Crohn病の直腸肛門病変の長期経過

Long-term Follow-up the Anorectal Lesions of Crohn's Disease

要旨　Crohn病に合併した直腸肛門病変にはCrohn病固有のprimary lesion（cavitating ulcer，anal fissureなど）と，これが原因となって生ずるsecondary lesion（痔瘻，直腸，肛門腟瘻など），そのほかに直接Crohn病と関係のないincidental lesionがある．わが国では痔瘻の合併頻度が高く，これらの病変は長期経過中には外科治療を受けることが多い．incidental lesionとしての痔瘻は通常の治療で長期予後は良好である．Crohn病に合併した直腸，肛門のprimary lesionやsecondary lesionは腸管病変と同じように経過中に再燃，再発を繰り返すことがある．難治性痔瘻例はprimary lesionを持つ症例や多発性痔瘻症例であった．根治的治療法が確立されていない現在，難治例に対しては再燃，再発の可能性を考慮し，QOLを重視した低侵襲の外科的治療法を行うことが必要である．

　Anorectal Crohn's disease is classified into three categories (primary lesion, secondary lesion and incidental lesion). In Japan, anal fistula is the most common anal lesion and treated surgically in the long follow-up period.

　Anal fistula with Crohn's disease as incidental lesion healed well. However, anal lesion as primary lesion or secondary lesion of Crohn's disease ocasionally had recurrence. Unhealed anal fistulae are frequently accompanied with primary lesions in the anus or multiple fistula openings. It is suggested that nonradical, conservative surgical treatment for anal fistula such us seton treatment in Crohn's disease is the best course to follow.