Crohn病の長期経過―大腸型・小腸型の病像の推移

Long-term Clinical Course of Crohn's Disease: Changes in Clinical Features of Small Intestine Type and Large Intestine Type

要旨　長期間経過観察されたCrohn病の17症例のX線像を用いて，Crohn病の病像の推移を検討して次の結論を得た．①小腸の縦走潰瘍の潰瘍周辺の腸管腔が正常に保たれている部位は，寛解，再燃を繰り返していた．②小腸の縦走潰瘍の横軸方向へはみ出した潰瘍部は，発症初期より狭小化し，長期経過するうちに狭窄，管状狭小化し，fissuring ulcerを形成するものがみられた．③この狭窄，管状狭小化した部位は切除標本では，腸間膜は線維化肥厚し，腸間膜対側の腸管は短縮していた．この部位はUⅠ-Ⅲ～Ⅳの潰瘍瘢痕がみられ，マイクロアンギオ像でも虚血状態に陥りやすい形態をしていた．④大腸Crohn病は発症初期から片側性の壁硬化，屈曲のみられる部位は，長期間経過するうちに狭小化，管状狭小を形成する傾向がみられ，この部位にfissuring ulcerもみられた．⑤手術率は約5割であった．

　Seventeen cases of Crohn's disease, in which the clinical course could be observed well were studied. Factors for aggravation of the x-ray findings were studied from the aspect of microcirculation disturbance. x-ray findings showing stenosis even in the remission period, and x-ray findings showing formation of fissuring ulcer were also studied.

　1) Longitudinal ulcer accompanying cobblestone-in the-small-intestine-type of Crohn's disease tended to become narrow or stenosed during the long-term clinical course. A tendency for fissuring ulcer to be formed was also seen.

　2) The ulcerous region across longitudinal ulcers became narrow and tended to form fissuring ulcer.

　3) With the large-intestine-type Crohn's disease, fissuring ulcer was liable to be formed in the crooked region seen from the beginning of the onset of the disease, and in the region showing irregular hardening of the wall during the long-term clinical course. The region which was stenosed even in the remission period tended to become narrower.

　4) Macroscopic examination of the region where the intestinal tract was shortened in the biopsy specimen revealed broad longitudinal ulcer (Ul-Ⅲ～Ⅳ), shortening of the side opposite to that to which the mesentery is attached, and thickening of the mesentery.

　Microangiographic examination of this region showed thickened mesentery and cicatrization of Ul-Ⅲ～Ⅳ which is supplied by a very small crooked short branch, and becomes easily ischemic with the movement of the intestinal tract, suggesting the possibility of thickening and fibrosis of the mesentery advancing further. It is surmised that thickening and fibrosis of the mesentery may be involved with shortening and narrowing of the intestinal tract noted in the remission period during observations over the long-term clinical course.

　5) The rate of operations performed for fistula, abscess-formation and symptoms of ileus was increased during the long-term clinical course of Crohn's disease.