽࢀ࡞࠸ࡇ࡜ࢆ☜ㄆࡍࡿᚲせࡀ࠶ࡿࠋ̿  ̿



 

A, B.

A, B: ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆ
ࣟࣜᮍឤᰁࡢ⫶ᗏ⭢㡿ᇦ࡛ࡣࠊගἑࡢ࠶ࡿ೺ᖖ⫶⢓⭷࡟㞟ྜ⣽㟼⬦ࡢつ๎ⓗ ࡞ 㓄 ิ RAC: regulararrangement of collecting
venules ࡟ࡼࡿࠊᩚ↛࡜㓄ิࡍࡿ↓ᩘࡢⅬࠊ࠶ࡿ࠸ࡣ㏆᥋ീ࡛ࡣࣄࢺࢹᶍᵝࢆ࿊ࡍࡿᡤぢࡀㄆࡵࡽࢀࡿࠋᮏᡤぢࡣ㝖⳦ᚋࡢ⑕౛࡛ࡶㄆࡵࡽࢀࡿࠋRAC (regular arrangement of collecting venules)C, D: ⫶ࡢ㛗㍈᪉ྥ࡟⦪㉮ࡍࡿⓎ㉥࡛ࠊᚑ᮶
kammrötung ࡜࠸ࢃࢀ࡚࠸ࡓᡤぢ࡛࠶ࡿࠋ෗┿ࡢᵝ࡟๓ᗞ㒊ࠊయ㒊ࢆၥࢃࡎㄆࡵࡽࢀࠊ⫶඲య࡟ཬࡪ
ሙྜࡶ࠶ࡿࠋࡲࡓࠊᮍឤ
ᰁࡢ⫶ࡤ࠿ࡾ࡛࡞ࡃࠊ㝖⳦ᚋ⑕౛࡛ࡶㄆࡵࡽࢀ
ࡿࠋ
C, D. ⛸⥺≧Ⓨ㉥ ࠸ࢃࡺࡿ kammrötung

E, F: 㯮Ⰽㄪࡢจ⾑ሢ ࣐࣊ࢳࣥ ࡢᏑᅾࡶࠊ࣊ࣜࢥ
ࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁࡢ
࡞࠸⫶࡛ㄆࡵࡽࢀࡿᡤぢ࡛࠶ࡿࠋ෗┿࡛ࡣ๓ᗞ㒊࡟ᩓᅾࡍࡿ࣐࣊ࢳࣥࢆㄆ
ࡵࡿࠋᮍឤᰁࡢ⫶ࡤ࠿ࡾ࡛࡞ࡃࠊ㝖⳦ᚋ⑕౛࡛ࡶ
ㄆࡵࡽࢀࡿࠋ

E, F.

࣐࣊ࢳࣥࡢ௜╔G, H: ⫶ᗏ⭢㡿ᇦࠊ≉࡟✴❞㒊࠿ࡽ⫶యୖ㒊࡟࠿
ࡅ࡚Ⓨ⏕ࡍࡿᒣ⏣ II ᆺ㹼Ϫᆺࠊᚄᩘੈ⛬ᗘࡢᑠ࣏࣮ࣜࣉ࡛࠶ࡿࠋ≉࡟୰ᖺዪᛶ࡛࣊ࣜࢥࣂࢡࢱ࣮࣭
ࣆࣟࣜឤᰁࡢ࡞࠸⫶ᗏ⭢࠿ࡽ㝖⳦ᚋ࡟ከࡃㄆࡵࡽ
ࢀࡿࠋࣉࣟࢺ࣏ࣥࣥࣉ㜼ᐖ⸆᭹⏝࡞࡝࡜ࡢ㛵㐃࡛ࠊ▷ᮇ㛫࡟኱ࡁࡉࠊᩘ
ࡢᾘ㛗ࢆ♧ࡍࠋ

