回腸終末部を除く回腸，空腸のパイエル板の研究―切除標本の術後造影および固定標本レントゲノグラムによる検討

Peyer's Patches in the Jejunum and Ileum Excluding Terninal Section: a roentgenographic study using fresh and fixed surgical specimens

要旨　小腸には集合リンパ濾胞であるパイエル板が存在し，この部は局所免疫機構の場として働き，また，小腸疾患の発生や進展に際しても関係が深いと考えられている，このパイエル板が回腸末端～回腸下部に多いことは，よく知られている．しかし，それより口側の回腸や空腸にも存在しうることは，意外と知られていない．特にパイエル板が空腸にあるか否かについては，解剖学や組織学の成書でも明確にされていないことが多い．そこでわれわれは，種々の原因で切除された小腸標本の13例（非びまん性病変8例，びまん性病変5例）にて，新鮮切除標本の二重造影像，固定標本のレントゲノグラムを撮影し，回腸終末部（回盲弁より口側30cmとした）以外のパイエル板について，存在の有無，腸間膜との関係，肉眼および組織像による形態と表面構造の特徴を検討した．その結果びまん性病度では粘膜表面からパイエル板を指摘することはできなかった．だが非びまん性病変の8例に関しては以下の結果を得た．①パイエル板は回腸終末部より口側の小腸にも認められ（8例中8例），空腸にも存在した（5例中5例），②8例から検討しえた25個のパイエル板の大きさは，最小5mm，最大45mmで平均15.4mmであった，③パイエル板部の粘膜表面は，周囲の絨毛粘膜部に比して，領域性を有した網目像や顆粒像を呈した，④パイエル板は腸問膜の反対側に存在した，⑤パイエル板部ではKerckring皺襞は欠如ないし消失していた，⑥肉眼では認識困難で，固定標本レントゲノグラムでのみ発見可能なパイエル板も存在した．

　Local immunological activity is carried on also in the small intestine, so the existence of a Peyer's patches comprised of aggregates of lymphatic follicles could be thought to have a close connection with the origin and progress of diseases in that region.

　It is well known that Peyer's patches are likely to be present at the end and lower section of the ileum. However, it is not clear this phenomenon is also able to be found at the entrance of the ileum excluding the terminal section and also in the jejunum.

　It is of special interest that Peyer's patches in the jejunum are rarely noted clearly in anatomical and histological literature. On account of this, we have taken both double contrast radiograph for fresh specimens and roentgenogram for fixed specimens in 13 cases resected for various reasons.

　Apart from whether or not Peyer's patches were present, and apart from its connection with the mesentery, we examined grossly and microscopicall the shape and surface structure characteristic to the section of the small intestine under study. The results of the examination were as follows: - 　1) Peyer's patches could be found not only in the ileum excluding the terminal section of it but also in the jejunum.

　2) The size of the 25 Peyer's patches obtained from eight specimens able to be discerned ranged from 5 mm to 45 mm in diameter, giving an average size of 15.4 mm.

　3) Compared to the villi nodules of the surroundings, the mucosa of the sections occupied by the Peyer's patches present a coarse net-work pattern or a granulated pattern.

　4) Most of the Peyer's patches were present at the opposite side of the mesentery.

　5) In the Peyer's patches section there was either a shortage or a complete absence of Kerckring's folds.

　6) Some Peyer's patches were almost indiscernible grossly, and others which could be detected only on the roentgenogram of fixed specimens.