非連続性病変を呈する潰瘍性大腸炎の臨床病理学的特徴

Clinicopathologic Study on Ulcerative Colitis with Skip Lesion Detected by Colonoscopic Examination

要旨　当部で大腸内視鏡検査を施行し，経過観察している潰瘍性大腸炎150症例のうち，内視鏡的に非連続性病変を認めた19症例（男性8例，女性11例，平均年齢35.8歳）を対象とし，経過中に非連続性となった症例12例と初回発作時に非連続性であった症例7例に分けてその特徴を検討した．経過中に非連続性となった症例の病変分布に一定の傾向はみられなかった．一方，初回発作時に非連続性であった症例の病変の分布は，直腸や虫垂に多かった．また，軽症例が多く，通常内視鏡観察で正常と思われる部位を色素撒布し拡大観察すると，リンパ濾胞の過形成の散在を全例に認め，病変の進展とリンパ組織との関連性を考えるうえで興味深い所見と考えられた．

　We assessed clinicopathologic findings of ulcerative colitis with skip lesion detected by colonoscopic examination. Of 150 patients with initial or recurrent active ulcerative colitis which had been examined by total colonoscopy in the past three years and six months at Hiroshima University Medical Hospital, we selected 19 cases that showed skip lesions. There were 12 patients who had the discontinuous lesions during the clinical course with treatment and 7 patients who had the discontinuous lesions at the on-set of the disease. There was no a fixed tendency in the distribution of the discontinuous lesions in patients during the clinical course with treatment. The discontinuous lesions of the 7 cases diagnosed at the initial stage were mainly observed in the rectum and appendix. By indigo carmine spraying and magnifying observation, hyperplasia of the lymph follicle was observed sporadically in all cases at the part showing normal appearance between macroscopic lesions at the on-set of the disease in the ordinary colonoscopic examination.