虚血性大腸炎20例の臨床像の経時的分析―X線および内視鏡像の推移を中心として

Studies on the Clinical Course of Ischemic Colitis: Mainly on Changes of Radiographic and Endoscopic Findings

　虚血性大腸炎は Boley ら（1963年）および Marston ら（1966年）の発表以来，1つの独立疾患として注目されるようになり，近年，報告例の増加に伴ってその臨床像および病理像も明確にされつつある．しかし，短時日のうちに急速に推移するとされている本症の病像の経時的変化については，いまだ十分に解明されているとはいい難い．

　先にわれわれは，本症の病理形態像とその経時的変化について報告した．今回は，注腸X線検査あるいは内視鏡検査が経過中2回以上にわたって施行された本症20例を対象とし，その自覚症状，炎症所見（血沈，白血球数），X線像および内視鏡像を経時的に分析したのでその成績を報告する．

　Twenty cases with ischemic colitis of which ten cases were of stricturing form and ten of transient form were studied clinically, radiographically and endoscopically to see their changes with the passage of time. The results were as follows:

　1) Subjective symptoms such as abdominal pain and bloody diarrhea in cases of stricturing form (2 to 66 days after the onset) disappeared significantly later than in cases of transient form (2 to 17 days) (p=0.05). On the other hand, leucocytosis and elevation of ESR in the former cases (17 to 60 days after the onset) normalized significantly later than in the latter cases (3 to 22 days) (p=0.01).

　2) The ESR on the first visit in cases of stricturing form (55.4±13.0mm in 1 hour) was significantly more elevated than in cases of transient form (10.5±2.8mm) (p=0.01).

　3) In seven cases of stricturing form, radiographic findings changed as follows: thumb-printing (within 8 days after the onset) → severe narrowing, sacculation, eccentric deformity and longitudinal ulcer (open or scar) (15 to 42 days) → decrease of narrowing, sacculation, eccentric deformity and longitudinal ulcerscar (56 to 61 days) → no change (76 to 143 days).

　4) ln three cases of stricturing form, the course was extremely delayed. Barium enema study revealed thumb-printing 21 to 29 days after the onset, and transverse ridging 29 to 65 days.

　5) In ten cases of transient form, radiographic findings changed as follows: thumb-printing (within 4 days after the onset) → longitudinal ulcer (open or scar) (9 to 11 days) → longitudinal ulcer-scar or normal (14 to 37 days).

　6) Endoscopically, the lesions healed 42 to 136 days after the onset in cases of stricturing form, while 10 to 55 days in cases of transient form.