Crohn病小腸病変に対する治療効果―狭窄形成術の進歩

Current Strictureplasty of Crohn's Disease

要旨　外科的治療が対象となる小腸狭窄病変長が12cm以下であれば，Heineke-Mikulicz法やFinney法など，古典的な狭窄形成術は腸管切除より優先される外科的治療であり，古典的な狭窄形成術の短期，長期成績は良好である．しかし，大腸の狭窄形成術の有効性は明らかでない．適応外は狭窄病変部に膿瘍・瘻孔形成，内科的治療抵抗性の出血，瘻孔合併がある場合である．古典的な狭窄形成術が困難な症例にも，新たな狭窄形成術が開発されている．狭窄形成術では病変が残存するため，発癌の報告もあり，サーベイランスが重要となる．

　The first choice of operative procedure for intestinal stenosis, less than 12cm in length, is strictureplasty. The efficacy of strictureplasty for the colon has not been clearly demonstrated. Because of its often excellent clinical outcome, strictureplasty has been established as a safe and effective surgical procedure for Crohn's disease, and its use has quickly become widespread. The most commonly used strictureplasty techniques include the Heineke-Mikulicz procedure and the Finney procedure. Strictureplasty is contraindicated in patients with active intraabdominal abscess, massive uncontrolled bleeding, fistula, and in those with panperitonitis due to intestinal perforation. A variety of new strictureplasty techniques have been developed and used for difficult cases. The problems associated with strictureplasty involve the risk of cancer development at the strictureplasty site because the procedure leaves the affected bowel unresected. Therefore, postoperative surveillance, including planned endoscopy, is essential.