胃と腸45巻10号

2010年09月発行

今月の主題 Crohn病小腸病変に対する診断と治療の進歩

主題

Crohn病小腸病変に対する治療効果―内視鏡的狭窄拡張術の適応と臨床効果

著者： 別府孝浩¹ 平井郁仁¹ 松井敏幸¹ 八尾建史¹ 西村拓¹ 関剛彦¹ 高津典孝¹ 矢野豊¹ 二宮風夫¹

所属機関： ¹福岡大学筑紫病院消化器科

ページ範囲：P.1668 - P.1675

文献概要

要旨　Crohn病（CD）の小腸狭窄に対する内視鏡的拡張療法（EBD）の方法，当科での治療成績と安全性について概説した．当科ではダブルバルーン小腸内視鏡（DBE）を用いてEBDを行っているが，CDの小腸狭窄へのEBDの適応は（1）閉塞症状を伴う小腸狭窄で，（2）狭窄長が3cm以下，（3）狭窄部に瘻孔や膿瘍のないもの，（4）狭窄部に深い潰瘍のないもの，（5）病変による強い屈曲がないものとしている．初回EBDから6か月以上経過した25例の解析では，短期成功率は72％，12か月後の累積手術回避率は72％であった．合併症は2例（8％）で認めたが，いずれも保存的治療にて改善し，外科的手術を要する穿孔などの重篤な合併症はなかった．当科では小腸狭窄を有するCD患者の臨床経過とQOLを改善しうるという観点から，DBEを用いたEBDを積極的に行っている．今後，多数例での長期成績の検討やさらなる安全性の向上が望まれる．

参考文献

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