経時的にみた虚血性大腸炎の臨床病理学的検討

Pathomorphological Change of Ischemic Colitis with Lapse of Time

要旨　種々の理由で腸切除が行われた虚血性大腸炎11例を用いて，同疾患の経時的変化を病理形態学的に検討し，その病型分類を試みた．また同疾患の特徴の1つである縦走性潰瘍の成り立ちについても言及した．病型は，びまん出血期，多発びらん期および潰瘍期に3大別された．潰瘍期は更に活動性潰瘍期，治癒進行性潰瘍期および治癒潰瘍期（潰瘍瘢痕期）に亜分類できた．活動性潰瘍期は発症後4日目と12日目の例にみられ，結腸紐上に沿う縦走潰瘍を伴っていた．治癒進行性潰瘍期は19日目と25日目に，治癒潰瘍期は46日目の例から認められた．縦走潰瘍は，初回発症時に形成される揚合と，多発びらんの融合・進展にて形成される揚合の2過程が考えられ，両者は初回の虚血の程度差によると考えられた．

　Pathomorphological changes of ischemi ccolitis with lapse of time were studied in eleven surgically resected cases and the following results were obtained:

　1) The stage of ischemic colitis was classified into diffuse hemorrhagic (active-healed), multiple erosive (active-healed) and ulcerative (mainly longitudinal) ones. Over and above this, the ulcerative stage was subdivided into active, healing and healed (scar) stages depending on macroscopic and microscopic characteristics.

　2) The pure form of diffuse hemorrhagic or multiple erosive stage was not found frequently in the resected materials where lesions were in the periphery of the ulcerative lesion. Both the hemorrhagic and the erosive stage either healed without any abnormalities of the intestinal lumen or grew worse to become the ulcerative stage. Active ulcer stage with distinct longitudinal ulcers was found in cases where there was a time lapse of four to twelve days after the onset of symptoms. Healing ulcer stage was seen from 19 to 25 days after the onset, but in one case it was seen on the 75th day. The healed ulcer stage was seen on the 46th, 66th, and 120 th day.

　3) The time necessary for scar stage largely depended on the degree of the initial attack or continuance of ischemia or on the stage of ischemic colitis. It is suggested that longitudinal ulcers might arise from enlargement and fusion of the multiple erosions or from the intensity of the initial attack of ischemia itself.