Crohn病の臨床経過―5年以上観察例

Clinical Course of Crohn's Disease: Study on Changes of Lesions in Radiological Findings in Cases Followed-up for More Than Five Years

要旨　5年以上にわたり，経過を観察しえたCrohn病10例を対象として，X線，内視鏡所見の経時的変化と共に，現在の社会生活状況につき検討し，現時点までの成績より次の結論を得た．①非切除例ではskin lesion間の病変の進展はみられるものの，口側，肛門側への進展はほとんどみられなかった．②小腸の敷石像を伴わない縦走潰瘍は，長年にわたりほとんど変化せず経過しており，長い狭窄への進展はみられなかった．③小腸，大腸いずれにおいても，敷石像から狭小，狭窄や瘻孔形成へと進展する例が多くみられた．④多発するアフタ様潰瘍や小潰瘍は，内科的治療が著効を示した症例では消失する場合もみられたが，無効の症例や再燃を繰り返すうちに敷石像へと進展することが多かった．⑤肛門部病変は経過中8例にみられ，著明な狭窄，尿道瘻，腟瘻をそれぞれ1例に認めた．根治手術を施行し再発のみられない1例を除き，再燃を繰り返している．⑥現在の社会生活状況についてみると，ほぼ正常3例，制限つき3例，入退院の繰り返し2例，腸閉塞，狭窄のため最近腸切除術を施行して社会復帰したのが2例であった．

　On ten patients with Crohn's disease followed-up for more than five years, authors studied chronological changes in x-ray and endoscopic findings and also in the current manner of life of the patients.

　Results obtained were as follows:

　1) In non-resected cases, while normal areas between skip lesions became involved, area of the lesions have not extended to proximal or distal site

　2) Longitudinal ulcers without cobblestone appearance in the small intestine have remained unchanged for a long period and have not developed to long stenosis.

　3) Both in small and large intestines, there were many cases in which cobblestone appearance developed into narrowing, stenosis and formation of fistulas.

　4) Multiple aphthoid ulcers and small ulcers disappeared in cases where medical management was effective. However, in case where it was not effective, relapse and remission of lesions repeated and cobblestone appearance developed.

　5) Anal lesions were seen in eight cases, and marked stenosis, urethral fistula and vaginal fistula were seen each in one case. Relapses of anal lesions have been repeated in all except one without recurrence after curative operation.

　6) As for the status of patients' manner of living today, three patients were almost normal, three with limitations, two with repetition of admission and two were comebacks to normal manner of life after undergoing colectomy recently for intestinal obstruction and stenosis.