虫垂開口部病変を伴う潰瘍性大腸炎の臨床的検討

Clinical Study of Ulcerative Colitis with Skipped Lesions at the Orifice of the Appendix

要旨　1996年6月から2008年9月までにtotal colonoscopyを施行した，初発かつ治療前の活動性潰瘍性大腸炎の中で虫垂開口部に病変を認めた症例について，性別・年齢・病型・病変部位・炎症反応・重症度・初期治療効果・治療後経過について検討した．また治療後経過については，再度total colonoscopyを施行し経過観察しえた症例を対象とした．虫垂開口部に病変を認めた症例は44例あり，経過を追えたのは33例であった．罹患範囲による分類では直腸炎型，区域型が多く，虫垂以外に非連続性病変を認める症例が45％と多かった．軽症例が多く，初回治療に対して反応がよい症例がほとんどであるが，長期経過観察において重症化する症例も認められた．区域型を含む非連続性病変を多く認めることより，初発時に虫垂病変を有する潰瘍性大腸炎は多中心性にUC病変が起こり，典型的なUCとは違う病態を示している可能性が考えられた．

　From among the patients of initial active ulcerative colitis（UC）who received total colonoscopy from June 1996 to September 2008 in our hospital, we selected those who had skipped lesions at the orifice of the appendix before treatment. Discontinuous lesions at the orifice of appendix were found among 44 patients, and we were able to follow the course of clinical and endoscopic findings among 33 of there patients. We examined the patients from the point of view of sex, age, disease type, site of lesions, inflammatory reaction, severity, therapeutic effect and post-treatment course, and we explained the clinical characteristics and endoscopic findings.

　The severity rating of all cases was mild and moderate. They responded satisfactorily to the initial treatment of salicylazosulfapyridine and mesalazine. During the follow-up over the long-term, The severity rating of 3 patients worsened to severe from mild.

　Skipped lesions except at the orifice of the appendix, and segmental colitis-type of UC were found at high rates in 6（13.6％）of the 44 UC patients. It was considered that skipped lesions were at numerous focal regions of abundant lymphoid tissues, and their clinical conditions were different from the typical conditions of ulcerative colitis.