小腸の生検診断

Biopsical Diagnosis of Lesions in the Small Intestine

　空腸および回腸の生検は歴史的には十二指腸の生検とほぼ同時期に始められた．すなわちShinerによって1956年にはじめてDuodenal Biopsy Tube¹⁾が発表されたが，これに続いて同じ年内にJejunal Biopsy Tube²⁾も発表されている．その後はCrosby³⁾，Rubin⁴⁾をはじめ多くの人々^{5)6)7)8)9)10)11)12)}によって小腸の生検器具が作製されているが，これらの器具はいずれも生検の可能な範囲を十二指腸に止まらず，空腸以下に及ぶものとしている．しかしながら近年始められた内視鏡を用いて行う生検では十二指腸が内視鏡の完成によってすでに日常の臨床に利用されているのに対して¹³⁾，空腸以下を観察の範囲とする小腸鏡は未だ試作の段階に止まっているため^14)15)16)17)，生検もまた実用化の域に到っていない．本稿では空腸より下部の小腸の生検に関する基礎的事項，生検器具と実施手技および生検材料の扱い方について述べるとともに2，3の症例を提示する．

　Biopsy of the small intestine is performed either “blindly” or under direct vision. Blind biopsy is indicated for diffuse mucosal alterations and direct vision biopsy in addition also for localized lesions. Blind biopsy is a suctional procedure for which wire, air or water pressure is employed in operating biopsy forceps. Endoscopy for direct vision biopsy is now being exploited for obtaining still better results. There are three ways of inserting endoscopy into the digestive tract: peroral, per anum and guiding with a string. Specimens obtained by our biopsy instrument (Tohokudai type) measured 3～6 mm in diameter, mostly containing tissue of the lamina propria. Biopsy particles taken out by biopsy under direct vision by means of endoscope were 1～2 mm in diameter. The size of a given specimen was found to be greatly related to that of the forceps. Biopsy is a safe procedure with few complications.

　Macroscopic observation of the mucosa of the small intestine is of great help in appraising the state of the villi. By observing, we were able to divide the normal state of the villi into three groups. Microscopic sections must be cut vertical to the mucosal surface for correct histologic diagnosis of changes in the villi. Pathologic changes should by all means be discriminated from artefacts. Deformity and atrophy of the villi are changes characteristic to the mucosal lesions of the small intestine. As a basis of correct diagnosis, our results of the measurement of the villi in each segment of the small intestine are presented here. Cases are also described, showing various pathologic changes and functional examinations related to them.