Crohn病の5年以上観察例の臨床経過―特に増悪要因とその背景

Clinical Courses of the Cases of Crohn's Disease Observed for More Than Five Years

要旨　経過を観察しえたCrohn病症例25例（非手術例12例，手術例13例）について臨床経過を検討し，経過の悪いものに対してはその要因を考え，更にその背景となっているものを検討してみた．まだ症例も少なく，観察期間も短く十分な考察はできなかった．したがって今回は成績を中心に述べた．

　A study was made of the clinical courses of 25 cases of Crohn's disease observed for over five years. The results obtained were as follows:

　1. The operation was performed once on nine of 13 cases, twice on three and four times on one, and one died of sepsis due to the abscess and fistula developed after the first operation.

　2. One of 12 non-operated cases showed some subjective improvements, nine had no remarkable changes and two showed some aggravation.

　3. The subjective symptoms on admission frequently included abdominal pain, fever and diarrhea.

　4. The non-operated cases showed some radiological aggravations in spite of the absence of subjective remarkable changes.

　5. Of the operated cases, three with virtual cicatrization had a very good prognosis.

　6. Three cases operated on twice involved the formation of ileus, perforation, fistula and abscess, respectively, and respective close relationship of these with granuloma, fissuring ulcer and concomitant lesion was suggested.

　7. Three cases with persisted longitudinal ulcer had a poor prognosis.

　8. Each of the cases with perforations had no little granuloma.

　9. The fissuring ulcer of Ul-Ⅱ was observed in all operated cases, of which those cases with a formation of fistula or abscess had the fissuring ulcer of Ul-Ⅲ to Ul-Ⅳ.