mucosal prolapse syndromeの病態と治療

Pathophysiology and Treatment of Mucosal Prolapse Syndrome

要旨　mucosal prolapse syndrome（MPS）は孤立性潰瘍症候群や深在囊胞性大腸炎などと同じ範疇に入る疾患であり，直腸の粘膜が重積あるいは脱出することにより直腸の粘膜に潰瘍あるいは隆起性病変を形成する．病理組織学的には粘膜固有層にfibromuscular obliterationを認めることを特徴とする．defecographyを行うと，MPS群は正常群に比べ怒責時に肛門直腸角の開大が小さく，排便困難は骨盤底筋群の強い緊張のためと思われ，その結果，強い“息み”を引き起こし，粘膜脱を起こすことが想像された．治療は排便習慣の改善が第一で，隆起型の病変や著明な粘膜脱に対しては粘膜縫縮や切除が有効である．

　Mucosal prolapse syndrome (MPS) is a disease belonging to the same category as solitary ulcer syndrome of the rectum or colitis cystica profunda, in which prolapse of the rectal mucosa through the anal canal induces ulcer or polypoid lesion in the rectal mucosa. Histopathologically it is characterized by fibromuscular obliteration in the lamina propria. Defecography revealed that an opening of the anorectal angle was smaller in the MPS group than in a normal group. Difficulty of defecation may be caused by strong tension of the pelvic floor, which induces strong "strain" followed by Prolapse of the rectal mucosa.

　The most important therapy is that which improves the habit of defecation. Surgical procedure such as ligature or excision of the mucosa is effective for polypiod lesion and severe prolapse of the mucosa.