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		<h1 class="catchCopy">婦人科超音波を用いた診断プロセスを，豊富な76症例で徹底解説!!</h1>
		

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					著：馬場一憲（埼玉医科大学総合医療センター）
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">婦人科領域においては超音波検査だけで診断でき，MRIやCTよりも診断が正確であるケースも多い．本書は，単に婦人科疾患の超音波画像を提示するのではなく，最初に得られた画像から何を考え，次に何を確認するのか，見るべきポイントは何かを示し，診断に至るまでのコツと考え方の解説に重点をおいてまとめた症例集である．充実の76症例250枚を超える超音波画像で，外来で，自分で検査して，診断に至るプロセスを身につけよう．描出した超音波画像から可能性のある疾患を検索できる画像索引も必見．まとまった時間が取りにくい産婦人科医・検査技師が，手元に置いてすぐに臨床現場で活用できる一冊．</section><section class="preface">序文<br><br>　超音波診断装置は，1970年代後半から産婦人科領域で使われ始め，それまで教科書の常識とされてきた事を次々に書き換えながら急速に普及していきました．そして今日では，断層像の画質は格段に良くなり，経腟法，カラードプラ法やパルスドプラ法，3次元超音波も日常診療で使われる時代になりました．<br>　しかし，産科での画像診断がほぼ超音波だけで行われているのに対し，婦人科ではMRIやCTなどが主というケースも少なくない状況です．学会での発表でも，婦人科疾患に関してはMRIやCTの画像が主で，超音波ドプラ法で血流を評価していないものや，超音波の画像すら出していないものまであります．<br>　もちろんMRIやCTは優れた画像診断法であることは間違いありませんが，婦人科疾患に関しては超音波検査だけで診断できるケースや，MRIやCTよりも診断が正確であるケースも少なくありません．筆者は婦人科超音波の有用性を多くの先生方に知っていただき，もっと超音波を活用していただきたいとの思いを持ち続けていましたが，幸いなことに，文光堂の浅井麻紀社長から婦人科超音波診断に関する書籍の出版という機会を与えていただくことができました．<br>　筆者が東京大学医学部附属病院産婦人科で研修を受けていた時,「ゲダンケンガング(Gedankengang)」という言葉をよく耳にしていました．考えの道筋，論理，考え方という意味に捉えていましたが，診断が間違ったり処置や治療が間違ったりするよりは，ゲダンケンガングが間違っているほうが問題視されていたように記憶しています．<br>　超音波検査は，このゲダンケンガングが重要な検査法です．プローブを当てて何が見えているか考え，仮説をたて，それを確認するためには何を描出すればよいかを考え，自分でプローブを操作して見たいところや見つけたい所見を描出し，時に仮説を修正しながら最後に診断に至るという，正に謎解きのような面白みがあります．そして何より，外来で，自分で検査して，ほとんどのケースで診断まで至ることができるというメリットがあります．<br><br>　本書をまとめるにあたり，文光堂の皆様には，編集，校閲，図の調整など細かい部分にもご配慮いただきましたが，特に編集企画部の照屋綾乃氏，堀内珠理氏には大変お世話になりました．また，埼玉医科大学総合医療センター病理部の田丸淳一教授には病理診断についてご助言を頂きました．そして，何より，超音波検査をさせていただいた患者の皆様，その後の治療に昼夜を問わず献身的に働き続けている埼玉医科大学総合医療センター産婦人科の医局員の皆さんには感謝の気持ちでいっぱいです．<br><br>　本書は，単に婦人科疾患の超音波画像を提示するのではなく，最初に得られた画像から，何を考え，次に何を確認して，どう診断に至るかというゲダンケンガングに重点を置いてまとめさせていただきました．本書が婦人科診療に関わる多くの医師，検査技師の方々に婦人科超音波の面白みを感じていただき，実地臨床で活用し，少しでも患者様のメリットとなりますよう祈ってやみません．