大腸結核の内視鏡診断

Endoscopic Diagnosis of Tuberculous Colitis

　腸結核は肉眼的にかなり特徴的なので潰瘍の活動性，非活動性を問わず診断は通常容易である．近年日本でもCrohn病の増加が注目され，それとの類似で腸結核があらためて注目されてきている．本号は特集号で，病理・X線なども他の執筆者によって書かれる．本稿では個々の症例の診断のいきさつは省き，腸結核と診断した症例の内視鏡所見のみに限って記載する．

腸結核の診断

　腸に結核性として妥当な病変があることと，結核に罹患している（あるいは罹患したことがある）ことを示す何らかの所見があることの2点が腸結核を診断するうえで必要である．最終的には病巣部に結陳菌を証明すること，あるいは特異的といわれる乾酪性肉芽腫の採取が診断の決めてとなる．しかし本症が手術されるのはごく特殊な場合であり，組織に菌や肉芽腫を証明するのは容易でない．そこで臨床的には前記の2点をもって臨床的に腸結核と診断を下し，抗結核療法を開始する．

　Tuberculous colitis is still popular and important to be differentiated from Crohn's colitis. Twenty nine cases of tuberculous colitis were experienced in our hospital in the past eight years. All of them except one had some lesions at the ileocecal area. One case was confined to the rectum. Among 28 cases of ileocecal tuberculosis, twelve were active and sixteen were inactive or healed colitis. As shown in table 1, most of tuberculous colitis were confined to the ileocecal area. At the ileocecal area, the disease was rather diffuse. Six cases had ileocecal lesions. Four had ileocecal lesions plus colon stricture and two had multiple ulcerations throughout the colon. The character of the tuberculous ulcer was as follows: 1. circular 2. elevated margin with peculiar pattern 3. flat and granular. Healed colitis showed ulcer scar with converging multiple diverticula formation when the ulcers were multiple. Cases of progressive systemic sclerosis and ulcerative colitis were presented for the differentiation from healed tuberculous colitis. The aim of biopsy is only to obtain pathognomonic tuberculous granuloma. It is, however, difficult to get complete granuloma by biopsy because of me-chanical damage by biopsy procedure. Therefore only part of or incomplete granuloma could be obtained most cases.