腸間膜静脈硬化症における漢方薬中止後の病像変化

Changes in Clinical Pictures of Mesenteric Phlebosclerosis after Herbal Medicine Discontinuation

要旨●腸間膜静脈硬化症の原因として漢方薬（山梔子を含む処方）長期服用が注目されている．本症の長期経過例の一部は増悪し，手術を要する場合もある．しかし，漢方薬中止後の本症の長期経過に関する報告はほとんどみられない．今回，自験例5例における漢方薬中止後の病像の変化を検討した．観察期間は1年11か月〜5年4か月（平均3年10か月）であった．有症状の2例では症状が消失した．内視鏡検査でみられる特徴的な色調変化，皺襞腫大および生検所見は全例で改善がみられた．CT検査でみられる石灰化も3例（60％）でやや軽減していた．これらの知見からも，本症と診断され漢方薬の服用が判明した場合は，服用中止が対処法としての第一選択と考えられる．

　Increasing attention has been paid to the potential role of herbal medicine（including sanshishi ingredient）as a cause of mesenteric phlebosclerosis. Some cases with this disorder have been reported to experience disease exacerbation and require surgery after long term follow-up. However, the outcome of this disorder after discontinuation of herbal medicine has not been clearly elucidated. In this article, we described the changes in clinical picture after discontinuation of herbal medicine in five cases. The period of observation ranged from 23 to 64 months with an average of 46 months. In two symptomatic cases, the symptoms disappeared. Both endoscopic（characteristic mucosal discoloration and fold thickening）and biopsy findings improved in all cases. The improvement in calcification of the mesenteric veins, as visualized on CT, was observed in three cases. These improvements in the clinical picture suggest that herbal medicine should be discontinued first in cases under such medication.