大腸憩室疾患の手術的治療

Surgical Treatment of Diverticular Disease of the Colon

要旨　大腸疾患は近年増加傾向にある．その合併症には憩室炎，大腸周囲膿瘍形成，穿孔，狭窄，出血などが外科の治療対象になる．憩室炎には右側大腸憩室炎と左大腸憩室炎があり，自験例では左側大腸憩室炎が外科手術の対象となることが多く，術後も含めて重症例を認めた．画像診断の進歩でその精度が向上したため，病態を客観的に判断して的確な外科治療を行うことが可能になった．自験例30例を検討して選択すべき術式は，左右側大腸憩室炎とも保存的治療後に膿瘍形成・狭窄を示した症例は手術の適応であり，左側大腸憩室炎の瘻孔症例もいったんは十分に炎症を制御した後で瘻孔を含めて切除手術を行う．穿孔例は救急手術でドレナージを行うとともにHartmann手術を行い，術後ICU管理が必要である．また，出血症例のほとんどは内科的治療で止血される．

　The incidence of diverticulitis of the colon is expected to increase in Japan. We encounter severe complications of diverticular diseases, such as a pericolic abscess, stricture after diverticulitis, colovesical fistula, and perforation of a colonic diveticulum. In this study, complications of right-sided diverticulitis are not as severe as those of left-sided diverticulitis. However right-sided and left-sided diverticulitis are complicated by a pricolic abcess and stricture which should undergo elective resection after medical treatment. The case of left sided diverciculitis may cause a fistulation with the urinary bladder, which requires the resection of the colon and fistula. In the case of perforation, Hartmann's operation is performed and management in the ICU should be made for the treatment of septic shock. Even massive bleeding of a diverticulum is able to be treated medically.