日本住血吸虫症における肝臓，消化管病変

Clinico-pathological Study of the Liver and Gastrointestinal Lesions in Schistosomiasis Japonica

　筑後川流域（久留米，鳥栖地区）は山梨県甲府盆地，広島県片山地方とならんで古くから日本住血吸虫（以下日虫と略す）の3大浸淫地の1つとして知られている．日虫寄生が肝硬変，門脈圧亢進症の原因となることは周知の事実でこれについての研究は比較的多いが，日虫に起因する消化管病変についての系統的研究は少ない．われわれは日虫症の主病変部である肝臓，および消化管病変について剖検例，生検例で検査する機会があったのでその成績の大要について報告する．

　A clinico-pathological study of the liver and gastrointestinal lesions of schistosomiasis Japonica seen in 92590 biopsies and 47 autopsies gave the following results:

　1) Ova were found in 5.2 per cent of all materials.

　2) A great number of ova were seen in the liver. In the gastrointestinal tract, the number of ova ranged from a few in the upper gastrointestinal tract to many in the lower, with the greatest number in the rectum. The incidence of positive biopsies reflected this distribution.

　3) Liver lesions were divided into three grades according to the degree of fibrosis.

　Liver cirrhosis due to schistosomiasis japonica (Grade Ⅲ of liver fibrosis) was seen in 12.7 per cent (6 cases). The degree of liver fibrosis did not always correlate with the number of ova.

　4) Histologically and macroscopically, two specific types of fibrosis, pipe-stem fibrosis and septal fibrosis, were seen in liver cirrhosis due to schistosomiasis Japonica.

　5) Histologically, ova were most numerous in the submucosa.

　6) The macroscopical changes associated with lower gastrointestinal ova included mucosal roughening, fibrosis and mural thickening, and multiple small brown serosal macules. Two patients also had multiple colonic polyps.

　7) The degree of liver fibrosis correlated well with lesions of the gastrointestinal tract, but the number of ova in the liver did not so well correlate with that in the gastrointestinal tract.

　8) Groups of ova were surrounded by focally hyalinized fibrous tissue.

　9) Thirteen patients, most of them elderly men, had colonic stenosis due to reaction to ova. Clinically and radiologically, most of them were thought to have carcinoma. In endemic areas, intestinal stenosis due to schistosomiasis Japonica should also be taken into account in patients with colonic stenosis suggesting carcinoma.

　10) Fifty-three cases of gastric carcinoma, 29 cases of colonic carcinoma, and 27 cases of hepatoma were seen in patients with schistosomiasis japonica. We had some discussion about carcinoma associated with schistosomiasis japonica, but definite conclusion about carcinogenicity of this disease could not be obtained.