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

Crohn病の小腸出血例の内視鏡診断―治療およびその臨床経過

著者： 平井郁仁¹ 別府孝浩¹ 西村拓¹ 辛島嘉彦¹ 二宮風夫¹ 槇信一朗¹ 高津典孝¹ 関剛彦¹ 久部高司¹ 高木靖寛¹ 八尾建史¹ 松井敏幸¹ 岩下明徳²

所属機関： ¹福岡大学筑紫病院消化器科 ²福岡大学筑紫病院病理部

ページ範囲：P.379 - P.387

要旨　本検討は，Crohn病（CD）における小腸出血の頻度，内視鏡検査の有用性および治療経過を明らかにすることを目的とした．当科においてダブルバルーン小腸内視鏡検査（DBE）を施行した155例のCD患者を対象とした．上下部消化管内視鏡検査で出血源を指摘できない，（1）DBE施行前の顕出血例，（2）出血源検索目的のDBE施行例，（3）出血症状の有無にかかわらずDBEで出血源を指摘しえた症例，を小腸出血例と定義した．小腸出血例は15例（9.7％）であり，このうち10例（66.7％）は，DBEで出血源を同定しえた．内視鏡的止血術（6症例）を含む保存的治療によって，すべての症例で一時止血が得られた．再出血は，15例中5例（33％）に認められ，累積非再出血率は，12か月後で73％，36か月後で63％だった．出血が原因で外科手術に至った症例や死亡例はなかった．再出血例5例は，非再出血例10例と比較し，出血部位が吻合部である頻度が有意に高かった．病型，初回出血後の治療内容および内視鏡的止血術の有無別での比較では，再出血例と非再出血例に明らかな相違を指摘できなかった．

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