Crohn病の外科治療

Surgical Treatment of Crohn's Disease

Crohn病（CD）の外科治療は，腸管病変と肛門病変に分けられる．腸管病変の治療の原則は，最小限の切除＋狭窄形成術である．腸管病変は，適切な時期に手術を行い，術後再燃予防に努めるべきである．抗TNF-α抗体製剤の術後再燃予防についての報告が増加しているが，長期的な経過に関しては今後の検討課題である．肛門病変に対する手術は，膿瘍のドレナージ＋seton法が原則である．肛門病変に対する抗TNF-α抗体製剤の有効性も多く報告されているが，直腸狭窄を合併している症例に対する有効性は十分ではない．また，発癌症例が増加しており，難治性の直腸肛門病変患者に対する直腸切断術の見極めが重要である．

　Surgical treatment for CD（Crohn's disease）is divided into intestinal lesions and anal lesions. In principle, minimal resection plus a strictureplasty is the standard treatment for intestinal lesions, though surgery should be performed with appropriate timing to prevent postoperative reactivation. Although the number of reports showing prevention of postoperative reactivation by use of an anti-TNFα antibody agent is increasing, the long-term course of those patients remains to be elucidated. For anal lesions, abscess drainage and a seton are generally utilized. Furthermore, though the effectiveness of an anti-TNFα antibody agent for treating anal lesions has been frequently reported, those in cases complicated with rectal stenosis have not been confirmed. Moreover, as the number of cancer cases is increasing, this information is important when deciding whether to perform rectal amputation for patients with intractable anorectal lesions.