胃と腸45巻3号

2010年03月発行

今月の主題 出血性小腸疾患─内視鏡診断・治療の最前線 主題

出血性小腸疾患に対する診断・治療の進め方

著者： 岡志郎¹ 田中信治¹ 宍戸孝好² 今川宏樹² 竹村嘉人² 濱田康彦² 吉田成人¹ 茶山一彰²

所属機関： ¹広島大学内視鏡診療科 ²広島大学消化器･代謝内科

ページ範囲：P.312 - P.320

要旨　出血を来す小腸疾患は，主に血管性病変，炎症性潰瘍性病変，腫瘍性病変に分類される．現在，出血性小腸疾患を疑った場合，カプセル内視鏡検査とバルーン内視鏡検査の使い分けが重要であるが，患者背景や出血の重症度などを考慮したうえで従来のX線造影検査や血管造影検査，体外式超音波検査など他の診断法と組み合わせながら適切に検査を進めていく必要がある．大量の血便などに伴うショック状態の患者に対しては全身状態の改善が最優先であり，その後に大腸内視鏡検査に続いて小腸内視鏡検査を行うか，血管造影あるいは出血シンチグラフィを行ったうえで小腸内視鏡検査を行う．出血性小腸疾患に対する内視鏡的止血手技は，止血機序から機械的止血法，熱凝固法，薬剤局注法，薬剤撒布法に大別されるが，バルーン内視鏡の発展により従来行われていた開腹手術が回避されるなど，患者のQOL向上に貢献できるようになった．

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