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1 Ｋ Ｓｅｒｖｅｒ １４１５７１ 新潟県厚生農業協同組合 本文 １５ｄ 五十嵐 ９７ １７ 胎盤病理の見方 簡易表を使った病理所見の標準化 厚生連医誌 第２ ３巻 １号 ９ ７ １ ７ ２ １ ４ 解 説 胎盤病理の見方 簡易表を使った病理所見の標準化 長岡中央綜合病院 病理部 病理医 い か らし とし ひこ 五十嵐俊彦 特殊な臓器の病理学的検討は難しい 新潟県内での 自然流産 異常妊娠 分娩例の絨毛 胎盤例は年間推 定５ 検体とされる 当施設においては 年間推定１ 例程の検体を診断している 胎盤病理の重要性は 福 島県立大野病院産科医逮捕事件 ２ ６年 における前 置胎盤と癒着胎盤に関する大阪府立母子保健総合医療 センター検査科中山雅弘部長の鑑定において明瞭であ る 胎盤病理の系統的な学習は困難であることより 胎盤の見方について胎盤病理所見簡易表を作成し報告 した 表１ １ ７ ９ １ 胎盤と臍帯の正常値に 関しても掲載した 表２ ６ ８ １ １ １３ 胎盤は胎児由来ではあるが胎児の状態を必ずしも反 映せず また 母体の状態を間接的にしか反映しない その為 周産期異常と胎盤所見は合致しないことが多 い この点において 形態学的検査には限界があるこ とを認識すべきである 画像検査や機能検査と組み合 わせて学際的に検討することが重要であり 産科学と 病理学に精通することが不可欠である ９ Kaplan CG. Color atlas of gross placental pathology. New York : Igaku-shoin.１ ９９４. １ Kaus FT et al. Placental pathology. Atlas of nontumor pathology, １st series, Fascicle ３. Washington : Armed forces institute of pathology.２ ４. １ １ Kaus FT et al. Placental pathology. Atlas of nontumor pathology, １st series, Fascicle ３. Washington : Armed forces institute of pathology.２ ４. p３１ １ ２２. １２ Pinar H et al. Reference values for sigleton and twin placental weights. Pediatr Pathol Lab Med １ ９９ ６ １６９ ４. １３ Naeye RL. Umbilical cord length. clinical significance. J Pediatr１ ９８ ５ １ ７ ２ ７ ８ ８１. キーワード 胎盤 病理 見方 標準化 病理所見 簡易表 Placental pathology, standardization of pathological examination with simplified assessment table 文 英 文 抄 Commentary Nagaoka Central General Hospital, Department of pathology ; Pathologist Toshihiko Ikarashi 献 １ 五十嵐俊彦 第Ⅱ章 １ B 妊娠と分娩 症例 胎盤病理所見 鈴木利光他監修 カラーダイナミッ ク病理学 ３ ６ ５症例からのアプローチ 東京 西村 書店 ２ １ ７４ ５ ８頁 入手 URL : http : //nrec.web.fc２ com/, ri 臨床病理 学 産科 胎盤解剖 区分１ ２ ３ ４ 胎盤 付属物 流産物 新生児分類 出生時体重 ２ 清 川 貴 子 入 手 URL : http : // jpngypathol/kiyokawa.pdf ３ 南口早智子 入手 URL : http : // jpngypathol/minamiguchi.pdf ４ Benirschke K, Kaufmann P. Pathology of the human １ ９９ placenta ２nd ed. New York : Springer-Verlag ５ Fox H. Pathology of the placenta １st ed. Vol ７ in the series Major problems in pathology. London : Saunders.１ ９ ７ ８ ６ Fox H. Pathology of the placenta. ２nd ed. Vol ７ in the series Major problems in pathology. London : Saunders.１ ９９ ７. p.４ ７ ２. ７ Joshi VV. Handbook of placental pathology. New York : Igaku-shoin.１ ９ ９４. ８ Kalousek DK et al. Pathology of the human embryo and previable fetus. New York : Spirnger １ ９ ９. p２２ ８. 録 The importance of placental pathology has been recognized in the judgment of obstetrician arrest case of Fukushima Prefectural Ohno Hospital in ２６, discussed about placenta previa and placenta accreta by Masahiro Nakayama, Director of Osaka Prefectural Maternal and Child Health Comprehensive Medical Care Center. There were no less than １ specimens related to pregnancy to be diagnosed annually in our laboratory. It is difficult for unfamiliar pathologists to examine placentas. We standardized the placental pathological examination with our simplified assessment table, reported in this paper Table １. The placenta is derived from fetus, but not accurately reflecting both the fetal condition and the maternal one. The placental pathological findings could not corresponded precisely to clinical perinatal abnormality. We should perceive this disadvantage of pathology clearly. The interdisciplinary examination with an imaging study and a clinical functional examination was required and the further mutual communication between pathologist and obstetrician was recommended. 97
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