小腸粘膜生検

PERORAL BIOPSY OF THE SMALL INTESTINE

Ⅰ．はじめに

　消化管の病理解剖学的研究は古くから行なわれているが，諸臓器の病理組織学的研究のなかで最も遅れていたのは腸管系の研究である．

　このことは，剖検では死後直ちに腸管を固定しないかぎり粘膜の自家融解が起こることや，腸管の腫瘍性病変，腸結核，腸チフスなどの病理に目が向けられ小腸の機能面からみた吸収障害などの病理学的な解明のてがかりが得られなかったことに原因したと思われる．Shiner，M.（1956）¹⁾に始まった小腸粘膜生検方法による小腸粘膜の病理学的研究は小腸疾患の研究に画期的な進歩をもたらし，以来，器具や術式の改良が加えられ，小腸機能検査法の進歩とあいまって，剖検組織では到底なし得なかった臨床病理学的な検索がすすめられるようになった．生検標本では，疾患の経過に従って生検し組織学的な検討ができ，またその病期における消化管の機能障害やレ線所見と組織学的変化を対比しうるので，小腸疾患の病態生理の研究の上でも欠くことのできないものになった．さらに，組織片を利用しての組織化学，酵素検査法，電子顕微鏡的検査への応用などが行なわれるようになり，小腸粘膜生検は小腸粘膜の基礎的な研究にも寄与するところが大きくなった．本稿では教室で行なっているMultipurpose Suction Biopsy Tubeを利用した生検方法の実際，組織診断における二，三の問題点を具体的に述べ，著者が経験した十二指腸粘膜生検で認めた病変にっいて記述し，おわりに最近の研究方向について紹介することにした．

　The histopathological study of the intestine lags far behind that of other parts of the digestive system, probably because autolytic phenomenon of the intestinal mucosa is invariably observed at necropsy and also because attention of pathologists are more often focussed on such aspects as neoplastic lesions of the intestine as well as its pathology in tuberculosis and typhoid fever, rather than on elucidation of its functional disorders such as absorption defects. Biopsy of the small intestine introduced by M. Shiner has been on that account epochal for the development of pathological study of the intestinal mucosa.

　In this paper is presented a brief description of a history of its development and some comments on its procedures, as well as its clinical application, accidental complications and practical instructions, with priority given to “multi-purpose suction biopsy tube” (Brandborg, L. L. and Rubin, C. R.) now being employed by the authors. Various problems are further discussed of studying histological findings of the intestinal mucosa.

　Flattening and edema of the duodenal mucosa with enlargement of lymphatic space therein, as observed by the authors in cases of liver cirrhosis with portal hypertension, are also described, together with chylus stagnation experienced in extreme portal hypertension. The authors are inclined to classify these pathological phenomenons altogether as “enterose”.

　Behavior of the duodenal mucosa is also studied in acute diarrheal diseases as manifested by its inflammatory changes such as disarrangement of its epithelial cells, into which infiltration of polymorphnuclear leucocytes are seen, or disappearance of brush borders of epithelial cells. These findings are observed to vanish within a short space of time.

　Lastly progress by utilizing biopsies of the intestinal mucosa is referred to in clinical as well as basic studies of the small intestine.