潰瘍性大腸炎の外科治療

Surgical Strategy for Ulcerative Colitis

潰瘍性大腸炎に対する外科治療としては，疾患根治性と肛門機能の保持を兼ね備えたIPAAが標準手術として確立されており，全身状態，病態，治療薬剤を考慮して，手術のタイミングを誤らないことが重要である．自験例の検討では，緊急手術例は21.9％で中毒性巨大結腸症が最も重篤な合併症と思われた．時代的に手術症例を比較すると，新しい治療薬の普及とともに，ステロイド剤強力治療ならびに投与量は減少し，緊急手術例の減少をもたらしていた．安定した状態での手術例の増加は，より安全な形での切除・再建例の増加につながっていた．今後は，高齢者に対する適切な内科的治療の選択および手術適応基準を明らかにすることが求められるだろう．また，増加している癌化例に対してはcolitic cancerの特徴を考慮したサーベイランス法の工夫が必要と考える．

　Restorative proctocolectomy and IPAA（ileal pouch anal anastomosis）for UC（ulcerative colitis）is able to resect curatively the lesion while maintaining the anal function in the long term, and IPAA has proven to be the standard surgical procedure. Therefore, it is necessary that surgical treatment should be indicated in consideration of the patient's general condition, disease activity and the effect of which medical drug is administered in each patient, and it is important to select a safer surgical procedure such as a staged operation.

　We studied the surgical indication and postoperative complications for 201 patients who underwent surgical treatment in our department. Seven patients complicated with toxic megacolon presented the most serious outcome in surgery become of their poorly preoperative condition and highly postoperative complications.

　In examination of the time course of treatment for patients with UC, new medical treatments have become widespread with more suitable selection. The total dosage and strong therapy of corticosteroids were gradually decreased. This led to a decrease in emergency operations and postoperative complications.

　Surgical treatment should be performed without delay for patients who do not respond to other medical treatment, and it is important that safer and more timely surgical procedures are studied. Additionally, it is required to know how suitable treatment methods are for elderly patients. The development of a high quality surveillance method for associated carcinoma is also required.