G, H. ⫶ᗏ⭢࣏࣮ࣜࣉᅗ 1. ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜᮍឤᰁ౛ࡢෆど㙾ᡤぢ̿  ̿ 㸦4㸧デ᩿ୖࡢせⅬ௨ୖࡣࠊ඾ᆺ౛࡟㛵ࡍࡿᡤぢ࡛࠶ࡿࠋᇶᮏⓗ࡟ࡣ⫶⅖ࡢ⤌⧊ᡤぢࢆᵓᡂࡍࡿ஧኱せ⣲࡛࠶ࡿ⅖
⑕ᛶኚ໬ ⅖⑕ࡢᏑᅾ࣭άືᗘ ࢆ཯ᫎࡋࡓᡤぢ࡜⅖⑕ᣢ⥆ࡢ⤖ᯝ࡜ࡋ࡚⏕ࡌࡿⴎ⦰࣭⭠ୖ⓶໬⏕࡟ὀ┠ࡋ࡚デ᩿ࢆ㐍ࡵࡿࡇ࡜࡟࡞ࡿࡀ 8)ࠊ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⫶⅖ࡢ multifocal gastritis࡜ࡋ࡚ࡢ≉ᛶࠊᗃ㛛⭢ཬࡧᄇ㛛⭢ഃ࠿ࡽ⫶ᗏ⭢㡿ᇦ࡬࡜㐍⾜ࡍࡿⴎ⦰ᛶ⫶⅖㐍ᒎࡢἲ๎࡟␃ពࡢ
ୖࠊឤᰁ≧ែࢆ♧ࡍ≉ᐃࡢᡤぢࡢᏑᅾ࡟ࡢࡳὀ┠ࡍࡿࡢ࡛ࡣ࡞ࡃࠊᗈࡃ⫶ෆ඲యࡢᡤぢࢆಠ▔ࡋࠊ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁࡢ᭷↓ࠊࡑࡢ⑓ᮇ࡟ࡘ࠸࡚⥲ྜⓗ࡟ุ᩿ࡍࡿᚲせࡀ࠶ࡿࠋ≉࡟ࠊ⳦㔞ࡢῶᑡࡋࡓⴎ⦰࣭⭠ୖ⓶໬⏕㐍⾜౛࡛ࡣデ᩿ࡢ㞴ࡋ࠸⑕౛ࡀ࠶ࡿࠋࡲࡓࠊ㝖⳦౛࡟㛵ࡋ࡚ࡣᮍࡔ⤒㦂▱ࡀᑡ࡞ࡃࠊ⑕౛ࡢ⫼ᬒࡀከᵝ࡛࠶ࡿࡇ࡜࠿ࡽࠊ඾ᆺ౛௨እ࡟㛵ࡍࡿ༑ศ࡞▱ぢࡢ㞟✚ࡀồࡵࡽࢀࡿ࡜ࡇࢁ࡛࠶ࡿࠋ
5㸧ࣁ࢖ࣜࢫࢡ࡜ࡋ࡚ࡢෆど㙾ീⴎ⦰ᛶ⫶⅖࣭⭠ୖ⓶໬⏕ࡀ⫶ࡀࢇࣁ࢖ࣜࢫࢡ࡛࠶ࡿࡇ࡜ࡣࡍ࡛࡟☜❧ࡋࡓ஦ᐇ࡛࠶ࡾࠊෆど㙾ⓗⴎ⦰ᛶ⫶⅖㐍ᒎ࡜࡜ࡶ࡟⫶ࡀࢇࣜࢫࢡୖ᪼ࢆㄆࡵࡿࡇ࡜ࡣࠊࡇࢀࡲ࡛ከࡃࡢ᳨ウ࡟ࡼࡾ᫂ࡽ࠿
࡟ࡉࢀ࡚࠸ࡿ 16, 17)ࠋࡲࡓࠊ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ࡟ࡼࡾⴎ⦰ᛶ⫶⅖㍍ᗘࡢ⫶య㒊࡟άືᛶ
⅖⑕ࡀច㉳ࡉࢀࡿ࡜⓾ぁ⫧኱ᆺ⫶⅖ࡀⓎ⏕ࡍࡿࡀࠊᮏ⫶⅖࡛ࡣᮍศ໬ࡀࢇࡢⓎ⏕ࣜࢫࢡࡀ㧗࠸ࡇ࡜ࡀࠊ⑕౛ᑐ↷◊✲ࠊࢥ࣮࣍ࢺ◊✲࡟ࡼࡾ☜ㄆࡉࢀ࡚࠸ࡿ 18-21)ࠋࡑࡢ௚ࠊᑠඣࡸⱝᖺ⪅࡟ㄆࡵࡽࢀࡿ㫽⫙⫶⅖ࡣࠊ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁࡢ⤖ᯝ⏕ࡌࡿ㢧ⴭ࡞ࣜࣥࣃℐ⬊ᙧᡂࢆ⫼ᬒ࡟ࡋࡓ⑓ែ࡛࠶ࡿࡀࠊᡂே౛࡛ࡣ⫶య㒊࡟Ⓨ⏕ࡍࡿᮍศ໬ࡀࢇࡢࣁ࢖ࣜࢫࢡ࡜⪃࠼ࡽࢀ࡚࠸ࡿ 22) ᅗ 2ࠊQ̾T ࠋ
6㸧௒ᚋࡢㄢ㢟ࡇࢀࡲ࡛⤌⧊Ꮫⓗデ᩿࡟౫Ꮡࡏࡊࡿࢆ࠼࡞࠿ࡗࡓ⫶⅖ࡢデ᩿ࡀࠊ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ
ࢆᇶ㍈࡟ᡤぢࡢྜ⌮ⓗᩚ⌮ࡀ࡞ࡉࢀࠊෆど㙾ᡤぢ࡟ᇶ࡙ࡃ᪂ࡋ࠸デ᩿Ꮫࡀ᳨ウࡉࢀ࡚࠸ࡿࠋᙧែ
Ꮫ࡟ࡼࡿデ᩿ࡢ㞴ࡋࡉࡣࠊᇶᮏⓗ࡟ࡣ୺ほⓗ࡞デ᩿࡛࠶ࡿ࡜࠸࠺ࡇ࡜࡟ᑾࡁࡿࠋࡑࡢⅬࡣ⫶⅖デ᩿ࡢ gold standard ࡛࠶ࡿ⏕᳨⑓⌮デ᩿࡟࠾࠸࡚ࡉ࠼ࠊデ᩿་࡟ࡼࡾぢゎࡢ┦㐪ࡀ࠶ࡿࡇ࡜ࡀሗ࿌
ࡉࢀ࡚࠸ࡿ஦ᐇ࠿ࡽࡶ᫂ࡽ࠿࡛࠶ࡾ 23)ࠊࡇࡢⅬ࡟⫶⅖ෆど㙾デ᩿ࡢ㞴ࡋࡉࡢᮏ㉁ࡀ࠶ࡿࠋࡋ࠿ࡋࠊ
඾ᆺ౛ࠊ≉࡟⫶ࡀࢇⓎ⏕ࡢ୺せ⤒㊰࡟࠾ࡅࡿࣁ࢖ࣜࢫࢡࡢデ᩿࡟ࡘ࠸࡚ࡣ⤒㦂▱ࡢᑡ࡞࠸㝖⳦⩌ࢆ㝖ࡅࡤࠊᐈほᛶࠊጇᙜᛶࡢ㧗࠸ෆど㙾デ᩿ࡀ☜❧ࡉࢀࡘࡘ࠶ࡿࠋ⌧᫬Ⅼ࡛ࡣࠊ᳨ᰝࡢ⡆౽ࡉ࡜ᬑཬࢆ㔜どࡋ࡚ࠊ㏻ᖖほᐹୗ࡛ࡢデ᩿Ꮫ☜❧࡟ດຊࡀഴࡅࡽࢀ࡚࠸ࡿࡀࠊࢥࣥࢺࣛࢫࢺἲࠊ⏬ീᙉㄪἲࠊᣑ኱ほᐹ࡞࡝ࡀຍࢃࡿࡇ࡜࡛ࠊ௒ᚋࠊ⢭ᗘࡢ㧗࠸Ᏻᐃឤࡢ࠶ࡿෆど㙾デ᩿ࡀ☜❧ࡉࢀࡿࡇ࡜ࡀண᝿ࡉࢀࡿࠋ☜❧ࡉࢀࡓ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁデ᩿ࡢෆど㙾ᑓ㛛᪋タ௨እ࡬ࡢᬑཬࠊ
✀ࠎࡢᆅᇦ࡟࠾ࡅࡿ⫶ࡀࢇ⨯ᝈ⋡ࡢ␗࡞ࡿ㞟ᅋࢆᑐ㇟࡟ࡋࡓࣜࢫࢡホ౯ࢆ┠ⓗ࡜ࡋࡓ㛗ᮇほᐹ◊✲࡞࡝ࢆ⤒࡚ࠊᑗ᮶ⓗ࡟⫶ෆど㙾᳨デࡢ⌧ሙ࡟኱ࡁ࡞㠉᪂ࡀࡶࡓࡽࡉࢀࡿࡇ࡜ࢆᮇᚅࡋࡓ࠸ࠋ̿  ̿ A, B: 㐍ᒎࡋࡓⴎ⦰ࡢ࡞࠸⑕౛ࡢ⫶ᗏ⭢㡿ᇦ඲ᇦ࡟ࢃࡓࡿᆒ୍࡟Ⓨ㉥ࡋࡓ ᒁ 㠃 ࡛ ࠊ ྠ 㒊 ࡢ RAC regulararrangement of collecting venules ࡣᾘኻࡋ࡚࠸ࡿࠋ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟ
ࣜឤᰁࢆ♧ࡍᇶᮏⓗ࡞ᡤぢ࡛࠶ࡿࠋ

A, B.

ÅₔᛶⓎ㉥

C, D: ⫶య㒊኱ᙙࡢ⓾ぁ⭘኱ࡶ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ࡟ࡼࡿάື
ᛶ⅖⑕ࡢᏑᅾࢆ♧ࡍ㔜せ࡞ᡤぢ࡛࠶ࡿࠋ≉࡟ᒅ᭤⺬⾜ࡍࡿ⭘኱ࡋࡓ⓾ぁࡀࠊ༑ศ࡞㏦Ẽୗ࡟ࡶ࠿࠿ࢃࡽࡎᾘ
ኻࡋ࡞࠸ሙྜࠊ࠶ࡿ࠸ࡣ㒊ศⓗ࡟ࡋ࠿ᾘኻࡋ࡞࠸ሙྜࠊᕧ኱⓾ぁ࡜デ᩿
ࡍࡿࠋ
C, D.

⓾ぁ⭘኱

E, F: ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ࡟
ࡼࡿ⢓⭷ࡢ⭘⬽ࠊ⫶ᑠ༊ࡢ⭘኱ࠊ⥭‶ࠊพฝࡀㄆࡵࡽࢀࡿࠋᗃ㛛⭢㡿ᇦ࡟ẚ㍑ࡋ࡚⫶ᗏ⭢㡿ᇦ࡛ࠊࡼࡾ㢧ⴭ࡞ᡤぢࢆ࿊ࡍࡿࠋ

E, F.

ᾋ⭘≧⢓⭷

G, H: ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ
࡟కࡗ࡚ฟ⌧ࡍࡿ኱ࡁࡉࠊᙧ≧࡟つ๎ᛶࡢ࡞࠸ᖹᆠ࡞Ⅼ≧Ⓨ㉥࡛࠶ࡾࠊ⫶య㒊࠿ࡽ✴❞㒊࡟ㄆࡵࡽࢀࡿࡇ࡜ࡀከ࠸ᡤぢ࡛࠶ࡿࠋ

G, H.

Ⅼ≧Ⓨ㉥

I, J: ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ⫶⢓⭷࡛ࡣࠊ୺࡜ࡋ࡚Ⓨ㉥⭘⬽࡞࡝௚ࡢ⅖⑕ᡤぢࢆ࿊ࡍࡿ⫶ᗏ⭢㡿ᇦࢆ୰
ᚰ࡟ᵝࠎ࡞ཌࡉࡢஙⓑⰍࡢ⢓ᾮ௜╔
ࢆㄆࡵࡿࠋ

I, J.

⢓ᾮ௜╔

ᅗ 2.࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜ⌧ឤᰁཬࡧ᪤ឤᰁ౛ࡢෆど㙾ᡤぢ ⥆ࡃ ̿  ̿

 K, L: ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁᣢ
⥆ࡢ⤖ᯝࡢᡤぢ࡛࠶ࡾࠊ⫶య㒊ࡢ⓾ぁࡣ᏶඲࡟ᾘኻࡋ࡚࠾ࡾࠊࡲࡔࡽ࡛⅊ⓑⰍࢆ࿊ࡍࡿ⳼ⷧ໬ࡋࡓ⢓⭷ࡣ⾑⟶㏱
ぢࡀ᫂ࡽ࠿࡛࠶ࡿࠋ

K, L.

