虚血性小腸病変の病理診断―自験132例の検索結果を中心に

Pathological Diagnosis of Small Intestinal Ischemic Lesions

要旨　虚血性小腸病変132例（絞扼による小腸虚血101例，腸間膜動脈血栓症12例，腸間膜静脈血栓症3例，その他の原因6例，狭義の虚血性小腸炎10例）の外科的切除標本を用いて，病理形態像を解析した．前三者はいずれも全例急性期であり，粘膜下層の浮腫と血管拡張が著明で，種々の程度に新鮮出血を伴っていた．腸間膜静脈血栓症は全て出血性梗塞像を呈したが，腸間膜動脈血栓症は出血性の他，貧血性または混合型の梗塞像を呈するものが9例存在した．狭義の虚血性小腸炎は急性期2例と慢性期（狭窄型）8例に大別され，後者は全て内腔の高度管状狭窄を示し，全周性の帯状潰瘍瘢痕を伴い，潰瘍深度はUL-IIs～IIIsで肉芽組織形成と線維筋症が目立った．

　The aim of this study was to clarify the pathological features of small intestinal ischemic lesions. We examined 132 lesions from 132 cases with ischemia（strangulation, mesenteric arterial thrombosis, mesenteric venous thrombosis, others, and ischemic enteritis : 101, 12, 3, 6, and 10 lesions, respectivity）between January, 2003 and March 2013 at our laboratory.

　The following results were obtained. The macroscopic and microscopic findings indicating that the ischemic lesion had been caused by mesenteric venous thrombosis were extensive hemorrhage, edema and congestion. The chronic phase（stricture form）of ischemic enteritis was macroscopically characterized by marked tubular stenosis and circular girdle ulcer with rough-surfaced texture. Microscopically, ulcers（UL-IIs or IIIs）with vascular-rich granulation tissue and prominent fibromusculosis of the submucosal tissue were also found at the lesions.