小児のmucosal prolapse syndrome―本邦若年者報告例の集計をもとに

Mucosal Prolapse Syndrome in Children: A Clinicopathological Analysis of Young Patients

要旨　自験例2例を含む若年者（19歳以下）の直腸の粘膜脱症候群（mucosal prolapse syndrome；MPS）42例の本邦報告例の集計をもとに，臨床病理学的な検討を加えた．最年少例は7歳で15歳を頂点とする発症がみられた．性別は男31例女11例であった．主訴は血便が最も多く91％にみられ，次いで粘液便もしくは粘血便（31％）がみられた．息みは85％にみられたが，直腸の粘膜脱は記載があるもののうち31％のみであった．病変の肉眼形態は隆起型が85％，潰瘍型が15％であった．発生部位は前壁40％，全周性27％，前側壁18％，側壁，後壁の順であり，下部直腸に存在していた．発生病理を念頭に置いた治療が望まれる．

　A clinicopathological analysis was carried out to determine the significance of mucosal prolapse syndrome in children by collecting 42 reported cases aged less than 19 years, including 2 cases which we encountered ourselves. The youngest patient was 7 years old and the largest number of patients was diagnosed at the age of 15 years. Thirty one patients were male and 11 were female. Rectal bleeding was the major symptom found in 91% of the patients. It was followed by mucus discharge (31%). Straining was revealed in most of the patients (85%), but rectal mucosal prolapse was proved in only 5 out of 16 patients. Eighty five percent of the patients had polypoid lesions, and only 15% had pure ulcerated lesions. The most common site of the lesion is the anterior wall (40%). It is followed by circumferential (27%), anterolateral (18%), lateral, and posterior wall. Most of the polypoid lesions were resected but simple resection without consideration of the pathogenesis of this condition does not guarantee a permanent cure. Prohibition of straining combined with resection of the polypoid lesion and rectopexy is thought to be the best therapy to recommend.