潰瘍性大腸炎の外科治療

Surgical Treatment for Patients with Intractable Ulcerative Colitis

要旨　潰瘍性大腸炎に対する手術適応は重症（28％），難冶（65％），大腸癌またはdysplasia（7％）で，難治が最も多かった．従来のステロイド治療に加えて血球成分除去療法などの治療効果を分析して新しい手術適応を作成する必要がある．手術術式は病変をすべて切除する大腸全摘，回腸囊肛門吻合術，また肛門管を温存して排便機能を良好にする回腸囊肛門管吻合術が標準術式である．当科では主に回腸囊肛門管吻合術を行い，ステロイド大量投与例を含めて94％人工肛門を造らない一期手術を行っている．術後の排便機能，QOLは良好で，成長障害，壊疽性膿皮症などの腸管外合併症も改善する．内科治療の効果が十分でない難治例では時期が遅れることなく手術を行うことが重要である．

　Surgical indications for ulcerative colitis in our series are fulminant colitis (29％), intractability (64％), cancer or dysplasia (7％). New surgical indications should be established because new medical treatments such as leucocytoapheresis and intravenous cyclosporine treatment have been developed. Standard surgical procedures are ileal pouch anal anastomosis with mucosal stripping, or stapled ileal pouch anal anastomosis in which we performed one-stage operations in 94 ％ of our patients including those who had used a large amount of steroid. Postoperative bowel function and QOL are satisfactory including improvement of growth retardation and pyoderma gangrenosum. Surgical treatment should be performed without delay for patients with intractability who do not respond to medical treatment.