大腸内視鏡検査における微細血管観察の試み―10%fluorescein液による螢光観察を中心に―

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  • NEW TRIAL IN COLONOSCOPY FOR RECOGNIZING MICROVESSELS OF COLONIC MUCOSA, USING FLUORESCENCE METHOD

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With recent advances in gastrointestinal rentogenology and endoscopy, ulcerative colitis has been diagnosed more frequently. But the accurate criteria of diagnosis of this disease has not been established. Therefore, its follow-up observation is important because of its chronic relapsing nature. In this paper, fundamental and endoscopical trials are presented for recognizing the architecture of microvessels of colonic mucosa. As a fundamental study, India ink was continuously dripped into Wistar rat at a constant pressure 100 cm H2O via thoracic artery after lavage by saline solution Tncluding heparin, and the microvessels were examined stereomicroscopically and histologically. Clinically, the endoscopical closed-up observation was applied to 28 cases of control and 39 of ulcerative colitis, histopathologically classified into three stages. Further, for recognizing the fine network pattern of regularly arranged microvessels of colonic mucosa, fluorescence method with magnifying observation was applied to 12 cases of ulcerative colitis and 8 of control.The obtained results were as follows; 1) Histologically, the microvessels of colonic mucosa filled with India ink were observed to run up along each colonic gland to make fine networks just beneath the mucosal surface. 2) Stereomicroscopically, it appeared as regularly arranged "honeycomb" like fine network pattern. 3) By usual endoscopy, arborescent vascular appeara-nces were obscure in 11 cases, and remarkably proliferat-ed and/or dilated microvessels in 12 among 13 cases of active stage of ulcerative colitis. 4) These findings were improved with diminishing mucosal inflammation, but the alteration of microvascular appearanbe remained for longer period than that of arborescent vessels. 5) By magnifying fluorescence method, the fluorescent fine network pattern could be seen obscurely and irregu-larly in 7 cases among 8 of active and almost quescent stages of ulcerative colitis, whereas in quescent stage, the fine network pattern appeared regularly in 1, slightly irregularly in 2 and irregularly in 1. From these results, the fluorescence method might be concluded to be useful in the follow-up study of ulerative colitis.

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