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Stomach and Intestine(Tokyo) Volume 18, Issue 7 （July 1983）

胃と腸 18巻7号（1983年7月発行）

Japanese English

今月の主題潰瘍性大腸炎―治療と経過を中心に

主題

内科からみた潰瘍性大腸炎の手術適応 The Operative Indication for Ulcerative Colitis 江頭芳樹 ¹ , 八尾恒良 ² , 渕上忠彦 ¹ , 有馬純孝 ³ , 伊藤英明 ⁴ Y. Egashira ¹ , T. Yao ² , T. Fuchigami ¹ , S. Arima ³ , H. Itoh ⁴ ¹九州大学医学部第2内科 ²福岡大学医学部第1内科 ³福岡大学医学部第1外科 ⁴九州大学医学部第1外科 ¹The Second Department of Internal Medicine, Faculty of Medicine, Kyushu University ²The First Department of Internal Medicine, School of Medicine, Fukuoka Uuniversity ³The First Department of Surgery, School of Medicine, Fukuoka University ⁴The First Department of Surgery, Faculty of Medicine, Kyushu University pp.693-702

発行日 1983年7月25日 Published Date 1983/7/25

DOI https://doi.org/10.11477/mf.1403109474

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Abstract 文献概要
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　潰瘍性大腸炎の治療は重大な合併症のないかぎり保存的に行うのが原則であるが，内科的治療が奏効しない難治例に対しては，ためらうことなく外科治療を行うこともまた必要である．欧米においては，最近10年間に激症例，重症例に対して手術が行われる頻度が増加しており，またより早期に行われる傾向にあるという¹⁾．これは手術適応と手術時期がしだいに明確にされつつあること，完全静脈栄養（total parenteral nutrition，以下TPN）などによって術前術後管理が向上したこと，外科技術の向上，より機能的な人工肛門の開発などによるものと考えられる¹⁾．

　本邦では本症が外科的手術の対象となる頻度は報告によって大きな差はあるが，20～30％前後とされている²⁾³⁾．その中で内科医にとって最も難しい問題は，保存的療法で十分な効果を上げえない場合，どの時点で手術に踏み切るかということであり，その点に関して検討された報告も散見される⁴⁾⁵⁾．基本的には効果的かつ十分な治療を行って，それが無効であると判明するまでは手術すべきでなく，また無効であるにもかかわらず漫然と長期にわたって内科的治療を続けてはならない，と言えよう．

　To know factors influencing the indications for an operation of patients with ulcerative colitis, eight patients operated on and 16 non-operated, were studied. Those 24 patients were divided into two groups according to the presence of massive melena. One group (group 1) consists of four patients who had had massive melena, two of which were subjected to a relatively early operation. Hemoglobin level, signs of inflammation, the severity based on Truelove ＆ Witts' criteria and the frequency as well as duration of melena were studied. The other group (group 2) consists of 20 patients who had been on a long-term conservative treatment, six of whom underwent an operation. Fifteen parameters such as severity, ESR, prealbumin were studied before and 1, 2, 4, 8, and 12 weeks after the treatment respeclively.

　(1) Group 1: Melena persisted for more than two weeks in patients operated on, whereas it was ameliorated within 10 days in patients with remission.

　Massive melena did not necessarily correlate with signs of inflammation.

　(2) Group 2: Regardless of time of judgement, it was difficult to decide the effectiveness of medical treatment by laboratory data such as ESR, hemoglobin, total protein, albumin, prealbumin and α₁-acidglycoprotein.

　However, patients in whom remission was achieved showed a significant improvement of severity at each time of evaluation later than four weeks, when compared to patients operated on. Consequently, in those with ineffective medical outcome, the decision of operative indication supposedly seemed to be made upon the severity. Furthermore, if the patients show the moderate severity even 8 or 12 weeks after the initiation of prednisolone therapy, the operative indication might relatively be applied to them.