Crohn病手術後の経過―再発の問題を中心として

Postoperative Course in Crohn's Disease: In regard to recurrence

要旨　Crohn病腸切除35症例について検討を加えた．性別では男性に，年齢では24歳以下の若年者に多くみられ，罹患部位は小腸型15例，小腸・大腸型16例，大腸型4例であった．手術適応としては腸管狭窄14例，瘻孔形成12例，内科的治療に抵抗7例であり，術式では回盲部を同時に切除する術式が76.5％に施行された．35例中，再手術（外科的再発）は13例（37.1％）であり，これらについて男女別，年齢別（24歳以下，25歳以上），罹患部位別に，また，術中漿膜所見で10cm以上離して切除した群と，そうでない群に分けて再発との関係を検討したが，有意の差はみられなかった．X線学的再発については，術後X線学的に追跡しえた23例を対象とし，14例（60.9％）に再発を認め，その再発までの期間は平均17.9カ月であった．これを同時期におけるCRP，血沈値などの炎症所見と比較すると，3例の不明例を除く11例中7例（63.6％）に陽性所見がみられた．X線学的非再発例では9例とも炎症所見陰性であった．術中内視鏡（17例）で残存病変なしとした8例では，5例（62.5％）にX線学的に再発が確認され，その再発までの期間は平均6.2カ月であった．残存病変の有無と再発に関しても，有意の差はみられず，内視鏡学的に観察して病変部をすべて切除する，いわゆる広範切除術は意味のないことだと思われた．術後の生活状況については，高い再発率を示したにもかかわらず，約90％の症例は良好な社会生活を営んでいる．

　Thirty five operated patients with Crohn's disease were studied and the following results were obtained.

　1) Twenty nine patients were males and six were females (sex ratio 5 : 1), and mean age at surgery was 23.9 years old.

　2) The anatomical distribution was small intestine type in 16 patients, small and large intestine in 14 and large intestine in four.

　3) Indication for operation were intestinal obstruction in 14, fistula formation in 12 patients (ileovesicular fistula in four).

　4) Twenty three patients (65.7％) were required the excision with ileocaecal region. Ileo-proctostomy was performed in three patients at the first operation and further operations in three cases.

　5) Thirteen patients (37.1％) with recurrent disease in 35 cases were treated at a second resection.

　6) Roentgenographic follow-up study was completely performed in 23 patients and its roentgenographic recurrence rate resulted in 61％, and its follow-up period was mean 56.8 months in recurrence cases.

　7) In eight of 17 patients, no residual lesions were confirmed by the intraoperative fiberscopy but its roentgenographic recurrence rate was 62.5％ and mean follow-up period 35.3 months. Consequently, the endoscopic radical resection is not recommended.

　8) Quality of life after surgery was in good general health about over 90％ of all patients.