消化管粘膜の微細血管像について

Micro-Vascular Pattern of the Biopsy Specimens of the Mucosa in the Gastrointestinal Tract under the Dissecting Microscope

　直視下に全消化管内腔を観察したいというendoscopistの夢は達せられたが，粘膜面のさらに微細な構造を内視鏡下に観察することについては，その努力はなされているにしても，今日なお容易ではない^1)～5)．

　すなわち，切除標本における拡大観察などの基礎的研究がなされているにしろ，生体における（特にヒト），あるいはそれに近い条件での微細血管像についての研究は比較的少ない．消化管，特に胃・小腸などにおける粘膜の微細構造は，粘膜面の炎症などの病態を反映していることは事実であり，また粘膜病変の良，悪性などの質的診断など，その寄与するところは極めて大きい．著者らは，いわゆる十二指腸炎につき総合的見地からその本態に対するアプローチを行ないつつあるが，なかでも十二指腸粘膜の微細構造を加味した粘膜内微細血管像に注目して検討している^6)～8)．この日的のために全消化管を通じての血管像の把握の必要性を痛感した．

　We assumed that the mucosal vascular pattern in the gastrointestinal tract would be capable of reflecting movement of blood flow in the submucosa. This hypothesis was confirmed by experimental study with a dog. The biopsy specimens of the mucosa in the gastrointestinal tract were obtained by gastro-, duodenoand colono-fiberscope, and were examined freshly under the dissecting microscope (Olympus type X-Tr, Nikon multiphoto). The specimens were observed and photographed in color simultaneously and the appearance correlated with subsequent histological finding.

Microvascular pattern of the normal gastric mucora was seen to surround the papilla. The appearance of each capillary was regular, smooth and not interrupted.

　On the other hand, in gastric or duodenal ulcer patients relapse was frequently observed in cases in which the capillaries surrounding the ulceration were few in number, narrow and irregular. There is difference between microvascularpattern andendoscopic finding in cases with gastric or duodenal ulcer scar. Not only endoscopic findings but also microvascular appearance in addition to micro-structure are necessary for a judgment whether a lesion is healed or not.

　In cases with inflammatory change of the large bowel, our method is very useful for the judgment of stage, especially for determining whether there is remission or not. We have emphasized that this method is simple and has clinical value for discovering inflammatory change in the gastrointestinal tract.