潰瘍性大腸炎穿孔手術28症例の検討 Twenty-eight Cases of Ulcerative Colitis Complicating Perforative Peritonitis

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2006年12月までに当科で手術を行った潰瘍性大腸炎(以下UC)症例902例のうち,穿孔で手術適応となった28症例につき,その臨床的特徴について検討した.炎症性腸疾患(以下IBD)における穿孔はクローン病,ベーチェット病に多いとされ,UCでは比較的少ないとされている.しかしUC穿孔症例では活動期,ステロイド大量投与症例が多く,surgical site infection(SSI)を初めとする術後合併症は高頻度に見られ,管理に苦渋した.さらに疾患の性質上,若年者が多く,QOLを考慮して可能な限り肛門温存に努めるべきであり,当科症例28例中24例(85.7%)に肛門温存手術が可能であった.<br>

Perforation resulting from inflammatory bowel disease (IBD) has been frequently reported in patients with Crohn's disease and Behcet's syndrome, whereas few of those cases have been reported to have ulcerative colitis (UC), even though perforation resulting from UC has frequently been observed in patients given high doses of steroids during the active phase. We studied the clinical characteristics of 28 patients indicated for surgery due to perforation, who were chosen from 902 patients with UC who underwent an operation in our department prior to December 2006. Of the 28 subjects in the present study, postoperative complications such as surgical site infection (SSI) were observed to have high rates of incidence, which resulted in difficult postoperative management. Further, younger patients comprised the majority in accordance with the characteristics of the disease, for whom conservation of anal function should be attempted as much as possible because of quality of life issues. Our results showed that 24 (85.7%) of the 28 patients could be treated by anal-conserving surgery.<br>

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  • 日本大腸肛門病学会雑誌  

    日本大腸肛門病学会雑誌 61(6), 298-302, 2008-06-01 

    The Japan Society of Coloproctology

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