特発性腸間膜静脈硬化症の病態と鑑別診断  [in Japanese] IDIOPATHIC MESENTERIC PHLEBOSCLEROSIS : ITS CLINICO-PHATHOLOGICAL FEATURES AND DIFFERENTIAL DIAGNOSIS  [in Japanese]

    • 八尾 隆史 YAO Takashi
    • 順天堂大学 人体病理病態学 Department of Human Pathology, Juntendo University School of Medicine
    • 平橋 美奈子 HIRAHASHI Minako
    • 九州大学大学院 医学研究院・形態機能病理学 Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University

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Abstract

特発性腸間膜静脈硬化症は比較的まれな疾患であるが,現在ではひとつの疾患概念として定着している.平均年齢60歳代で,やや女性に多く,日本人を中心としたアジア人のみが罹患している.その病変は回盲部から横行結腸までが最も多いが,S状結腸・直腸へも広がっている症例もみられる.腹部単純X線写真では右側腹部に線状石灰化像あるいはCT検査にて腸管壁および腸間膜に一致して石灰化像を認めるのが典型的である.組織学的には静脈壁の著明な線維性肥厚と石灰化,粘膜下層の高度の線維化,粘膜固有層の著明な膠原線維の血管周囲性沈着などが特徴的所見であり,びらんや潰瘍部以外では炎症所見に乏しいことも重要なその特徴の一つである.無症状の場合は保存的に管理し,自覚症状の出現や潰瘍・狭窄を伴った場合は外科的切除されるのが一般的である.<BR>その原因は不明であるが,漢方薬を含めた何らかのToxic agentが特発性腸間膜静脈硬化症の発症の要因の一つとして注目されている.今後,発症原因が解明され予防法が確立されることを期待したい.

Idiopathic mesenteric phlebosclerosis is a relatively rare disease, however, it has now been established as a single disease entity. Clinically it is characterized by the average age in the 6<SUP>th</SUP> decade, a slightly higher prevalence in women, affecting only Asian patients (especially Japanese), and right-sided colon predominance. Calcification along the intestinal wall in plain abdominal X-ray images, and calcification along the mesenteric veins in CT scans are characteristic features. Histologically, perivascular collagen deposition, marked submucosal fibrosis and calcification in the veins are characteristic features, accompanied by minimal inflammation except for areas of erosion. Clinically, conservative management is common for asymptomatic patients and, surgical resection is generally accepted for the patients with stenosis, ulcers of the colon or other such symptoms. The cause of idiopathic mesenteric phlebosclerosis still remains unknown, however Chinese medicine, including some toxic agents, has been attracting attention as a factor in the development of idiopathic mesenteric phlebosclerosis. In the future, it is expected that preventive measure will be established by elucidating its cause.

Journal

GASTROENTEROLOGICAL ENDOSCOPY  

GASTROENTEROLOGICAL ENDOSCOPY 54(3), 415-423, 2012-03-20 

Japan Gastroenterological Endoscopy Society

References:  108

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Codes

  • NII Article ID (NAID) :
    10030293861
  • NII NACSIS-CAT ID (NCID) :
    AN00192102
  • Text Lang :
    JPN
  • Article Type :
    REV
  • ISSN :
    03871207
  • Databases :
    CJP  J-STAGE