POSTMORTEM SURVEY OF DIVERTICULAR DISEASE OF COLON .2. MUSCULAR ABNORMALITY IN SIGMOID COLON
POSTMORTEM SURVEY OF DIVERTICULAR DISEASE OF COLON .2. MUSCULAR ABNORMALITY IN SIGMOID COLON
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DOI：
10.1136/gut.10.5.344
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发表时间：
1969-01-01
期刊：
影响因子：
24.5
通讯作者：
HUGHES, LE
中科院分区：
文献类型：
--
作者：
HUGHES, LE
在本世纪早期，人们对乙状结肠憩室及其相关的憩室炎进行了清晰而全面的描述（Telling和Gruner，1917）。此时发现肠壁增厚，尤其是纵肌增厚是常见的（基思，1910）。从那时起，肌肉增厚经常被注意到，并在病理标本的插图中清楚地显示出来，但似乎并没有被认为是疾病本身的一个因素。相反，与炎症并发症相比，它一直被视为一个次要和不重要的方面。这可能源于Spriggs和Marxer（1925）从放射学研究中得出的观点，即肌肉异常与其说是已确诊疾病的一部分，不如说是憩室前状态的一部分。Morson首先对肌肉疾病的真正意义提出了见解，他指出，许多因假定的憩室炎而切除的病例没有显示出炎症性疾病的证据，但所有标本中都存在相当程度的肌肉增厚（Morson，1963）。本文引起了人们对憩室病肌肉方面的兴趣，并对放射学表现（威廉姆斯，1963，1967 b）和测压研究（Painter，1964; Arfwidsson，1964）作了全面的描述。在这些论文中，已经以相当长的篇幅讨论了乙状结肠中经常出现的肌肉变化，并将其作为一个起点，这是一种特征性的、容易识别的晚期疾病。然而，由于对这种肌肉异常的定义尚不明确，对其发生的频率、程度以及与憩室病理或临床症状的关系尚没有准确的描述，因此没有进行详细的分析。为了弥补其中的一些不足，特别是为进一步的研究提供初步的基础，进行了结肠尸检。本文所描述的工作的主要目的是获得对一般人群中这种异常的总体看法，并从整体上评估其与憩室病的关系。对一个较小的实验组的研究已被用来提供一个更详细的异常及其与乙状结肠和相关憩室的空间关系的组织学图片，这项工作将在其他地方进行。乙状结肠肌切开术（Reilly，1966）的引入，减轻了归因于这种肌肉增厚的症状，增加了这类研究的意义。
Diverticula of the sigmoid colon and associated diverticulitis were described clearly and fully in the early years of this century (Telling and Gruner, 1917). It was noted at this time that thickening of the bowel wall and of the longitudinal muscle in particular was a common finding (Keith, 1910). Since that time, the muscular thickening has often been noted, and shown clearly in illustrations of pathological specimens, but does not seem to have been considered as an element of the disease in its own right. Rather, it has been looked on as a subsidiary and unimportant aspect in comparison with the inflammatory complications. This perhaps stems from the view of Spriggs and Marxer (1925), derived from radiological studies, that the muscle abnormality was more a part of the prediverticular state than part of the established disease. An insight into the true significance of the muscle disorder was first given by Morson, who pointed out that many cases subjected to resection for supposed diverticulitis showed no evidence of inflammatory disease, but that a very considerable degree of muscular thickening was present in all the specimens (Morson, 1963). This paper has stimu-lated interest in the muscular aspect of diverticular disease, and comprehensive descriptions of radio-logical appearances (Williams, 1963, 1967b) and of manometric studies (Painter, 1964; Arfwidsson, 1964) have appeared. In these papers, the muscle change often present in the sigmoid colon has been discussed at considerable length, taking as a starting point the advanced stage of the condition which is characteristic and readily recognized. However, no detailed analysis has been made in that this muscle abnormality has not been defined, andno accurate description has been made of its frequency, extent, and relation to diverticular pathology or clinical symptoms.An investigation of colons at necropsy has been carried out in an attempt to remedy some of these deficiencies, and in particular, to put forward a tentative basis for further research. The main purpose of the work described in this paper has been to obtain an overall view of this abnormality in the general population, and to assess its relationship to diverticular disease asa whole. Studies on a smaller experimental group have been used to give a more detailed histological picture of the abnorm-ality and its spatial relationship to thesigmoid colon and associated diverticula, and this work is to be reportedelsewhere. The introduction of sigmoid myotomy (Reilly, 1966), for the relief of symptoms which have been ascribed to this muscular thickening, has added significance to studies of this type.