限局性腸炎の外科的治療

Surgical Management of Regional Enteritis

　限局性腸炎は1932年Crohnら¹⁾によってはじめて報告されたが，現在でもなお原因や病態の不明な疾患である．したがってその治療は対症療法が主になされており，そのうち難治性のものや合併症を併発した場合が手術適応となっている．しかし，外科治療の面では手術術式や再発などの問題がある．今回，著者らは教室で経験した限局性腸炎26例について臨床所見と手術成績を検討し，あわせて外科治療上の問題点を中心に老察を加えた．

自験例の検討

　1．限局性腸炎の頻度

　限局性腸炎などの腸の非特異性潰瘍の概念や分類などについては現在やや混乱がみられているが，教室における症例を疾患別に示すとTable 1のごとくである．すなわち，昭和36年4月より49年3月までに経験した腸の非特異性潰瘍86例のうちもっとも多いのは潰瘍性大腸炎50例であり，次いで限局性腸炎26例である．また特発性潰瘍10例については大腸の症例が2例のみで，残り8例は小腸のいわゆる非特異性多発性小腸潰瘍と称されるものである．また限局性腸炎の頻度についてみると同期間の入院患者総数9,613例の0.3％に相当した．

　A study has been made of clinical findings and the results of surgery in regional enteritis encountered in our department between April 1961 and March 1974. This disease was often seen in realatively younger people; in fact, 11 out of 26 cases belonged to the age group 30～39. Male and female were equally affected by it. Preoperative diagnosis has been done by both clinical symptoms consisting mostly of abdominal pain and roentgenography of the small bowel with enema and peroral adminstration of contrast media. Correct diagnosis prior to operation was done in only 15 out of 26 cases. Resection of the affected segment was performed in all cases. As a rule, the diseased part was sufficiently excised, including the regoinal lymph nodes of the mesentery. No bypass operation was attempted. In 9 cases the lesion was seen in only the small bowel ; in 4 it was in the colon, and in 8 cases in both. The results of surgical intervention shows that direct death was seen in 1 case, while its end results show that all patients had social reinstallment except a single case of recurrence. There was no relationship between recurrence and either the patients' age or the length of the illness. It was noteworthy that in 5 out of 6 cases re-operated on ileocecal resection was performed. Finally, since at present the cause and clinical aspects of regional enteritis are not clarified, some comments are made on the issue of surgical procedures and on recurrence.