ⴎ⦰

M, N: ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁ࡟
ࡼࡿⴎ⦰ᛶ⫶⅖࡟㝶కࡋ࡚⏕ࡎࡿᡤぢ࡛ࠊ඲࿘ᛶ࡟኱ᑠࡢ〣Ⰽㄪ㝯㉳ࡀほᐹࡉࢀࡿࠋⰍ⣲ᩓᕸ࡟ࡼࡾࠊࡑࡢᏑᅾ
ࡀࡼࡾ᫂☜࡜࡞ࡿࠋ୍⯡ⓗ࡟ࡣࠊศ໬
ᆺ⫶ࡀࢇࡢⓎ⏕ࡢࣁ࢖ࣜࢫࢡ࡛࠶ࡾࠊ
๓ࡀࢇ≧ែ࡜⪃࠼ࡽࢀ࡚࠸ࡿࠋ

M, N.

⭠ୖ⓶໬⏕

O, P: ࢃࡎ࠿࡟㝗พࡋࡓከᙬ࡞ᙧ≧ࢆ࿊ࡍࡿⓎ㉥ࡀᩓᅾࡍࡿ㝖⳦ᚋ࡟≉ᚩⓗ࡞ᡤぢ࡛࠶ࡿࠋ⅖⑕࡟ࡼࡿⓎ㉥ࡀᨵၿࡍࡿ୍᪉࡛ࠊⴎ⦰ࡸ⭠ୖ⓶໬⏕࡛ࡣⓎ㉥ࡀṧࡿࡇ࡜࡟ࡼࡾ⏕ࡌࡿ࡜⪃࠼ࡽࢀ࡚࠸ࡿࠋ

O, P. ᆅᅗ≧Ⓨ㉥

Q, R, S, T: 2–3 ੈ⛬ᗘࡢ㢛⢏≧ᑠ㝯㉳ࡀᆒ୍࡟ᐦ㞟ࡋ࡚㫽⫙≧ࡢᡤぢࢆ࿊ࡍࡿࠋከࡃࡣ ๓ᗞ㒊࠿ࡽ⫶ゅ࡟࠿ࡅ࡚ዲⓎࡍࡿࠋ㏆᥋ീ࡛ࡣಶࠎࡢᑠ㝯㉳ࡢ୰ᚰ࡟㝗พࢆㄆࡵࠊ࣊ࣜࢥࣂࢡࢱ
࣮࣭ࣆࣟࣜឤᰁ࡟క࠺⭘኱ࡋࡓࣜࣥࣃ
ℐ⬊ࡢᡤぢ࡛࠶ࡿࠋᑠඣ࣭ⱝᖺ⪅࡟ዲⓎࡍࡿ⫶⅖ࡢ୍ᙧែ࡛࠶ࡾࠊⱝᖺ⪅⫶ࡀࢇࡢࣁ࢖ࣜࢫࢡ࡜ࡋ࡚ࡢྍ⬟ᛶࡀᣦ᦬ࡉࢀ࡚࠸ࡿࠋ

Q, R, S, T.

㫽⫙⫶⅖ᅗ 2.࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜ⌧ឤᰁཬࡧ᪤ឤᰁ౛ࡢෆど㙾ᡤぢ̿  ̿



 

ཧ⪃ᩥ⊩
1㸧 Schindler R. Die diagnostiche Bedeutung der Gastroskopie. München Med Wchnschr 1922; 69:535–
537.
2㸧 Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance inchronic gastritis. Endoscopy 1969; 3:87–97.
3㸧 Strickland RG, Mackay IR. A reappraisal of the nature and significance of chronic atrophic gastritis.
Am J Dig Dis 1973; 18:426–440.
4㸧 Whitehead R. The classification of chronic gastritis: current status. J Clin Gastroenterol 1995;
21:S131–134.
5㸧 Misiewicz JJ. The Sydney System: a new classification of gastritis. Introduction. J Gastroenterol
Hepatol 1991; 6:207–208.
6㸧 Dixon MF, Genta RM, Yardley JH, et al. Classification and grading of gastritis. The updated Sydney
System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol
1996; 20:1161–1181.
7㸧 Tytgat GN. The Sydney System: endoscopic division. Endoscopic appearances in gastritis/duodenitis.
J Gastroenterol Hepatol 1991; 6:223–234.
8㸧 ᴬಙᘅ. ៏ᛶ⫶⅖ࡢෆど㙾デ᩿. ⥈ྜ⮫∠ 1998; 47:912–918.
9㸧 ஭⏣࿴ᚨ ┘ಟ 㸬H. pylori ࡢデ᩿ἲ 3 ෆど㙾デ᩿㸬ୗᒣᏕ ⦅㸪Helicobacter pylori ឤᰁࡢᇶ♏࡜⮫ᗋ㸪᪥ᮏ࣓ࢹ࢕࢝ࣝࢭࣥࢱ࣮㸪ᮾி㸪2000㸪144–152.
10㸧 Nomura S, Terao S, Adachi K, et al. Endoscopic diagnosis of gastric mucosal activity andinflammation. Dig Endosc 2013; 25:136–146.
11㸧 Kato M, Terao S, Adachi K, et al. Changes in endoscopic findings of gastritis after cure of H.ௗpylori
infection: multicenter prospective trial. Dig Endosc 2013; 25:264–273.
12㸧 Kato T, Yagi N, Kamada T, et al. Diagnosis of Helicobacter pylori infection in gastric mucosa byendoscopic features: a multicenter prospective study. Dig Endosc 2013; 25:508–518.
13㸧 Fukuta N, Ida K, Kato T, et al. Endoscopic diagnosis of gastric intestinal metaplasia: a prospective
multicenter study. Dig Endosc 2013; 25:526–534.
14㸧 Nomura S, Ida K, Terao S, et al. Endoscopic diagnosis of gastric mucosal atrophy: multicenterprospective study. Dig Endosc 2014; 26:709–719.
15㸧 ᫓㛫㈼㸬⫶⅖ࡢி㒔ศ㢮㸬᪥ᮏ࣓ࢹ࢕࢝ࣝࢭࣥࢱ࣮㸪ᮾி㸪2014.
16㸧 Tatsuta M, Iishi H, Nakaizumi A, et al. Fundal atrophic gastritis as a risk factor for gastric cancer. Int J
Cancer 1993; 53:70–74.
17㸧 ⣽ᕝ἞㸪ᾏᓮὈ἞㸪ᐑỌኴ㛛㸪௚㸬ෆど㙾ほᐹ౛࠿ࡽࡳࡓ⫶⒴ࣁ࢖ࣜࢫࢡࢢ࣮ࣝࣉ㸬⫶࡜⭠
2009; 44:1357–1366.
18㸧 Nishibayashi H, Kanayama S, Kiyohara T, et al. Helicobacter pylori-induced enlarged-fold gastritis isassociated with increased mutagenicity of gastric juice, increased oxidative DNA damage, and anincreased risk of gastric carcinoma. J Gastroenterol Hepatol 2003; 18:1384–1391.
19㸧 Ohyama I, Ohmiya N, Niwa Y, et al. The association between tumour necrosis factor-alpha gene̿  ̿ polymorphism and the susceptibility to rugal hyperplastic gastritis and gastric carcinoma. Eur J
Gastroenterol Hepatol 2004; 16:693–700.
20㸧 Oguri A, Ohmiya N, Taguchi A, et al. Rugal hyperplastic gastritis increases the risk of gastriccarcinoma, especially diffuse and p53-independent subtypes. Eur J Gastroenterol Hepatol 2007;
19:561–566.
21㸧 Watanabe M, Kato J, Inoue I, et al. Development of gastric cancer in nonatrophic stomach with highly
active inflammation identified by serum levels of pepsinogen and Helicobacter pylori antibody
together with endoscopic rugal hyperplastic gastritis. Int J Cancer 2012; 131:2632–2642.
22㸧 Kamada T, Tanaka A, Yamanaka Y, et al. Nodular gastritis with Helicobacter pylori infection isstrongly associated with diffuse-type gastric cancer in young patients. Dig Endosc 2007; 19:180–184.
23㸧 Capelle LG, de Vries AC, Haringsma J, et al. The staging of gastritis with the OLGA system by using
intestinal metaplasia as an accurate alternative for atrophic gastritis. Gastrointest Endosc 2010;
71:1150–1158.