<br><br>2020年3月　<br>馬場一憲</section><section class="indexes">画像索引<br><br>総　論<br>　1　下腹部の腫瘤・囊胞診断の基本<br>　2　経腟法のコツ<br>　3　超音波ドプラ法使用上の注意点<br>　4　3次元超音波の活用<br><br>症　例<br>［卵巣］<br>　001　内部が完全に無エコーな囊胞（1）<br>　002　内部が完全に無エコーな囊胞（2）<br>　003　充実部分を認めない大きな囊胞<br>　004　すりガラス状のエコーで満たされた囊胞<br>　005　 不均一な内部エコーを有する大きな囊胞と見逃されていた小さな囊胞<br>　006　レース状のエコーを有する囊胞<br>　007　点状エコーのある卵巣囊胞<br>　008　輝度がやや高い粒状のエコーを有する囊胞<br>　009　多房性の囊胞（1）<br>　010　多房性の囊胞（2）<br>　011　高輝度な塊や線状エコーのある囊胞<br>　012　壁から隆起した充実部分がある囊胞（1）<br>　013　壁から隆起した充実部分がある囊胞（2）<br>　014　壁から隆起した充実部分がある妊娠中の卵巣囊胞（1）<br>　015　壁から隆起した充実部分がある妊娠中の卵巣囊胞（2）<br>　016　分娩後も残存した子宮内膜症性卵巣の囊胞<br>　017　層状構造と充実部分がある腫瘤<br>　018　充実部分を含む卵巣囊腫疑い<br>　019　充実部分のある2.5cmの卵巣囊胞<br>　020　卵巣の境界悪性腫瘍摘出後に出現した対側の小さな囊胞<br>　021　充実部分を含む小さな卵巣囊腫<br>　022　中隔の厚い囊胞<br>　023　一部の中隔が厚く充実性に見える囊胞<br>　024　中隔から隆起した充実部分のある卵巣囊胞<br>　025　多房性で中隔の一部に小さな充実部分のある卵巣囊胞<br>　026　壁の一部に多房性の塊のある囊胞<br>　027　中隔が厚く不整な多房性の囊胞<br>　028　破裂した中隔の厚い多房性囊胞<br>　029　無数の虫食い像や囊胞部分を含む大きな腫瘤<br>　030　一部に囊胞部分がある充実性腫瘤<br>　031　囊胞部分が混在する充実性腫瘤<br>　032　充実部分と囊胞部分がまだら状に混在した巨大腫瘤<br>　033　急速に腫大した充実性の卵巣腫瘤<br>　034　血流を認めない充実性の下腹部腫瘤<br>　035　ダグラス窩の充実性腫瘤<br>　036　乳癌術後の卵巣腫大<br>　037　胃癌治療後の両側の卵巣腫瘤<br>　038　卵巣囊腫茎捻転の疑い<br>　039　管腔構造を伴う卵巣囊胞？<br>　040　卵巣脇の充実性腫瘤<br>［子宮］<br>　041　高輝度な子宮腫瘤<br>　042　子宮内腔に突出する充実性腫瘤<br>　043　腫大した子宮と直腸背側の腫瘤<br>　044　子宮と離れた充実性の腫瘤<br>　045　無数の囊胞部分を含む子宮の腫瘤（1）<br>　046　無数の囊胞部分を含む子宮の腫瘤（2）<br>　047　無数の虫食い像や高輝度点状エコーを含む腫瘤<br>　048　囊胞部分と充実部分が混在した巨大な腫瘤<br>　049　筋腫分娩の疑い<br>　050　子宮頸管内の多房性の腫瘤<br>　051　子宮内腔の腫瘤<br>　052　子宮内膜が左右に分かれている<br>　053　子宮が極端に横に曲がっている<br>　054　子宮内容除去術後の大量出血<br>［腟］<br>　055　腟壁から隆起した充実性腫瘤（1）<br>　056　腟壁から隆起した充実性腫瘤（2）<br>［妊娠］<br>　057　異所性妊娠疑い<br>　058　卵管妊娠疑い（1）<br>　059　卵管妊娠疑い（2）<br>　060　見逃されていた胎囊<br>　061　子宮内容除去術後に残った胎囊<br>　062　頸管妊娠疑い（1）<br>　063　頸管妊娠疑い（2）<br>　064　帝王切開瘢痕部妊娠の疑い<br>　065　胞状奇胎疑い（1）<br>　066　胞状奇胎疑い（2）<br>　067　胞状奇胎疑い（3）<br>［他領域］<br>　068　上腹部の充実性腫瘤<br>　069　右下腹部の充実性腫瘤<br>　070　囊胞部分を含む巨大な充実性腫瘤<br>　071　壁から隆起した充実部分と水平像がある囊胞<br>　072　すじ状の腹水を伴う壁の厚い囊胞<br>　073　管腔構造の腫瘤<br>　074　中央が囊胞状になった巨大腹部腫瘤<br>　075　内部に大きな囊胞を含む充実性腫瘤<br>　076　直腸背側の充実性腫瘤<br><br>索　引</section></article>
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