術中小腸内視鏡検査―その方法と意義

Operative Fiberscopy of the Small Intestine

　近年，小腸疾患に対する関心が高まり，種々の内視鏡検査が試みられている．しかし現行の小腸内視鏡検査法は，胃や大腸の場合のように精密な観察や直視下生検を目的としたものにはほど遠い．

　われわれは，開腹手術時にファイバースコープを小腸に挿入し，全小腸の観察と直視下生検を行っている．本稿では，その方法と成績を示し，若干の考察を加える．

　Operative fiberscopy of the small intestine was done in 26 patients with various intestinal diseases. A fiberscope sterilized by ethylene oxide gas was introduced into the lumen through one or two enterotomy incisions and the intestine was carefully observed.

　In 7 of 15 patients with familial polyposis coli, several tiny and whitish polyps were recognized in the proximal jejunum. These were poorly demonstrable by X-ray examination. The biopsy specimens of these polyps showed adenoma in three patients.

　In eight patients (Crohn's disease 3, chronic hemorrhagic ulcers of the small intestine 3, intestinal tuberculosis 1, unclassified ulcer of the small intestine 1), operative fiberscopy was done to define the extent of the lesion, and resection of the small intestine was performed. The extent defined by endoscopy was greater than that by extraluminal appearance and palpation in three patients.

　In one of two patients with intestinal tuberculosis, operative fiberscopy was very helpful to the diagnosis, but diagnostic findings were not observed in the other patient.

　We could not observe the lesion well in a patient with jejunal carcinoma because of bleeding.

　By comparing X-ray findings with endoscopic features we would be able to read X-ray films more correctly.

　While non-operative fiberscopy of the small intestine is little useful today, operative fiberscopy is very easy and informative and we hope it would be widely adopted.