炎症性腸疾患治療上の問題点 Surgical Aspects in Management of Inflammatory Bowel Disease

炎症性腸疾患(IBD)にほさまざまな疾患が含まれているので,正しい治療を行うには先ずその分類と各疾患の病態を把握しておくことが大切である.代表的な潰瘍性大腸炎では,激症型の手術時期を失しないことが肝要であり,難治例においては手術時期が遅れたために,患者のquality of lifeが著しく損なわれないようにしなければならない.10年以上の長期経過例においてはdyaplasia,癌の早期発見のためにsurvaillance colonoscopyを行う必要がある.Crohn病では合併症を解除するために必要最小限の小範囲切除が勧められている.合併する痔瘻は切開開放で治療できる.孤立性直腸潰瘍症候群,急性出血性直腸潰瘍のごとき新しく認知された疾患も念頭に入れておく必要がある.特に後者は突然大出血を来すことがあり,その存在を知らないと正しい対処に苦慮することになる.

Surgical aspects in management of inflammatory bowel disease(IBD)were reviewed with special emphasis on ulcerative colitis(UC). In a severe attack of UC a delay in surgical intervention may cost the patient's life. In chronic intractable cases a delay in surgery may affect the patient's quality of life. The modern technique of a pouch-operation avoiding ileostomy has made the decision of surgery much easier for both patients and physicians. Surveilance for dysplasia and cancer in long-standing colitis is mandatory. In Crohn's disease only minimal surgery for relieving complications with supplementary nutritional therapy is recommended. Anal fistula irrelevant to Crohn's disease itself can be treated as the usual fashion, laying it open. As rare conditions, clinicopathological features and management of solitary ulcer syndrome of the rectum and acute hemorrhagic ulcer of the rectum were described. It is important to understand the classification of IBD and the clinicopathological features of each disease for the correct management of IBD.