炎症性腸疾患の病理像からみた難治要因―Crohn病を中心に

Histopathological Refractory Factors in Inflammatory Bowel Disease―Investigation of the Resected Cases of Patients with Crohn's Disease

要旨　本研究ではCrohn病(CD)の病理組織学的難治性要因の解明を目的として初回腸管切除術後に腸管病変再燃のため再切除が必要となった20例(再切除例)と，初回腸管切除術以降現在までに最低5年以上腸管切除術が施行されていない10例(非再切除例)の初回腸管切除標本を用いた臨床病理学的検討を行った．組織学的には肉芽腫性炎症に伴う閉塞性リンパ管炎やリンパ管拡張，腸管神経叢の形態変化や炎症細胞浸潤が高頻度にみられた．CDの病理組織学的な難治性要因解明のためには特異的な所見である類上皮細胞肉芽腫の研究に加えてこれらの肉芽腫性閉塞性リンパ管炎や腸管神経叢の形態変化などを十分に把握し詳細に検討することが重要と思われた．

　Crohn's disease (CD) shows various intestinal lesions and complications, so treatment is difficult and may follow an intractable course. There are many reports of a clinical refractory factor. However, the histopathological refractory factors have not been made clear. The aim of the present study is to investigate characteristic pathologic factors of resected CD cases. Among 30 CD patients who had undergone initial resection, 20 patients needed reoperations, and the remaining 10 patients were followed up for more than five years. Histopathologically, granulomatous lymphangitis obliterans and myenteric plexitis were observed in a high percentage of the resected CD specimens. These are findings which could be of special significance when thinking about a refractory factor in Crohn's disease.