腸型Behçet病と単純性潰瘍の長期経過―腸管合併症を中心に

Long-term Course of Intestinal Behçet's Disease and Simple Ulcer with SpecialReference to Intestinal Complications

　腸型Behçet病(B病)と単純性潰瘍(S病)の長期経過を，腸管合併症に焦点をあて検討した．当院で経験したB病20例とS病21例の中で，腸管合併症を認めたのは各々12例(60％)と7例(33％)で，B病のほうが高頻度な傾向を認めた(p＝0.08)．腸管合併症ののべ発生件数は27回で，その内容は瘻孔が11回(41％)で最も多く，穿孔はB病にのみ3回認められた．5年以上経過観察しえた16例で，腸病変の経時的推移について検討すると，初回の消化管造影で腸潰瘍が管腔の半周以上を占めるほど大型で，周囲腸管の伸展性も不良の場合は，腸管合併症への進展が有意に高頻度であった．なお長期経過例の外科手術率は69％(11/16例)と高率であり，手術適応の82％(14/17回)を腸管合併症が占めていた．以上の結果より，B病とS病で腸管合併症の頻度や内容が異なるが，両疾患ともに長期経過で腸潰瘍が腸管合併症へ進展し，手術適応となる頻度が高いことが明らかになった．

　We examined the intestinal complications of intestinal Behçet's disease (B disease) and simple ulcer (S disease). We encountered 20 cases of B disease and 21 cases of S disease in our hospital. Intestinal complications developed a total of 27 times in 12 cases (60 ％) of B disease and 7 cases (33 ％) of S disease. Thus, these complications were more frequently observed in B disease than in S disease. Complications occurred 10 times after surgical operation. The intestinal complications which were frequently observed were fistula (11 times) and stenosis (8 times). Intestinal perforation was only observed in 3 cases of B disease.

　We also examined the long-term course of B disease and S disease, especially for the development and outcome of intestinal complications. Materials were 9 cases with B disease and 7 with S disease. These cases were followed up for more than 5 years (average of 11.6 years), and morphological findings were evaluated by radiographic and colonoscopic examinations, repeatedly. When we examined the morphological changes of intestinal ulcers, progression to the intestinal complications (fistula, stenosis and perforation) was more frequently observed in cases with large ulcers (average of 3.8 cm in diameter) with poor wall distensibility, and which existed in the ileocecal portion and in anastomoses after operations.