㸦୍℩㞞ኵ㸧̿  ̿ 

3. ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜ㝖⳦
1㸧↓⑕≧⪅ࢆᑐ㇟࡜ࡋࡓ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜ㝖⳦ࡢຠᯝ↓⑕≧⪅ࢆᑐ㇟࡜ࡋࡓ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜ㝖⳦࡟㛵ࡍࡿ◊✲ࡣࠊ᪥ᮏࠊ୰ᅜ࡞࡝࡛ᐇ᪋ࡉ
ࢀࡓ↓సⅭ໬ẚ㍑ᑐ↷ヨ㦂ࡀ 5 ௳࠶ࡿࡀࠊ࠸ࡎࢀࡶᑠつᶍ࡛࠶ࡾࠊ༢⊂࡛⫶ࡀࢇᢚไຠᯝࢆㄆࡵ
ࡓࡢࡣᑐ㇟ᩘࡀ᭱ࡶከ࠸୰ᅜࡢ◊✲ 1 ௳ࡢࡳ࡛࠶ࡿࠋࡇࢀࡽࡢ◊✲࡟ຍ࠼ࠊ༡⡿࡛⾜ࢃࢀࡓ↓సⅭ໬ẚ㍑ᑐ↷ヨ㦂ࢆᑐ㇟࡜ࡋࡓ࣓ࢱ࣭࢔ࢼࣜࢩࢫ࡛ࡣࠊ 34%ࡢ⫶ࡀࢇᢚไຠᯝࢆㄆࡵ࡚࠸ࡿ 1) ࠋࡋ࠿ࡋࠊ᪥ᮏࢆྵࡴ⫶ࡀࢇ㧗⨯ᝈᆅᇦࡢ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜࡢᮾ࢔ࢪ࢔ᰴ࡟㝈ᐃࡋࠊࡉࡽ࡟
」ᩘࡢ࣓ࢱ࣭࢔ࢼࣜࢩࢫࡢ᪉ἲࢆ⏝࠸᳨࡚ウࡋࡓ⤖ᯝࠊ34㹼35%ࡢ⫶ࡀࢇᢚไຠᯝࡢഴྥࡣㄆࡵࡽ
ࢀࡿࡶࡢࡢ᭷ព࡛ࡣ࡞࠿ࡗࡓ 2)ࠋ
ᅜෆ࡛ࡣಖ㝤㐺⏝࡟క࠸ࠊᾘ໬ᛶ₽⒆ࡢᝈ⪅ࢆᑐ㇟࡜ࡋࡓ㝖⳦࡟㛵ࡍࡿࢥ࣮࣍ࢺ◊✲ࡀᩘከࡃሗ࿌ࡉࢀࠊ㛗ᮇほᐹ࡟ࡼࡿ⫶ࡀࢇⓎ⑕ࢆ࢔࢘ࢺ࣒࢝࡜ࡋࡓ◊✲ࡶ࠶ࡿࠋࡇࢀࡽࡢ◊✲࠿ࡽࠊⱝᖺ
⪅࡟ẚ࡭㧗㱋⪅࡬ࡢ㝖⳦࡟ࡼࡿ⫶ࡀࢇⓎ⑕ᢚไຠᯝࡀᑠࡉ࠸ࡇ࡜ࡀ♧ࡉࢀ࡚࠸ࡿ 4, 5)ࠋ
2㸧㝖⳦ࡢ୙฼┈㝖⳦ࡢ୙฼┈࡟ࡣࠊୗ⑩ࠊ࿡ぬ␗ᖖࠊ㏫ὶᛶ㣗㐨⅖ࠊ⸆๣⪏ᛶ⳦ቑຍࡀ࠶ࡿ 2, 3)ࠋ㝖⳦࡟ࡼࡿ๪
స⏝ࡢⓎ⏕ࡣ 5㹼50%࡜ࡤࡽࡘࡁࡀ࠶ࡿࡀࠊୗ⑩ࠊ࿡ぬ␗ᖖࡣ୍⯡࡟ࡼࡃࡳࡽࢀࠊඹ࡟ 10%⛬ᗘ࡛࠶ࡿࠋ㝖⳦ᚋࡢ㏫ὶᛶ㣗㐨⅖ࡣ 8㹼30%ቑຍࡍࡿࠋ㔜⠜࡞അⓎ⑕࡜ࡋ࡚ࡣࠊᅜෆ࠿ࡽഇ⭷ᛶ⭠⅖ࡢධ㝔౛ࡀሗ࿌ࡉࢀ࡚࠸ࡓࠋࡲࡓࠊ㝖⳦࡟ࡼࡿ⪏ᛶ⳦ࡢቑຍࡶሗ࿌ࡉࢀ࡚࠸ࡿ 3)ࠋ
3㸧௒ᚋࡢㄢ㢟 㝖⳦ࡢ⫶ࡀࢇⓎ⑕ᢚไຠᯝࡣࠊ☜ᐃⓗ࡛ࡣ࡞ࡃࠊຍ㱋࡟ࡼࡾࡑࡢຠᯝࡣῶᑡࡍࡿࠋ୍᪉ࠊ㝖⳦࡟ࡼࡿ୙฼┈ࡶሗ࿌ࡉࢀࡘࡘ࠶ࡿࠋ㝖⳦ࡢຠᯝࡀ㝈ᐃⓗ࡛࠶ࡿࡇ࡜࡜ࠊ୙฼┈࡟ࡘ࠸࡚ࡢ᝟ሗࢆ
බᖹ࡟ఏ࠼ࠊ㝖⳦ཷ⒪ࡢྍྰࢆᨭ᥼ࡍࡿࠋࡉࡽ࡟ࠊ㝖⳦ᚋࡶ⥅⥆ࡋ࡚⤒㐣ほᐹࡀᚲせ࡞ࡇ࡜ࢆㄝ
᫂ࡍ࡭ࡁ࡛࠶ࡿࠋ

ཧ⪃ᩥ⊩1㸧 Ford AC, Forman D, Hunt RH, et al. Helicobacter pylori eradication therapy to prevent gastric cancer
in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomised
controlled trials. BMJ 2014; 348:g3174.
2㸧 ᅜ❧ࡀࢇ◊✲ࢭࣥࢱ࣮ ࡀࢇண㜵᳨࣭デ◊✲ࢭࣥࢱ࣮㸬᭷ຠᛶホ౯࡟ᇶ࡙ࡃ⫶ࡀࢇ᳨デ࢞࢖ࢻ
ࣛ࢖ࣥ 2014 ᖺᗘ∧㸬2015㸪ᮾி
3㸧 IARC Helicobacter pylori Working Group. Helicobacter pylori eradication as a strategy for preventing
gastric cancer. International Agency for Research on Cancer (IARC Working Group Reports, Vol. 8,
Lyon, 2014, 174–180.
4㸧 Take S, Mizuno M, Ishiki K, et al. Baseline gastric mucosal atrophy is a risk factor associated with thedevelopment of gastric cancer after Helicobacter pylori eradication therapy in patients with peptic
ulcer diseases. J Gastroenterol 2007; 42(Suppl 17):21–27.
5㸧 Wu CY, Kuo KN, Wu MS, et al. Early Helicobacter pylori eradication decreases risk of gastric cancer
in patients with peptic ulcer disease. Gastroenterology 2009; 137:1641–1648.
℈ᓥࡕࡉ࡜̿  ̿



Q & A ࠙ᕷ༊⏫ᮧ⦅ࠚQ1. ᑠࡉ࡞⏫ᮧࡔࡅ࡛ࡣࠊ⫶ෆど㙾᳨デࢆ㐠Ⴀ࡛ࡁࡲࡏࢇࠋ஧ḟ་⒪ᅪࡸ㒆ᕷ༊་ᖌ఍ࡢ༢఩ࠊ
࠶ࡿ࠸ࡣ┴ࣞ࣋ࣝ࡞࡝࡛ࠊ」ᩘࡢᕷ༊⏫ᮧࡀඹྠࡋ࡚⫶ෆど㙾᳨デࢆ⾜࠺ࡇ࡜ࡣ࡛ࡁࡲࡍ࠿㸽A㸬ᆅᇦࡢᐇែ࡟༶ࡋ࡚ࠊ」ᩘࡢᕷ༊⏫ᮧࡀඹྠࡋ࡚⫶ෆど㙾᳨デࢆ⾜࠺ࡇ࡜ࡣྍ⬟࡛ࡍࠋࡇࡢሙ
ྜ࡟ࡣࠊᕷ༊⏫ᮧ࡜ጤクඛ ᳨デᶵ㛵ࠊ་ᖌ఍࡞࡝ ࡜࡜ࡶ࡟ࠊ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࢆタ⨨ࡋ࡚ࡃࡔࡉ࠸ࠋ

