臨床的・内視鏡的立場からみた潰瘍性大腸炎をめぐる2・3の問題

Endoscopical Studies on Ulcerative Colitis

　潰瘍性大腸炎は1859年Wilks¹⁾の報告を始めとするといわれるが，その後，数多くの報告が相次ぎ欧米では比較的popularな大腸疾患とみなされている²⁾．他方，本邦では1928年稲田³⁾の報告を嚆矢とするが，1958年松永⁴⁾の報告を契機に次第に注目されるようになるまでは，比較的稀な下部消化管疾患の一つに過ぎなかった．しかし，内視鏡検査をはじめとする診断技術の進歩にあいまって，今日では本邦でもそれ程稀な疾患とはいえなくなってきている⁵⁾．すなわち，本症の内視鏡による観察は，近年グラスファイバーの導入による大腸ファイバースコープの開発・進歩によって病変部位の一層広範囲な把握も可能となり⁶⁾，いわゆる慢性大腸炎の概念も改めてこのような立場から検討される機運となってきた．すなわち慢性大腸炎のうち，病因の不明なものは非特異性炎症性大腸疾患として本症に包括される傾向にあり⁷⁾⁸⁾，本症の概念そのものも変遷しつつあることも見逃せない⁹⁾．

　本症はその病因，病型分類，さらには肉芽腫性大腸炎との異同など，現在なお多くの未解決な問題を残しているが¹⁰⁾．本文では教室の自験例を中心に，2，3の臨床的，内視鏡的知見を述べる．

　During the last three years colonofiberscopy has been performed in 256 patients in our department complaining of abdominal pain or disturbance of the defecation, and 25 cases of ulcerative colitis were found. In this paper, ulcerative colitis has been investigated from the clinical and endoscopical viewpoint.

　1) According to Roth's clinical classification of ulcerative colitis, 9 cases of them belonged to chronic continuous type, 15 to relapsing-remitting one and 1 to acute fulminating one. However, we differentiated chronic continuous type from relapsing-remitting one in 4 months after the first attack, not in 6 months as reported by Roth, because the clinical symptoms disappeared within 4 months after medical treatment in the greater part of our remitting cases.

　2) Endoscopical findings were classified into three grades for ulcerative colitis; 1st grade (most reliable of ulcerative colitis): pseudopolyposis ; 2nd grade (highly suspicious): multiple ulcers and/or erosions; 3rd grade (suspicious): easy bleeding, abnormal visual capillaries, redness and uneveness of the mucous membrane. In the diagrosis of these 3rd grade ones, dye scattering method was useful for the demonstration of the superficial minute mucosal changes, and for differentiation from non-ulcerative colitis.

　3) Active and inactive stage of the disease were judged endoscopically from the vulnerability of mucosa and this was closely correlated with clinical and histological findings.

　4) The prognosis of ulcerative colitis is hard to tell clinically and endoscopically, but there was observed a significant correlation between the frequency of the defecations and the extension of endoscopical active lesion.