腹腔鏡補助下結腸亜全摘術を施行した特発性腸間膜静脈硬化症の3例

Three cases of idiopathic mesenteric phlebosclerosis treated by laparoscopy-assisted subtotal colectomy

◆要旨：特発性腸間膜静脈硬化症（idiopathic mesenteric phlebosclerosis：IMP）は腸間膜静脈硬化に起因した血流障害による慢性虚血性大腸病変とされ，自己免疫疾患や漢方薬の長期内服が原因の1つとされている．腹痛やイレウスを起こし持続する場合には原因腸管の切除が必要となる．当院では2006年から2014年の間に3例のIMPに対し手術を施行した．症例はすべて女性で，それぞれ56歳，78歳，54歳であった．全例イレウス症状をきたしており，盲腸から左半結腸まで病変が拡がっていたため腹腔鏡補助下結腸亜全摘術を施行した．全例とも術後経過は良好で，現在も再発することなく存命中である．IMPは良性疾患であるが病変が広範囲にわたることもあり，腹腔鏡下手術のよい適応であった．

Idiopathic mesenteric phlebosclerosis（IMP） is defined as a chronic ischemic colon disease due to phlebosclerosis of the mesenteric vein. It is considered to be caused by autoimmune diseases or long-term internal use of Chinese herbal medicines. The symptoms are stomachache and diarrhea. It may cause ileus, and in that case, colectomy may be required. In 2006-2014, we performed laparoscopy-assisted subtotal colectomy for three cases of IMP. All patients were female, and had a long history of taking Chinese herbal medicines. They all complained of stomachache, and we diagnosed ileus caused by IMP. Their IMPs were extended from cecum to sigmoid colon, so we conducted laparoscopy-assisted subtotal colectomy. After operation, their symptoms improved immediately, and up to now IMP has not recurred. Since IMP is a benign disease, it is a good indication for laparoscopy operation.