腸結核の肉眼所見と結核肉芽腫の存在について―全割切片作製による再構築から

Macroscopic Appearance and Presence of Tuberculous Granuloma in Intestinal Tuberculosis

　腸結核症は，最近欧米ではきわめて稀とされているが，本邦では少ないといわれながらも，かなりの報告例がみられる．また，近年腸検査法の進歩により，腸の潰瘍性病変，特にわが国においては，欧米に比べて少ないとされていたクローン病，潰瘍性大腸炎に関する関心が高まり，それらに関する論文も増加してきている．ここで，わが国では腸結核とこれらの疾患との鑑別が重要な問題となってくる．従来，岡¹⁾，黒丸²⁾，岩崎³⁾らは腸結核症は肺結核症に続発する管内性転移によるものが大部分で，腸に原発する結核は非常に稀であると述べているが，最近は肺に活動性の結核病巣が認められない腸結核の症例報告が増えてきている^5)～9)．また，化学療法の大きな進歩により，以前の腸結核とは様相が異なってきている可能性がある¹⁰⁾．

　最近，臨床的，X線学的，内視鏡学的に腸結核症と診断，手術しても，病理組織学的には結核と確診がつけられない症例が増加している．このような症例の中には，臨床的にも病理組織学的にもクローン病あるいは潰瘍性大腸炎との鑑別がきわめて困難な症例もある．

　Pathohistological investigations were made on intestinal tuberculosis in terms of the incidence according to macroscopic findings of tuberculous lesions and granuloma formation (macroscopic) in eleven patients from the Second Department of Internal Medicine, Kagoshima University Hospital and its affiliated hospitals where some of the patients had been operated on. Tuberculous granuloma accompanied with caseation necrosis of related lymphnodes was seen in all eleven cases.

　1. Both caseation necrosis of lymphnodes and granuloma on the intestinal wall were recognized in four cases. Five cases, however, presented granuloma only (with caseation necrosis of related lymphnodes) and two cases had no granuloma at all.

　2. Intestinal tuberculosis lesion area was further divided, based on macroscopical findings, into three regions; open-ulcer, ulcer-scar and atrophic-mucosal areas. Then the incidence of tuberculous granuloma in each area was investigated. Granuloma was found in about half cases of each area group and there were a few macroscopical differences seen among the groups. However, granulomatous quantity of the lesions reduced macroscopically according to different areas; open-ulcer area, ulcer-scar area and atrophicmucosal area, in that order.

　3. As for granuloma accompanied with caseation necrosis which is characteristic of tuberculous lesion it was seen macroscopically in five lesions (36%) out of fourteen, though it was found in two lesions (7%) out of twenty-eight in combined ulcer-scar and atrophic-mucosal area, that is, scarred area.

　4. Medical histories of eleven studied patients showed two active pulmonary tuberculosis cases, seven obsolete and two without pulmonary tuberculosis.