10.小腸腫瘍癌，悪性リンパ腫，GISTなど

Small Intestinal Tumors and Gastrointestinal Bleeding

要旨　小腸の形態診断はX線検査が中心であったが，近年，カプセル内視鏡やダブルバルーン法小腸内視鏡検査の出現でやや様変わりしつつある．これらは特に小腸疾患が原因である消化管出血の診断に有用である．当科では出血源の検索として25症例39回のダブルバルーン法小腸内視鏡検査が行われ，20例（80.0％）で何らかの所見が認められ，さらに11例（44.0％）では出血源の特定が可能であった．小腸腫瘍が原因であったのはgastrointestinal stromal tumorの1例のみであった．小腸腫瘍が消化管出血の原因となることはまれであるが，検索が不十分のため発見が遅れることも多い．また，各腫瘍別に発現しやすい症状や症候も異なっている．本稿では小腸腫瘍中，比較的頻度が高い原発性腺癌，悪性リンパ腫，gastrointestinal stromal tumor，脂肪腫について各疾患の出血の頻度やその他の臨床的事項を中心に概説した．

　Until now, X-ray examination has been the main procedure for the diagnosis of small intestinal disease. Since the new methods―double-balloon endoscopy (DBE) and capsule endoscopy―have been used the diagnostic procedure for the small intestine is presently changing. The methods mentioned above are especially useful for the diagnosis of gastrointestinal bleeding of small intestinal disease. DBE was performed on 25 patients, on 39 occasions in our hospital. The source of bleeding was identified in 11 (44 ％) of 25 patients. It was only in one case that the cause of the bleeding was a small intestinal tumor. Thus, it is an uncommon clinical condition, but diagnosis of small intestinal tumors is often delayed because of insufficient examination. The incidence of the symptom and objective sign due to small intestinal tumors varies according to their types. We described four types of tumors (primary adenocacinoma, malignant lymphoma, Gastrointestinal stromal tumor, lipoma) whose frequency was comparatively high. The frequency of gastrointestinal bleeding and other clinical features of these disease were recorded.