潰瘍性大腸炎の長期経過―腸管の形態的変化を中心に

Long-term Follow-up of the Patients with Ulcerative Colitis

要旨　潰瘍性大腸炎の長期経過中に生じる様々な変化のうち，特に腸管の形態的変化を中心に，短期群72例，中期群66例，そして長期群36例の病態を対比した．発症時の病変範囲が直腸炎型および左側大腸炎型のうち，炎症範囲が口側へ進展したのは短期群8.6％，中期群12.1％，長期群16.7％であり，ほとんどの症例では発症時に病変範囲が決定された．再発時には直腸よりもS状結腸以遠の深部腸管に著しい場合が41.7％にみられた．本症の活動領域は複雑であり，定期検査として直腸の内視鏡検査だけでは対応できない症例も少なくなかった．長期経過観察の過程で生じる腸管の変化として，腸管の短縮と狭小について検討した．短縮，狭小ともに高度な場合はなく，中等度ないし軽度の変形にとどまった．大腸の部位別にみると，これらの変形はS状結腸，横行結腸において著しく，直腸では軽微であった．経時的にみると，短縮は時間が経過するにつれて程度が進行するが，狭小は変化が少なかった．内視鏡的にみた緩解期の粘膜面の変化を検討したが，発症時の病変範囲，炎症の強さと持続期間に比例して，粘膜面に変化が残ることが確認された．

　Follow-up study was conducted regarding the morphological changes of the large intestine among 174 patients with ulcerative colitis. Follow-up period was short for 72, medium for 66 and long for 36 patients.

　Among the patients with proctitis or left-sided colitis at the onset, oral extension of the disease process was observed in 8.6% of the short-period group, 12.1% in medium-period group and 16.7% in long-period group;the extent of the disease was already determined at the onset in most of the cases. In case of recurrence, the main site of involvement was the sigmoid or more proximal colon in 41.7%. The assessment of the disease activity is in fact complicated, and sometimes difficult by routine colonoscopy.

　Of the morphological changes observed during the follow-up period, shortening and narrowing of the intestine were evaluated. These changes were mild to moderate in all the patients. The sigmoid and transverse colon had the most pronounced change and the rectum slight. While the degree of deformity due to shortening tended to progress with the lapse of time, the degree of narrowing remained relatively unchanged. Endoscopic appearance of the colorectal mucosa in the quiescent phase was related to extent of the disease involvement at the onset, the severity of inflammation and the duration of the active phase.