Crohn病と肛門部病変

Anal Lesions in Patients with Crohn's Disease

要旨　Crohn病に合併した肛門部病変について，東京女子医科大学消化器病センターの症例を中心に検討した．Crohn病に肛門部病変を合併した頻度は，筆者らの施設では55％で肛門部病変中71％が痔瘻であった．肛門部病変を合併した患者の61％（Crohn病全体の34％）がCrohn病診断以前に肛門部病変を認めていた．若年者に痔瘻があるときは，積極的な大腸・小腸の検索，病変部の生検が必要である．また，過去に局所手術を受けた24例中8例（33％）が完治をみなかった．手術による合併症は認めなかった．局所手術に関しては，積極的意見，消極的意見の両方があるが，肛門部病変の自然長期予後は悪くはないので，術後の再発率，便失禁，狭窄などの合併症発生の危険を考え合わせると，手術は慎重に行われるべきである．

　Forty-seven patients with Crohn's disease were investigated to assess the frequency of anal lesions. 55％ of the patients have had evidence of anal complications. Anal fistula was shown in 71％ in the patients with anal lesions. Anal lesions were recognized as initial manifestations of Crohn's disease in 61％ of patients. It is very important clinically for the young patients with anal fistulas to perform a survey of the colon and small intestine together with biopsy from the anal lesion. Recurrence rate after local operation of anal lesions was 33％. The frequency of anal lesions was 11-82％ in reports from Europe and United States. Both agressive and conservative advice about treatment of anal lesions was stated in the reports. We thought that it was advisable to treat. The patients with anal Crohn's lesion conservatively, because natural prognosis of the anal lesions is not so bad, and local operation would involve risk of anal complications.