Q2. ⫶ෆど㙾᳨ᰝࢆᐇ᪋࡛ࡁࡿ་⒪ᶵ㛵ࡀ࠶ࡾࡲࡏࢇࠋఫẸ࠿ࡽࡣ⫶ෆど㙾᳨デࡢᕼᮃࡀ࡛࡚࠸
ࡲࡍࡀࠊ࡝ࡢࡼ࠺࡟ᑐฎࡋࡓࡽࡼ࠸࡛ࡋࡻ࠺࠿ࠋ
A㸬⫶ࡀࢇ᳨デ࡜ࡋ࡚⫶ࡀࢇṚஸ⋡ῶᑡຠᯝࡀ࠶ࡿࡢࡣࠊ⫶ෆど㙾᳨ᰝ࡜⫶ X ⥺᳨ᰝࡢ୧⪅࡛ࡍࠋ⫶ X ⥺᳨デ࡛ࡶ⫶ࡀࢇṚஸ⋡ῶᑡຠᯝࡀ࠶ࡿࡇ࡜ࢆ୎ᑀ࡟ㄝ᫂ࡋ࡚ࡃࡔࡉ࠸ࠋ୍ࡘࡢᕷ༊⏫ᮧ࡛⫶ෆど㙾᳨デࢆ᪋⾜࡛ࡁ࡞࠸ሙྜ࡟ࡣࠊ㏆㞄ࡢᕷ༊⏫ᮧ࡜㐃ᦠࡋࠊ⫶ෆど㙾᳨デࡢᐇ᪋࡛ࡁࡿ᪋タࢆ☜ಖࡍࡿࡇ࡜ࢆ᳨ウࡍࡿࡢࡀࡼ࠸࡛ࡋࡻ࠺ࠋ

Q3. ᑓ㛛་ࡀ☜ಖ࡛ࡁ࡞࠸ሙྜࡣࠊ⫶ෆど㙾᳨デࡣᐇ᪋࡛ࡁ࡞࠸ࡢ࡛ࡋࡻ࠺࠿ࠋ
A㸬ᑓ㛛་࡛ࡣ࡞ࡃ࡚ࡶ⫶ෆど㙾᳨デࢆᐇ᪋ࡍࡿࡇ࡜ࡣྍ⬟࡛ࡍࠋᕷ༊⏫ᮧ࡟ࡼࡗ࡚ࡣࠊ⫶ෆど㙾᳨デࡢཧຍ᮲௳࡜ࡋ࡚ᖺ㛫ࡢ⫶ෆど㙾᳨ᰝ௳ᩘࢆつᐃࡋ࡚࠸ࡿ࡜ࡇࢁࡶ࠶ࡾࡲࡍࠋࡓࡔࡋࠊᏳ඲
࡛㉁ࡢ㧗࠸᳨ᰝࢆᥦ౪ࡍࡿࡓࡵ࡟ࡣࠊㄞᙳ఍ࡢᐇ᪋ࡸഅⓎ⑕ᑐ⟇ࢆᩚഛࡋࠊ⾜ᨻ࡜᳨デᐇ᪋୺య་ᖌ఍࡞࡝ ࡀ㐃ᦠࡋ࡚ࠊ⫶ෆど㙾᳨デࢆᐇ᪋ࡍࡿᚲせࡀ࠶ࡾࡲࡍࠋෆど㙾᳨ᰝ་ࡢᑓ㛛ᛶࡣၥ࠸ࡲࡏࢇࡀࠊ⫶ෆど㙾᳨デࡢࢲࣈࣝࢳ࢙ࢵࢡࢆ⾜࠺ㄞᙳጤဨ఍࡟ᑓ㛛་ࡀྵࡲࢀࡿࡇ࡜ࡀᇶᮏ᮲
௳࡛ࡍࠋ
Q4. ⫶ෆど㙾᳨デࢆ⾜࠺ࡓࡵࡢ་⒪ᶵ㛵ࡀ☜ಖ࡛ࡁࡲࡏࢇࠋABC ἲ ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜᢠ
య᳨ᰝ࡜࣌ࣉࢩࣀࢤ᳨ࣥᰝࡢే⏝ἲ ࡛⫶ෆど㙾᳨デࡢᑐ㇟ࢆ㞟⣙໬ࡍࡿࡇ࡜ࡣྍ⬟࡛ࡍ࠿ࠋA㸬ABC ἲࡣᐃἲࢆ㐺ษ࡟㑅࡭ࡤࠊ⫶ࡀࢇࣜࢫࢡࢆᒙู໬ࡍࡿࡇ࡜ࡣྍ⬟࡛ࡍࠋࡋ࠿ࡋࠊపࣜ

ࢫࢡ࡜⪃࠼ࡽࢀࡿ A ⩌ ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜᢠయ᳨ᰝ㝜ᛶࠊ࣌ࣉࢩࣀࢤ᳨ࣥᰝ㝜ᛶ ࡢ୰࡟ࡶ⫶ࡀࢇࣜࢫࢡࡢ࠶ࡿே ⴎ⦰ᛶ⫶⅖ࡸ㝖⳦ᚋ ࡀྵࡲࢀ࡚࠸ࡲࡍࠋࡲࡓࠊ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜ
࡟ឤᰁࡋࡓሙྜ࡛ࡶࡍ࡭࡚ࡢேࡀ⫶ࡀࢇ࡟࡞ࡿࢃࡅ࡛࡞࠸ࡇ࡜࠿ࡽࠊ㺀⫶ࡀࢇⓎ⑕ࣜࢫࢡ࠶ࡾ㺁࡜࠸࠺ㄗࡗࡓࣛ࣋ࣜࣥࢢࢆࡍࡿྍ⬟ᛶࡶ࠶ࡾࡲࡍࠋABC ἲ࡟ࡼࡾ⫶ෆど㙾᳨デࡢᑐ㇟ࢆ㞟⣙໬࡛ࡁࡿ࡜࠸࠺⛉Ꮫⓗ᰿ᣐࡣ༑ศ࡛ࡣ࡞ࡃࠊ᳨デ࡟ᛂ⏝ࡍࡿ࡟ࡣ௒ᚋࡢ᳨ウࡀᚲせ࡛ࡍ ABC ἲࡢㄢ㢟ࡣ
P.79–80 ཧ↷ ࠋ
Q5. ࢲࣈࣝࢳ࢙ࢵࢡࡣᚲせ࡛ࡋࡻ࠺࠿ࠋ
A. ㉁ࡢ㧗࠸⫶ෆど㙾᳨デࢆ⾜࠺ࡓࡵ࡟ࡣ඲౛ࢆࢲࣈࣝࢳ࢙ࢵࢡࡍࡿࡇ࡜ࡀᚲせ࡛ࡍࠋ୍㒊ࡢᢤࡁྲྀࡾㄪᰝࢆ⾜࠺ࡔࡅ࡛ࡣ୙༑ศ࡛ࡍࠋ̿  ̿



