治療からみた潰瘍性大腸炎の長期予後

Long Term Therapeutic Outcome of Ulcerative Colitis

要旨　日本人の潰瘍性大腸炎の長期予後を厚生省の研究班の集計でみると，薬物治療中の患者が41％，緩解中と受診していないものを合わせて54％，手術例0.6％，死亡例0.7％と全般的には良好である．内科治療上の問題点は厚生省研究班で規定した“難治例”をどのように治療していくかであり，これらの症例を緩解に導入し，また，導入するのが困難な症例は副腎皮質ホルモン投与量なども考慮して外科療法を考えていく．外科治療では病変をすべて切除して，肛門機能を温存する手術が主流となっている．これらの手術成績を向上させ，術後の肛門機能や，術後の合併症に対処して，長期予後を更に良くする必要がある．

　According to the report from the research committee of Ministry of Welfare, long-term therapeutic outcomes are as follows:41% under the medical treatment, 54% in remission and not treated, 0.6% operated, and 0.7% died. Overall long term therapeutic outcome is fair. The crucial point in the medical treatment is how to treat “intractable cases” defined by the research committee. If they do not enter the remission in a short period of time, surgical treatment should be considered taking into account the amount of steroid hormone used. Restorative proctocolectomy is becoming the main stream of the surgical treatment. To improve postoperative quality of life, postoperative anal function should be maintained and complications should be minimized.