Crohn病の胃・十二指腸病変に対する外科治療

Surgical Treatment for Gastroduodenal Crohn's Disease

要旨　Crohn病に合併する胃・十二指腸病変に対する外科治療の頻度を自験腸管手術例に占める割合でみると7％（26/374例）であった．Crohn病自体の病変をprimary lesion，他病変から胃・十二指腸に波及した病変をsecondary lesionとすると，後者が69％（18/26例）と多くを占めた．手術例のうち，胃では結腸，回腸結腸吻合部からの瘻孔が多く（3例），原発巣切除と瘻孔部楔状切除を行い，十二指腸では第1部～第2部の長い狭窄（7例）に対して胃空腸吻合術，secondary lesionであることが多い十二指腸瘻（17例）に対しては病変切除後の欠損部が小さければ単純閉鎖，大きければ十二指腸空腸Roux-Y吻合術が適しており，各手術の術後経過は良好であった．secondary lesionについてはこれらの病変を併発する前に原発病変の外科治療を行うことが必要である．

　The incidence of surgical treatment for gastroduodenal Crohn's disease was 7％ which was 26 out of 374 cases that underwent intestinal surgery in our institute. Many lesions (69％) were secondary lesions which came from primary Crohn's disease. All 3 lesions in the stomach were gastrocolonic fistulas which were treated by wedge resection of the stomach and with resection of the diseased colon. Long duodenal stricture was found in 7 cases, which were treated using gastrojejunostomy. In 17 cases with duodenal fistulas, simple closure was performed for small size fistulas and duodenojejunostomy was carried out for large-size duodenal defects, which showed less complications and which had good functiuon.