Q6. ⫶ෆど㙾᳨デࡢࢲࣈࣝࢳ࢙ࢵࢡࢆ⾜࠺་ᖌࡀ☜ಖ࡛ࡁࡲࡏࢇࠋ࡝ࡢࡼ࠺࡟ᑐฎࡋࡓࡽ࠸࠸࡛
ࡋࡻ࠺࠿ࠋ
A㸬୍㒊ࡢᆅᇦ࡛ࡣࠊෆど㙾グ㘓⏬ീࢆ㟁㏦ࢩࢫࢸ࣒࡛ࡘ࡞ࡂࠊ 㐲᪉ࡢᑓ㛛་࡟ㄞᙳࢆ౫㢗ࡍࡿࢩࢫࢸ࣒ࡀ㛤Ⓨࡉࢀ࡚࠸ࡲࡍࠋᆅᇦ࡛⫶ෆど㙾᳨デࡢࢲࣈࣝࢳ࢙ࢵࢡࢆ⾜࠺་ᖌࡀ☜ಖ࡛ࡁ࡞࠸
ሙྜ࡟ࡣࠊࡇ࠺ࡋࡓࢩࢫࢸ࣒ࡢ฼⏝ࡢ᳨ウࢆ࠾່ࡵࡋࡲࡍࠋ
Q7. ⫶ෆど㙾᳨ᰝ་࡟ࡼࡾࠊෆど㙾グ㘓⏬ീࡢࢥ࣐ᩘࡀ␗࡞ࡾࡲࡍࠋ⏬ീࡢᶆ‽໬ࡣᚲせ࡛ࡋࡻ࠺࠿ࠋA㸬⫶ෆど㙾᳨ᰝ࡛ࡣࠊ⫶ࡢ୰ࢆ⥙⨶ⓗ࡟ほᐹࡍࡿࡇ࡜ࡀ㔜せ࡛ࡍࠋከࡃࡢ⏬ീࢆ᧜ࡗ࡚࠸࡚ࡶࠊ
ࡍ࡭࡚ࡢ㒊఩ࢆ⥙⨶ࡋ࡚࠸࡞ࡅࢀࡤ༑ศ࡞デ᩿ࡣ࡛ࡁࡲࡏࢇࠋᮏ࣐ࢽࣗ࢔ࣝࢆཧ↷ࡋ࡚࠸ࡓࡔࡁࠊ
ᚲせ࡞㒊఩ࢆḞ࠿ࡉࡎࠊ30㹼40 ࢥ࣐ࡢ⏬ീࢆ᧜ᙳࡍࡿࡢࡀ⌮᝿ⓗ࡛ࡍࠋ
Q8. ࢲࣈࣝࢳ࢙ࢵࢡࡢ࡯࠿࡟ࠊෆど㙾⏬ീࡢⅬ᳨ࡀᚲせ࡛ࡍ࠿ࠋA㸬ࢲࣈࣝࢳ࢙ࢵࢡࡣ୺࡜ࡋ࡚ṇࡋ࠸デ᩿ࢆ⾜࠺ࡇ࡜ࡀ┠ⓗ࡜࡞ࡾࡲࡍࠋࢲࣈࣝࢳ࢙ࢵࢡࡢ㝿࡟ࡶ᧜ᙳ᪉ἲ࡞࡝࡟ࡘ࠸࡚ㄞᙳጤဨ఍࠿ࡽᣦ᦬ࡀ࠶ࡿሙྜࡶ࠶ࡾࡲࡍࠋࡋ࠿ࡋࠊ⫶ෆど㙾᳨デࡢᶆ‽໬ࢆᅗࡿࡓࡵ࡟ࡣࠊ⏬ീࡢ⥙⨶ᛶࡸデ᩿࡟㐺ࡋࡓ⏬ീࡢⅬ᳨ࡶู㏵࡟ᚲせ࡛ࡍࠋQ9. ⫶ෆど㙾᳨デ࡛ࡣࠊ஦๓࡟ឤᰁ⑕ࡢ᳨ᰝࡀᚲせ࡛ࡍ࠿ࠋA. ஦๓ࡢឤᰁ⑕᳨ᰝࡣ୙せ࡛ࡍࠋࡓࡔࡋࠊෆど㙾ࡣṇࡋࡃὙί࣭ᾘẘࡉࢀ࡚࠸ࡿࡇ࡜ࡀ๓ᥦ࡛ࠊ
㐺ษ࡞᪉ἲࢆ㑂Ᏺࡍࡿᚲせࡀ࠶ࡾࡲࡍࠋෆど㙾ࡢὙί࣭ᾘẘ᪉ἲࡣ๓㏙ P.64 ࢆཧ↷ࡋ࡚ࡃࡔࡉ࠸ࠋ
Q10. ⫶ෆど㙾᳨デ⤖ᯝࡢ㺀せ⢭᳨㺁ࡣ࡝ࡢࡼ࠺࡟ᐃ⩏ࡉࢀࡲࡍ࠿ࠋ
A. ⫶ෆど㙾᳨デࡢุᐃ⤖ᯝࡀ㺀⏕᳨࠶ࡾ㺁㺀෌᳨ᰝ࠶ࡾ㺁ࡀࠊ㺀せ⢭᳨㺁࡟┦ᙜࡋࡲࡍࠋ P.42 ཧ↷
Q11. ⫶ෆど㙾᳨デࡢ⤖ᯝࡣ࡝ࡢࡼ࠺࡟ఏ㐩ࡍࢀࡤ࠸࠸࡛ࡋࡻ࠺࠿ࠋ
A㸬㺀␗ᖖ࡞ࡋ㺁ࡢุᐃࡣࠊ㒑㏦࡟ࡼࡿ⤖ᯝࡢఏ㐩ࡀྍ⬟࡛ࡍࠋࡋ࠿ࡋࠊ㺀⫶ࡀࢇ࠶ࡾ㺁㺀⫶ࡀࢇ␲࠸㺁㺀෌᳨ᰝ࠶ࡾ㺁࡟ࡘ࠸࡚ࡣࠊ᳨ᰝ་ࡀෆど㙾⏬ീࢆᥦ♧ࡋ࡞ࡀࡽࠊᑐ㠃࡛ཷデ⪅࡬ㄝ᫂ࡋࠊḟࡢ᳨ᰝ࡞࡝ࡢᣦ♧ࢆࡍࡿࡇ࡜ࡀᮃࡲࡋ࠸᪉ἲ࡛ࡍࠋㄞᙳጤဨ఍࡟ࡼࡿࢲࣈࣝࢳ࢙ࢵࢡࡢุᐃ࡜ࠊ᳨ᰝ
ᙜึࡢุᐃࡀ␗࡞ࡿሙྜ࡟ࡣࠊᚲࡎᑐ㠃࡛⤖ᯝࢆㄝ᫂ࡋ࡚ࡃࡔࡉ࠸ࠋ
Q12. ⫶ෆど㙾᳨デࡢഅⓎ⑕ࡀ㉳ࡇࡗࡓሙྜ࡟ࡣࠊ࡝ࡢࡼ࠺࡞ᑐᛂࡀᚲせ࡛ࡋࡻ࠺࠿ࠋ
A㸬⫶ෆど㙾᳨ᰝࡢഅⓎ⑕ࡣࠊ㢖ᗘࡢ㧗࠸㰯ฟ⾑ࡸࠊ✸Ꮝ࡞࡝ࡢ㔜⠜࡛ධ㝔ࢆせࡍࡿ౛࡞࡝ᵝࠎ࡛ࡍࠋ୍㒊ࡢᕷ༊⏫ᮧ࡛ࡣࠊഅⓎ⑕ᑐᛂࡢ㈐௵ࢆ஦๓࡟Ỵࡵ࡚࠸ࡿሙྜࡶ࠶ࡾࡲࡍࡀࠊഅⓎ⑕ࡢ✀㢮ࡸ⛬ᗘ࡟ࡼࡾุ᩿ࡍࡿሙྜࡶ࠶ࡾࡲࡍࠋഅⓎ⑕ࡀ㉳ࡇࡗࡓሙྜ࡟ࡣࠊ㏿ࡸ࠿࡟ᕷ༊⏫ᮧ࡟ሗ࿌ࡍࡿࡇ࡜ࢆ⩏ົ࡙ࡅ࡚ࡃࡔࡉ࠸ࠋࡑࡢࡓࡵ࡟ࠊ஦๓࡟അⓎ⑕ࡀ㉳ࡇࡗࡓሙྜࡢሗ࿌࡟ࡘ࠸࡚ࣇࣟ
࣮ࢳ࣮ࣕࢺࢆసᡂࡋ࡚ࡃࡔࡉ࠸ࠋ̿  ̿

