Crohn病の形態と臨床症状

Morphology and Clinical Symptoms of Crohn's Disease

　Crohn病の肉眼形態と臨床症状の相関をみるため，自験例につき検討した．その結果，（1）小腸病変は縦走潰瘍を主体にしたものが圧倒的に多く，hose-pipe像，cobblestone像の典型的なものはみられなかった．（2）大腸病変は欧米の症例に類似したもの，特に広汎かつ典型的なcobble-stone像を呈するものが多かった．（3）病変部位，肉眼所見と臨床症状，検査データに有意の相関はみられなかった．（4）合併症では肛門部病変が多く，全身合併症はまれであった．小腸Crohn病で穿孔で発症したものが3例あった．（5）長期観察しえた症例についてみると，大腸病変では肉眼所見に変化がみられることが多いが，小腸病変では病変の進行が遅いという印象を受けた．

　対象症例

　当消化器病センターおよび関連病院で経験したCrohn病を材料とした．内訳は小腸Crohn病10例，小腸・大腸Crohn病10例，大腸Crohn病5例の計25例である．術後症例（腸管切除後再発2例，腸管非切除で吻合術のみ1例）は検討から除外した．またCrohn病と診断した症例でも，小腸・大腸以外に限局した例，症状に重大な影響を及ぼす合併症（腸癌など）のある例などは除外した．

　Twenty-five cases of Crohn's disease (CD) were studied to know the relation between morphology and clinical findings. They were ten cases of small intestinal CD, ten cases of ileocolitis and five cases of colitis. The results were: (1) Majority of small intestinal diseases were composed mainly of longitudinal ulcers with (or without) stenosis. Cases with hose-pipe stenosis and extensive cobblestoning were not experienced. (2) Colonic lesions were similar to those of western countries. Typical and extensive cobblestoning and marginal ulceration is the representative colonic lesion. (3) No significant relation was known to exist between morphological and clinical findings. Abdominal pain and diarrhea were the chief complaints regardless the location and morphology of the lesions. Also elevated ESR and positive CRP were found in most cases. (4) Anal fistula were found in 14 of 25 cases of CD. It was more frequent in cases with colonic lesion (11 of 15). Appendectomy had been perfommed in nine cases. Three cases of free ileal perforation and five cases of internal fistula were found. (5) It should be noticed that cobblestoning of the colon disappeared during medical treatment in three cases. As for ileal lesion no significant change was found during follow-up study.