虚血性小腸狭窄（狭窄型虚血性小腸炎）の臨床病理学的検索

Clinicopathologic Study on Ischemic Stricture of the Small Intestine

要旨　虚血性小腸狭窄18症例18手術材料について，臨床病理学的立場から検討した．18例は原因により特発性13例と腹部外傷5例に分けられたが，両者の肉眼像と組織像はほぼ同じであった．本病変の肉眼像の特徴は，①求心性管状狭窄，②境界明瞭な全周性区域性潰瘍，③腸管壁の強い肥厚であり，主な組織所見は，①潰瘍の深さは種々で，56％がUl-Ⅲ以上，②潰瘍底の血管に富む肉芽組織，③粘膜下層を主とする高度の線維筋症と線維化，④比較的強い慢性炎症細胞浸潤，⑤種々の程度の担鉄細胞の出現であった．成因に関する所見として，15例に小中型動脈内膜の軽度～中等度肥厚が，4例に器質化血栓が，4例にリンパ管壁の著明な肥厚がみられた．以上の結果を基に，本病変の病理形態の特徴，成因，鑑別疾患などについて簡単に考察を加えた．

　Clinicopathologic study on ischemic stricture of the small intestine was carried out in 18 resected specimens obtained from 18 patients. The results obtained were as follows.

　1) Of the 18 patients, five had histories of abdominal trauma and the remainder had histories neither of abdominal trauma, nor strangulated hernia, nor radiotherapy or treatment for arterial hypertenstion. Pathomorphologic findings in both groups were almost identical.

　2) The macroscopic characteristics of the lesions were tubular and concentric stenosis, annular and segmental ulcer, and marked thickening of the wall in the narrowed segments.

　3) The microscopic appearances were composed of five main pictures as follows; 1) ulcers of Ul-Ⅱ to Ul-Ⅳ, 2) open ulcers floored with richly vascular granulation tissue, 3) prominent fibromusculosis and fibrosis mainly in the submucosa, 4) relatively marked inflammatory infiltrate consisting chiefly of lymphocytes and plasma cells, 5) presence of hemosiderin-laden macrophages scattered through the entire thickness of the intestine.

　4) Among pathomorphologic findings, regarded as the causative factors, were slight to moderate fibromuscular intimal thickening of the small to medium-sized arteries situaed in the serosa (15 cases), organized and recanalized thrombus (4 cases), and marked thickening of the lymphatic wall (4 cases).

　According to the results obtained, brief discussion was made on its pathomorphologic characteristics, causative factors and differential diagnosis, and on the pathomorphologic differences between ischemic stricture of the small intestine and ischemic colitis of the stricture type.