家族性大腸腺腫症の空・回腸病変―術中内視鏡による検索

Jejunoileal Lesions in Familial Adenomatosis of the Colon, Detected by Operative Fiberscopy

　1882年Cripps¹⁾の発表以来，家族性大腸腺腫症は大腸にびまん性に無数の腺腫が発生し，しかもそれらが高率に癌化する遺伝性疾患であることが判明した．その後，大腸外随伴病変として骨腫・軟部腫瘍（Gardner症候群）²⁾，脳腫瘍（Turcot症候群）³⁾，粛牙病変⁴⁾，甲状腺癌⁵⁾⁶⁾なども随伴することが報告されてきた．

　最近，本症に胃病変^7)～10)や十二指腸病変¹¹⁾が高率に合併することが，わが国において指摘された．しかし，空・回腸病変の合併については，同部位が診断困難なためか偶然発見されたという報告が散見されるに過ぎない．

　Operative fiberscopy of the jejunoileum was carried out at the time of total colectomy in 14 patients with familial adenomatosis of the colon belonging to 12 families.

　A fiberscope (GTF-K type, Olympus, Tokyo) was introduced into the lumen through one or two enterotomy incisions and careful observation was done from the beginning of the jejunum to the terminal ileum.

　In 8 of all 14 cases multiple sessile polyps were found in the proximal jejunum. All polyps were whitish and tiny (less than 3 mm in diameter). Histological examination on 5 cases all revealed adenoma.

　Eleven cases (79%) had multiple polyps due to lymphoid hyperplasia in the terminal ileum, including three cases with concomitant presence of ileal adenomas. Multiple ileal adenomas were found incidentally among lymphoid polyposis. These lesions were both too tiny and whitish to be differentiated endoscopically.

　As a result adenomatous lesions in the jejunoileum were found in 9 of 14 cases (64%). Operative fiberscopy was unquestionably a surperior method of examination. It is suggested that clinicians should pay much more attention to jejunoileal complications in this disease.