潰瘍性大腸炎の外科治療

Surgical Management of Ulcerative Colitis

要旨●自然肛門温存術である大腸全摘回腸囊肛門吻合術（IPAA）と大腸全摘回腸囊肛門管吻合術（IACA）が，潰瘍性大腸炎（UC）に対する標準術式である．手術適応の症例においては，癌化例の比率が増加している．腹腔鏡手術の短期成績は開腹手術と同等であるが，患者の状態や栄養状態，併存症などのさまざまな病態を考慮して腹腔鏡手術や分割手術を選択する．緊急手術例で死亡率が高く，高齢初発患者は手術率が高いことを念頭に，内科医と十分な連携をとり適切なタイミングで手術を決定しなければならない．pouch機能不全の発生率は5年以上の研究では7.7%，10年以上では10.3%であった．手術成績は向上しQOLが保たれているが，長期の経過観察が重要である．

　The standard surgical procedures for ulcerative colitis include total colectomy with ileal pouch-anal anastomosis and total colectomy with ileal pouch-anal canal anastomosis, which are sphincter-preserving operations. The proportion of colitic cancer cases indicated for surgery is increasing. Both laparoscopic and staged operations should be considered depending on the patient's condition. Given that the mortality rate is high in emergency surgical cases and the surgical rate is efficient in elderly-onset cases, surgery must be decided at the appropriate time based on close cooperation between physicians and surgeons. The incidence rates of pouch dysfunction were 7.7% and 10.3% in studies with a median follow-up of ≧5 years and ≧10 years, respectively. The surgical outcomes have improved and the patients' quality of life has been maintained ; however, long-term follow-up is still important.