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Q & A ࠙་⒪ᶵ㛵⦅ࠚ
Q1. ⫶ෆど㙾᳨デࢆ⾜࠺ࡇ࡜ࡀ࡛ࡁࡿࡢࡣᑓ㛛་ࡔࡅ࡛ࡋࡻ࠺࠿ࠋ
A㸬ෆど㙾ᑓ㛛་௨እࡶ⫶ෆど㙾᳨デࢆᐇ᪋ࡍࡿࡇ࡜ࡣྍ⬟࡛ࡍࠋࡓࡔࡋࠊᕷ༊⏫ᮧ࡟ࡼࡾ⫶ෆど㙾᳨デ࡟ཧຍ࡛ࡁࡿ་ᖌࡢ᮲௳ࢆᐃࡵ࡚࠸ࡿሙྜࡶ࠶ࡾࡲࡍࡢ࡛ࠊࡈ☜ㄆࡃࡔࡉ࠸ࠋᮏ࣐ࢽࣗ࢔
࡛ࣝࡣ⫶ෆど㙾᳨デ㐠Ⴀጤဨ఍ ௬⛠ ࢆ⤌⧊ࡋࠊࡑࡢጤဨ఍᳨࡛ᰝ་ࡢㄆᐃࢆ⾜࠺ࡇ࡜ࢆ᥎ዡࡋ
࡚࠸ࡲࡍࠋᑓ㛛་௨እࡢ᪉ࡀཧຍࡍࡿሙྜ࡟ࡣࠊࢲࣈࣝࢳ࢙ࢵࢡࡢࡓࡵࡢㄞᙳ఍ࡸ◊ಟ఍࡟ฟᖍࡋࠊ⫶ෆど㙾᳨ᰝࡢࢫ࢟ࣝ࢔ࢵࣉࢆᅗࡿࡇ࡜ࡀᚲせ࡛ࡍࠋQ2. ⫶ෆど㙾᳨デࢆ⾜࠺࡜ࡁ࡟ࠊ㙠②⸆ ࣈࢫࢥࣃࣥ®࡞࡝ ࢆ౑ࡗ࡚࠸࠸࡛ࡋࡻ࠺࠿ࠋ
A㸬㙠②⸆ ࣈࢫࢥࣃࣥ®࡞࡝ ࡢ౑⏝ࡣྍ⬟࡛ࡍࠋࡋ࠿ࡋࠊ⥳ෆ㞀ࠊ๓❧⭢⫧኱⑕ࠊᚰ⑌ᝈࠊ⏥≧⭢ᶵ⬟ஹ㐍⑕࡞࡝ࡢ᪉࡟ࡣ౑⏝࡛ࡁࡲࡏࢇࠋ
Q3. ཷデ⪅࠿ࡽ㙠③⸆࣭㙠㟼⸆౑⏝ࡢ౫㢗ࡀ࠶ࡾࡲࡋࡓࠋ౑⏝ࡋ࡚࠸࠸࡛ࡋࡻ࠺࠿㸽A. ⫶ෆど㙾᳨デ࡛ࡣࠊ㙠③⸆࣭㙠㟼⸆ࡣཎ๎౑⏝ࡋ࡞࠸ࡇ࡜࡜ࡋ࡚࠸ࡲࡍࠋཷデ⪅࡟ࡣࠊ㙠③⸆࣭㙠㟼⸆ࡢ౑⏝࡟ࡼࡾഅⓎ⑕ࡢࣜࢫࢡࡀ࠶ࡿࡇ࡜ࡸࠊ㙠③⸆࣭㙠㟼⸆ࢆ౑⏝ࡋ࡞ࡃ࡚ࡶ༑ศ࡞᳨ᰝࡀ
࡛ࡁࡿࡇ࡜ࢆ୎ᑀ࡟ㄝ᫂ࡋ࡚ࡃࡔࡉ࠸ࠋ

Q4. ⫶ෆど㙾᳨デࡢ㝖እ᮲௳ ᢠ⾑ᰦ⸆ࢆ᭹⏝୰࡞࡝ ࡟ヱᙜࡍࡿ᪉࡟ࡣࠊ࡝ࡢࡼ࠺࡟ᑐᛂࡋࡓࡽ
ࡼ࠸࡛ࡋࡻ࠺࠿㸽A㸬ᢠ⾑ᰦ⸆᭹⏝୰࡟⫶ෆど㙾᳨ᰝ࡛⏕᳨ࢆ⾜ࡗࡓሙྜࠊ ฟ⾑ࡀ㉳ࡇࡿྍ⬟ᛶࡀ㧗ࡃ࡞ࡾࡲࡍࠋ
⏕᳨ࢆ⾜ࢃ࡞࠸ほᐹࡔࡅ࡛ࡶࠊ୍ᐃ㢖ᗘࡢฟ⾑ࡀ㉳ࡇࡿྍ⬟ᛶࡀ࠶ࡾ⢓⭷⿣๰ ࣐࣮ࣟࣜ࣡࢖ࢫ⑕
ೃ⩌࡞࡝ ࡢࣜࢫࢡࡶ࠶ࡾࡲࡍࠋṆ⾑ฎ⨨ࡢ࡛ࡁ࡞࠸་⒪ᶵ㛵࡛ࡢࠊ⫶ෆど㙾᳨デࡢᐇ᪋ࡣ᥎ዡ࡛
ࡁࡲࡏࢇࠋྠᵝ࡟⫶ࡀࢇṚஸ⋡ῶᑡຠᯝࡢ࠶ࡿ⫶ X ⥺᳨デࡢཷデࢆ່ࡵ࡚ࡃࡔࡉ࠸ࠋ
Q5. ⫶ෆど㙾᳨デࢆᐇ᪋୰࡟ࠊ㺀⫶ࡀࢇ␲࠸㺁ࡢ⑓ኚࢆⓎぢࡋࡲࡋࡓࠋࡑࡢሙ࡛⏕᳨ࢆ⾜࠺ࡇ࡜ࡣ࡛ࡁࡲࡍ࠿ࠋ
A㸬⫶ෆど㙾᳨デᐇ᪋୰࡛ࡶࠊࡑࡢሙ࡛⏕᳨ࢆ⾜࠺ࡇ࡜ࡣྍ⬟࡛ࡍࠋཷデ⪅࡟ࡣ᳨ᰝ๓࡟⏕᳨ࡢྍ⬟ᛶࡀ࠶ࡿࡇ࡜ࠊࡑࡢሙྜ࡟ࡣࠊ⏕᳨࡟ࡘ࠸࡚ࡣ་⒪ಖ㝤ࡢ㐺⏝࡜࡞ࡾࠊ⮬ᕫ㈇ᢸࡀ⏕ࡌࡿࡇ࡜ࢆㄝ᫂ࡋ࡚ࡃࡔࡉ࠸ࠋ
Q6. ෆど㙾ࡢὙίࡣᚑ᮶࡝࠾ࡾᡭὙ࠸ࡔࡅ࡛⾜ࡗ࡚࠸ࡲࡍࠋ⫶ෆど㙾᳨デ࡟ཧຍࡍࡿࡓࡵ࡟ࡣࠊ
⮬ືὙίᾘẘᶵࡢ㉎ධࡀᚲせ࡛ࡋࡻ࠺࠿ࠋ
A㸬⫶ෆど㙾ࡢὙίࡣࠊᶆ‽ⓗ࡞᪉ἲ࡟ࡼࡿᡭὙ࠸࡛ࡣ༑ศ࡞Ὑίࡀ࡛ࡁࡲࡏࢇࠋ㐺ษ࡞⏝ᡭὙίࡢᚋ࡟ࠊ⮬ືὙίᾘẘᶵ࡟ࡼࡿ෌ᗘࡢὙί࣭ᾘẘࢆ⾜ࡗ࡚ࡃࡔࡉ࠸ࠋ⫶ෆど㙾᳨ᰝࢆᏳ඲࡟⾜࠺ࡓࡵ࡟ࡣ⮬ືὙίᾘẘᶵࡣᚲ㡲࡛ࡍࠋ̿  ̿

