大腸ポリポージス

Polyposis of the Colon

　Morson¹⁾は，大腸ポリープを表1のごとく分類しているが，大腸ポリープの分類は諸家^2)3)4)5)により多様である．特に大腸ポリポージスという言葉の定義については混乱が多く，単に複数のポリープをポリポージスと呼称している者も少なくない．Welch⁴⁾は比較的限局した範囲に発生した複数のポリープをmultiple polyposisと呼んでおり，Dorand's illustrated“Medical dictionary”のpolyposisの項には，“The development of multiple polyps on a part．”と説明されているにすぎない．槇⁶⁾は，ポリポージスとは単に数個のポリープが発生した場合を意味するものでなく，より多数のポリープが広範囲に発生したものを意味すべきであると述べている，すなわち，大腸ポリープを（a）単発性ポリープ（polyp），（b）比較的限局した範囲に2個以上のものが存在する場合を多発性ポリープ（multiple polyp），（c）結腸に広範囲に多発しているものをびまん性ポリポージス（diffuse polyposis）と分類しており，卜部⁷⁾もこれに同意している．著者らもこの分類が臨床上妥当であると考えている．しかし，Peutz-Jeghers症候群のポリープは，必ずしもdiffuse polyposisではないが，multiple polypsとも異なるので，大腸ポリポージスに含めた．

　大腸ポリポージスは，稀な疾患であるといわれてきたが，Colonofiberscopeの開発された昭和43年5月から47年5月までの4年間に，松永内科教室では家族性大腸ポリポージス3家系17症例，Peutz-Jeghers症候群3家系6症例を経験しており，決してごく稀な疾患ではない．

　From 1968, when colonofiberscope was first developed, we in the Matsunaga Department of Internal Medicine, School of Medicine, Hirosaki University, have so far come across 17 cases of familial polyposis of the colon, a disease generally considered of rare occurrence, in 3 families along with 6 cases of PeutzJehgers' syndrome in another 3 families. Seven patients with polyposis of the colon have also undergone surgical intervention in the Ouchi Department of Surgery. Based on our experiences and with reference to the literature, we have described diagnosis and treatment of polyposis of the colon. Eight such cases encountered in one family are also illustrated in this paper.

　Diagnosis of familial polyposis of the colon can easily be made x-ray study of the colon is combined with colonofiberscopy. Only atypical cases merit special attention ; otherwise they may be treated as colon carcinoma, as is exemplified in a case here presented. Subjective symptoms can entirely be absent in the young. Once a diagnosis of polyposis of the colon is established, it is essential to examine the family as well. The youngest we were able to diagnose was a 7-year-old boy.

　The rate of malignant degeneration in polyposis of the colon was very high in our experiences ; it was 41 per cent as a whole, while in persons over the age of 30 it was as high as 75 per cent. As prophylactic measure as well as for radical cure, total colectomy would be most desirable. Choice of surgical procedure naturally depends on individual situation.

　Good results have been obtained in the young by total resection of the colon and rectum or ileorectostomy. The mean age of patients who have undergone surgical correction in our collected series in Japan is 28.6 in non-cancerated cases ; in those with malignant changes it is 37.7. As no malignant finding has been demonstrated in patients under 20, we are of the opinion that clinical follow-up of polyposis of the colon may be allowed to go on until the age of 20 ; thereafter surgical intervention should be done at the earliest opportunity.