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Stomach and Intestine(Tokyo) Volume 28, Issue 9 （August 1993）

胃と腸 28巻9号（1993年8月発行）

Japanese English

今月の主題虚血性腸病変の新しい捉え方

主題

原因別にみた虚血性腸病変の病理形態 Pathomorphologic Study on Ischemic Lesions of the Small and Large Intestine. 岩下明徳 ¹ , 竹村聡 ¹ , 山田豊 ¹ , 長谷川修三 ¹ , 八尾隆史 ² , 宇都宮尚 ² , 平川克哉 ³ , 黒岩重和 ⁴ , 村山寛 ⁵ , 飯田三雄 ⁶ , 八尾恒良 ⁷ Akinori Iwashita ¹ ¹福岡大学筑紫病院病理 ²九州大学医学部第2病理 ³松山赤十字病院消化器センター ⁴浜の町病院病理 ⁵福岡大学医学部第1病理 ⁶九州大学医学部第2内科 ⁷福岡大学筑紫病院消化器科 ¹Department of Pathology, Fukuoka University Chikushi Hospital ⁵l キーワード：腸間膜動・静脈血栓症 , 虚血性小腸炎 , 虚血性大腸炎 , 静脈硬化症 , 腸 Keyword: 腸間膜動・静脈血栓症 , 虚血性小腸炎 , 虚血性大腸炎 , 静脈硬化症 , 腸 pp.927-941

発行日 1993年8月25日 Published Date 1993/8/25

DOI https://doi.org/10.11477/mf.1403106238

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要旨　虚血性腸病変96症例〔上腸間膜動脈血栓・閉塞症（SMA-EO）21例，上腸間膜静脈血栓症（SMV-E）6例，虚血性小腸炎20例，虚血性大腸炎46例，静脈硬化症3例〕の摘出材料を用いて，病理形態学的立場から検討した．SMA-EOとSMV-Eを比較すると前者は貧血性梗塞9例と混合型梗塞11例に分けられ，後者は全例出血性梗塞であった．組織学的にも後者で出血，うっ血，水腫が強い．虚血性小腸炎と虚血性大腸炎の肉眼像は，前者は全周性帯状潰瘍，後者は結腸紐に沿う2～3状の縦走性潰瘍，全周性帯状潰瘍，匍行状潰瘍および3者の混合型が特徴的であった．組織学的には両者ともに血管性肉芽組織，線維筋症，担鉄細胞，器質化血栓ないしアテローマ塞栓が注目された．静脈硬化症による腸病変は右半結腸のみに存在し，肉眼上暗紫色調，半月ひだ腫大・消失を伴う著明な壁肥厚が特徴的で，光顕的には静脈壁の線維性肥厚と石灰化，粘膜下層の高度線維化と粘膜の血管周囲性膠原線維の沈着，および粘膜下層の小血管壁への泡沫細胞の出現が特異的であった．以上の結果をもとに，SMA-EOとSMV-Eの鑑別は可能であることを指摘し，併せて静脈硬化症による虚血性腸病変はnew entityである可能性を考察した．

　To evaluate ischemic lesions of the small and large intestine pathomorphologically, we examined 94 surgical and 2 autopsy specimens from 2l patients with superior mesenteric thrombosis or occlusion (SMA-EO), six patients with superior mesenteric venous thrombosis (SMV-E), 20 patients with ischemic enteritis, 46 patients with ischemic colitis and three patients with phlebosclerosis.

　(1) The size of the lesions caused by SMA-EO was larger than that caused by SMV-E. In 20 acute lesions by SMA-EO, nine of them were anemic infarcts of the bowel macroscopically, and the others were a combination of anemic and hemorrhagic infarcts. Microscopic examination revealed that the lesions by SMV-E had more extensive hemorrhage, edema, and congestion than those by SMA-EO.

　(2) The stricture type of ischemic enteritis was macroscopically characterized by a tubular stenosis, and an annular and segmental ulcer. The microscopic features were summarized as follows: 1) Ul-Ⅱ, Ⅲ and Ⅳ ulcers, 2) open ulcers with vascular-rich granulation tissue in the center, 3) prominent fibromusculosis and fibrosis mainly located in the submucosa, 4) hemosiderinladen macrophages scattered throughout the whole layers of the intestine, 5) organized thrombi in the blood vessels of the serosa (4 cases) and atheromatous emboli in the small arteries (one case).

　(3) The stricture type of ischemic colitis was macroscopically characterized by 2 or 3 longitudinal linear ulcers along the teniae coli, annular and segmental or serpiginous ulcers, and combined ulcers. The histological features of the ischemic colitis were almost the same as those of the ischemic enteritis.

　(4) All three lesions caused by phlebosclerosis were found in the right colon, especially in the cecum and ascending colon. The macroscopic characteristics of the lesions were a dark purple colored surface and marked thickening of the wall and disappearance of plicae semilunares coli. A healed Ul-Ⅲ ulcer was found only in one patient. The microscopic characteristics were marked fibrous thickening of the venous wall with calcification, marked submucosal fibrosis, collagenous deposition around the blood vessels in the mucosa, foamy macrophages within the small vessel wall in the submucosa, but no thrombus in the vessels.

　We discuss the pathomorphologic characteristics, factors causing ischemic lesions and differences of the lesions caused by SMA-EO and SMV-E. Phlebosclerosis may be a new entity of ischemic colitis.