長期経過例からみた腸型Behçet病と単純性潰瘍の治療

Long Time Course and Treatment of Intestinal Behçet's Disease and Simple Ulcer

　過去に当科で経験した腸型Behçet病(以下，腸型BD)17例と単純性潰瘍3例の計20例の治療内容と経過について検討した．単純性潰瘍は内科治療の反応が得られず，3例全例手術となった．一方，腸型BDの手術例は8例であるが，再手術例はない．また腸型BDの経過は発症時に最も重篤であり，再燃と緩解を繰り返しながら，徐々に鎮静化することが，17例中10例で内視鏡的にも確認された．単純性潰瘍と腸型BDの鑑別は，経過と他の随伴症状から可能であった．疾患entityについては議論のあるところであるが，互いに移行しあう症例はなかった．予後には病変の大きさも関与しているが，腸型BDに関しては原疾患自体の経過と腸管の病勢はほぼ一致しており，他臓器の病変も考慮した疾患自体のコントロールに主眼を置いて問題ないと考えられた．

　To evaluate the long clinical course and treatment of intestinal Behçet's disease (BD) and Simple ulcer, we surveyed 17 patients for over 7 years with intestinal BD and 3 patients with Simple ulcers diagnosed from 1974 to 1995. It was clarified that both diseases were easily diagnosed by the presence or absence of other BD manifestations. Simple ulcer is basically drug-resistant, and, therefore, surgical treatment is needed in every case. On the other hand, BD lesions improve and relapse spontaneously except in the case of huge ulcers and disease activity lessens gradually under medication such as Steroid Hormone (SH), Salazosulfapyridine (SASP) and Colchicine over a long period, which coincides with the natural course of BD itself. Surgery was performed in 8 patients with huge ulcer, perforation, hematochezia, and abscess formation. These observations suggest it is most important to treat only the BD itself, unless the ulcer is huge, perforated or bleeding. It is recommended that simple ulcer without stenosis, hematochezia or perforation should be observed while withholding therapy.