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Stomach and Intestine(Tokyo) Volume 44, Issue 2 （February 2009）

胃と腸 44巻2号（2009年2月発行）

Japanese English

今月の主題特発性腸間膜静脈硬化症（idiopathic mesenteric phlebosclerosis）―概念と臨床的取り扱い

主題

idiopathic mesenteric phlebosclerosis（特発性腸間膜静脈硬化症）の経過 Clinical Course of Idiopathic Mesenteric Phlebosclerosis 西村拓 ¹ , 松井敏幸 ¹ , 平井郁仁 ¹ , 高木靖寛 ¹ , 津田純郎 ¹ , 池田圭祐 ² , 岩下明徳 ² , 頼岡誠 ³ , 畠山定宗 ⁴ , 帆足俊男 ⁵ , 古賀有希 ⁶ , 櫻井俊弘 ⁷ , 梶原哲郎 ⁸ Taku Nishimura ¹ , Toshiyuki Matsui ¹ , Fumihito Hirai ¹ , Yasuhiro Takaki ¹ , Sumio Tsuda ¹ , Keisuke Ikeda ² , Akinori Iwashita ² , Makoto Yorioka ³ , Sadamune Hatakeyama ⁴ , Toshio Hoashi ⁵ , Yuki Koga ⁶ , Toshihiro Sakurai ⁷ , Tetsuro Kajiwara ⁸ ¹福岡大学筑紫病院消化器科 ²福岡大学筑紫病院病理 ³佐田病院 ⁴畠山クリニック ⁵帆足医院 ⁶新小倉病院 ⁷芦屋中央病院 ⁸佐賀県立病院好生館放射線科 ¹Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan ²Department of Pathology, Fukuoka University Chikushi Hospital, Chikushino, Japan ³Sada Hospital, Fukuoka, Japan ⁴Hatayama Clinic, Fukuoka, Japan ⁵Hoashi Hospital, Chikushino, Japan ⁶Shin-Kokura Hospital, Kitakyushu, Japan ⁷Ashiya Chuo Hospital, Fukuoka, Japan ⁸Department of Radiology, Koseikan Saga Prefectural Hospital, Saga, Japan キーワード：特発性腸間膜静脈硬化症 , 画像所見 , 経過 , 治療 Keyword: 特発性腸間膜静脈硬化症 , 画像所見 , 経過 , 治療 pp.191-205

発行日 2009年2月25日 Published Date 2009/2/25

DOI https://doi.org/10.11477/mf.1403101580

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要旨　形態学的あるいは病理学的にidiopathic mesenteric phlebosclerosis（IMP）は，原因不明であり，治療法ならびに予後はほとんど不明である．本研究はIMPの予後を知ることを目的とした．対象はIMPと診断された14例である．初回形態とその後の形態の推移を中心に経過観察を行った．3例は症状の進行により手術を要した．24か月以上経過観察できた未手術例7例と対比して形態の差異をみた結果，未手術例7例には，明らかな形態の進行性変化はなく，初回形態の重症度が軽度であることがわかった．この結果より発症初期から比較的短時間に狭窄と壁肥厚が進行する症例は閉塞症状のため手術となる．一方，非進行例では長期間ほとんど無症状であり，形態変化もなかった．以上よりIMPには2病型があると結論した．

　Idiopathic mesenteric phlebosclerosis（IMP）is characterized by some pathological and clinical features, however, the etiology of IMP has not yet been elucidated fully. In addition proper treatment selection and long-term prognosis is not known. In this study we aimed to analyze the long-term prognosis of IMP. The subjects of the study were fourteen patients who were diagnosed and followed up at our hospital or other affiliated hospitals.

　The symptoms and colonic lesions at the initial visit and serial changes during the follow-up period are researched. Three patients were operated on and eleven patients were followed up conservatively. Seven patients followed up for more than two years and three patients who were operated on were compared in clinical features and in colonic lesions. In seven patients who were not operated on there was no progress in symptoms or in colonic lesions.

　These patients had milder colonic lesions at the initial visit compared to the patients who were operated on. The reasons for the operations were obstructive symptoms or narrowed colonic lesions, which had progressed in a short period. In contrast in cases in which there had been no progress there were few symptoms and these occurred over a long period. From these observations, it is concluded that IMP is divided into two types based on the progress of the disease.