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Q7㸬⫶ෆど㙾᳨デ࡜ࡋ࡚⾜ࡗࡓ᳨ᰝ⤖ᯝ࡟ࡘ࠸࡚ࡣࠊࢲࣈࣝࢳ࢙ࢵࢡࢆ⾜࠺ᚲせࡀ࠶ࡾࡲࡍ࠿ࠋ
A㸬⫶ෆど㙾᳨デ࡜ࡋ࡚᭱⤊ⓗ࡞⤖ᯝࢆุ᩿ࡍࡿࡓࡵ࡟ࡣࠊࢲࣈࣝࢳ࢙ࢵࢡࡣᚲ㡲࡛ࡍࠋ᳨ᰝ་༢
⊂࡛ࡢุ᩿ࡢࡳ࡛ࡣ୙༑ศ࡛ࡍࠋ᳨ᰝ་ࡀᑓ㛛་࡛࠶ࡿ࠿࡝࠺࠿࡟࠿࠿ࢃࡽࡎ ࠊ ᚲࡎࢲࣈࣝࢳ࢙
ࢵࢡࢆ⾜ࡗ࡚ࡃࡔࡉ࠸ࠋ
Q8. ⫶ෆど㙾᳨ᰝᐇ᪋᫬࡟ࡣ㺀⫶ࡀࢇ࡞ࡋ㺁࡜ุᐃࡋࡲࡋࡓࡀࠊࢲࣈࣝࢳ࢙ࢵࢡ࡛㺀⫶ࡀࢇ␲࠸㺁ࡀᣦ᦬ࡉࢀࡲࡋࡓࠋཷデ⪅࡟ࡣ࡝ࡢࡼ࠺࡟ㄝ᫂ࡍࢀࡤ࠸࠸࡛ࡋࡻ࠺࠿ࠋ
A㸬⫶ෆど㙾᳨ᰝ᪋⾜᫬࡟ࡣ⑓ኚࡀㄆ㆑࡛ࡁ࡞࠸ሙྜ࡛ࡶࠊࢲࣈࣝࢳ࢙ࢵࢡ࡛㺀⫶ࡀࢇ␲࠸㺁ࡢ⑓ኚࡀぢࡘ࠿ࡿሙྜࡣ࠶ࡾࡲࡍࠋ᳨ᰝ⤊஢┤ᚋࡢㄝ࡛᫂ࡣࠊࢲࣈࣝࢳ࢙ࢵࢡ࡟ࡼࡾุᐃ⤖ᯝࡀኚࢃࡿ
ྍ⬟ᛶࡀ࠶ࡿࡇ࡜ࢆㄝ᫂ࡋ࡚ࡃࡔࡉ࠸ࠋࡲࡓࠊ㏣ຍ࡛⏕᳨ࡀᚲせ࡟࡞ࡿሙྜ࡟ࡣࠊෆど㙾⏬ീࢆᥦ♧ࡋࠊᣦ᦬ࡉࢀࡓ⑓ኚ࡟ࡘ࠸࡚ㄝ᫂ࡍࡿࡇ࡜ࡀᮃࡲࡋ࠸࡛ࡋࡻ࠺ࠋ
Q9. ᪥ᖖデ⒪ࡀᛁࡋࡃㄞᙳ఍࡟࡞࠿࡞࠿ཧຍ࡛ࡁࡲࡏࢇࠋㄞᙳ఍࡟ཧຍ࡛ࡁ࡞࠸ሙྜࡣࠊ⫶ෆど㙾᳨デ࡟ཧຍ࡛ࡁࡲࡏࢇ࠿ࠋ
A㸬⫶ෆど㙾᳨デࡢ⏬ീ࡟ࡘ࠸࡚ࢲࣈࣝࢳ࢙ࢵࢡࢆཷࡅࡿࡇ࡜ࡣᚲせ࡛ࡍࡀࠊㄞᙳ఍࡬ࡢฟᖍࡣᚲ
㡲࡛ࡣ࠶ࡾࡲࡏࢇࠋࡓࡔࡋࠊᕷ༊⏫ᮧ࡟ࡼࡗ࡚ࡣࠊㄞᙳ఍ࡸ◊ಟ఍࡞࡝࡬ࡢฟᖍࢆࠊ⫶ෆど㙾᳨デࡢ᳨ᰝ་ࡢ᮲௳࡜ࡋ࡚࠸ࡿ࡜ࡇࢁࡶ࠶ࡾࡲࡍࠋᑓ㛛་௨እࡢ᪉ࡀ⫶ෆど㙾᳨デ࡟ཧຍࡍࡿሙྜ
࡟ࡣࠊࢲࣈࣝࢳ࢙ࢵࢡࡢࡓࡵࡢㄞᙳ఍ࡸ◊ಟ఍࡟ྍ⬟࡞㝈ࡾฟᖍࡋࠊ⫶ෆど㙾᳨ᰝࡢࢫ࢟ࣝ࢔ࢵ
ࣉࢆᅗࡿࡇ࡜ࢆ࠾່ࡵࡋࡲࡍࠋ
Q10. ⫶ෆど㙾᳨デ࡛࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁᡤぢࢆㄆࡵࡲࡋࡓࠋ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜ㝖⳦ࢆࡋࡓ࡯࠺ࡀࡼ࠸࡛ࡋࡻ࠺࠿ࠋ
A㸬⫶ෆど㙾᳨デ࡛࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁᡤぢࢆㄆࡵࡓሙྜࡣࠊ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤ
ᰁ᳨ᰝࢆ⾜࠸ࠊឤᰁࢆ☜ㄆࡋࡓୖ࡛ࠊ་⒪ಖ㝤ࢆ⏝࠸࡚㝖⳦ࢆࡍࡿࡇ࡜ࡀྍ⬟࡛ࡍࠋ࣊ࣜࢥࣂࢡ
ࢱ࣮࣭ࣆࣟࣜࡢ㝖⳦ࢆࡋࡓሙྜࠊ⫶ࡀࢇⓎ⑕ࣜࢫࢡࡣ⣙ 35%ῶᑡࡋࡲࡍࠋ ࡋ࠿ࡋࠊ⫶ࡀࢇ࡟࡞ࡿ
ྍ⬟ᛶࡀ඲ࡃ࡞ࡃ࡞ࡿࢃࡅ࡛ࡣ࠶ࡾࡲࡏࢇࠋ࣊ࣜࢥࣂࢡࢱ࣮࣭ࣆࣟࣜឤᰁࡋ࡚࠸ࡿሙྜ࡛ࡶࠊ⫶ࡀࢇ࡟࡞ࡿࡢࡣ 1㹼2%࡟ࡍࡂࡲࡏࢇࠋ⫶ࡀࢇⓎ⑕ࢆࡍ࡭࡚ண㜵࡛ࡁࡿࢃࡅ࡛ࡣ࡞࠸ࡇ࡜ࠊ㝖⳦࡟ࡼࡿ๪స⏝ࡀ࠶ࡿࡇ࡜ࠊ㝖⳦ᚋࡶ⫶ෆど㙾᳨ᰝ࡞࡝࡟ࡼࡿᐃᮇⓗ࡞⤒㐣ほᐹࡀᚲせ࡞ࡇ࡜ࢆㄝ᫂
ࡋ࡚ࡃࡔࡉ࠸ࠋ
Q11. ⫶ෆど㙾᳨ᰝ᪉ἲ࡟ࡘ࠸࡚ࡣ⮬᪋タ࡛ᩍ⫱ᣦᑟࡋ࡚࠸ࡲࡍࠋ᳨ᰝ࡟ᚑ஦ࡍࡿ࣓ࢹ࢕࢝ࣝࢫࢱࢵࣇ ┳ㆤᖌࠊ⮫ᗋ᳨ᰝᢏᖌ࡞࡝ ࡶ◊ಟ఍࡬ࡢฟᖍࡣᚲせ࡛ࡍ࠿ࠋA㸬㛵㐃ࡢ▱㆑ࢆ࢔ࢵࣉࢹ࣮ࢺࡋࠊཷデ⪅࡬ṇࡋ࠸᝟ሗࢆᥦ౪ࡍࡿࡓࡵ࡟ࠊ⫶ෆど㙾᳨ᰝ࡟ᚑ஦ࡍ
ࡿࡍ࡭࡚ࡢ࣓ࢹ࢕࢝ࣝࢫࢱࢵࣇ ┳ㆤᖌࠊ⮫ᗋ᳨ᰝᢏᖌ࡞࡝ ࡶ◊ಟ఍࡬ࡢฟᖍࡣᚲ㡲࡛ࡍࠋࡓࡔ
ࡋࠊ࣓ࢹ࢕࢝ࣝࢫࢱࢵࣇ࡟ࡣ⫶ෆど㙾ࡢṇࡋ࠸Ὑί࣭ᾘẘ᪉ἲ࡟ࡘ࠸࡚ࡢ◊ಟࡣᚲ㡲࡛ࡍࡀࠊ◊ಟ࣒࢝ࣜ࢟ࣗࣛ P.48 ཧ↷ ࡟࠶ࡿ௚ࡢ㡯┠ࡣດຊ┠ᶆ࡛ࡍࠋ㸦℈ᓥࡕࡉ࡜㸧̿  ̿
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