腸型Behçet病および単純性潰瘍の経過―X線像の推移を中心として

Clinical Course of Intestinal Lesions in Patients with Intestinal Behçet's Disease and Simple Ulcer

要旨　腸型Behçet病15例（不全型12例，疑い3例）と単純性潰瘍4例の腸病変を平均6.2年間経過観察し，そのX線像の推移を検討した．その結果，以下の成績を得た．①非手術例12例中8例は回腸末端～回盲部の深い潰瘍から成る定型的病変を有したが，残りの4例は不整形ないし類円形の潰瘍あるいはアフタのみから成る非定型的病変を示した．②定型的病変8例は保存的治療に反応し，一時的に縮小あるいは瘢痕化するが，経過中に再燃を来し4例は手術に至っていた．③回腸末端に多発潰瘍を認めた非手術例4例では，各潰瘍の変化は多様であり，同一時期に増大，新生，縮小あるいは治癒した潰瘍が混在していた．④非定型的病変から成る4例も保存的治療によく反応し，経過中定型的病変への進展はみられなかった．⑤手術は10例に16回（術後例）施行され，再発は12術後例（75％）に発生した．⑥再発は吻合部に好発し，術後2年以内に起こっていた．⑦再発早期のX線像として，吻合部の浮腫像と吻合部回腸側のアフタが1例ずつ描出された．⑧再発病変に対しても保存的治療は有効であった．⑨臨床経過は，腸型Behçet病15例と単純性潰瘍4例の間で明らかな差異を認めなかった．以上の成績から，本症では非手術例，手術例にかかわらず消化器症状をほとんど伴わない時期から定期的に消化管検査を施行し，小潰瘍やアフタの段階で発見し早期に治療を開始することが最も重要であると考えた．

　The clinical course of intestinal lesions was studied in 15 patients with intestinal Behçet's disease (12 of complete form and 3 of suspicious form) and 4 with simple ulcer. These patients were followed up for an average of 6.2 years (ranging from 1 year and 9 months to 15 years and 10 months) and repeatedly examined by radiography and/or endoscopy of the intestine. The resuits were summarized as follows.

　1) Of 12 non-surgical cases, 8 had typical intestinal lesions consisting of deep ulcers in the ileocecal region. In the remaining 4, radiography and endoscopy revealed atypical intestinal lesions. Two of them had irregularly-shaped or round-shaped ulcers in the ileum and colon, and 2 had only aphthoid ulcers in the colon.

　2) In 8cases with typical intestinal lesions, medical treatment using a combination of total parenteral nutrilion, salicylazosulfapyridine, and prednisolone, or using only one of these methods, was temporarily effective, but the intestinal lesions relapsed and recurred during the follow-up period.

　3) In 4 non-surgical cases with multiple ulcers of the terminal ileum, follow-up radiography revealed various changes of each ulcer. At each examination, it was found that an enlarged ulcer or a newly developed ulcer was often mixed with a healed ulcer.

　4) Four cases with atypical intestinal lesion showed good response to the medical treatments. None of the cases showed progression to typical intestinal lesion.

　5) Surgical resection was performed 16 times in 10 cases. Recurrence of intestinal ulcer was observed in 12 (75%) of the 16 surgical cases.

　6) Recurrence of the intestinal ulcer, commonly seen at the anastomotic site, occurred within 2 years after operation.

　7) Edematous change of the anastomotic site and aphthoid ulcers of the ileum were demonstrated as being characteristic radiographic findings at the early stage of recurrence.

　8) Recurrent ulcers were successfully treated by the medical therapies, but their effectiveness was temporary.

　9) There were no essential differences between the clinical courses of intestinal Behçet's disease and simple ulcer.

　10) These results suggest that, in this disease, to detect early lesions such as small ulcers and aphthoid ulcers, periodic follow-up examinations of the intestine should be carried out even in patients without digestive symptoms.