小児潰瘍性大腸炎の外科療法(全国アンケート調査並びに文献考察)

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The choise of treatment for ulcerative colitis surgical indication and selection of operative method has been debatable. In this view point, a survey of nation wide was done including concerning 591 general hospitals throughout Japan regardiny the surgical results of this disease. Fourhundred and fifteen hospitals (70.2%) have responded. A total of 27 cases were included in this study. The result of the long term prognosis in these 27 cases was analysed objectively (27 cases, 100%) and subjectively (17 cases, 63%). To this analysis, previously reported 14 cases were added. Of 41 cases thus prepared, 9 sphincter preserving method was performed in 24 with an ileoanostomy in 9, ileorectostomy in 10 and ileocolostomy in 5. In the other 13 cases, a permanent ileostomy was carried out. The overall surgical mortality was 4.9%. Surgical complications were seen in 40% of those undergoing an endorectal ileal pull-througn operations and in 10% of ileorectostomy. Reoperation was carried out in 3 of 10 cases (30%) who had undergone an endorectal ileal pull-through method. Recurrence rate in the ileorectostomy was 50 percent. In regard to the cancer risk of the preserved rectal mucosa, no rectal carcinoma was found in these cases during follow-up period. All the 11 patients who had undergone a sphincter preserving operation have returned to normal life. Two of 6 patients with a permanent ileostomy can not enjoy a social life due to incontinence. The patients who had undergone an ileorectostomy have better continence than those of an endorectal ileal pull-through operation. In this survey, it has been suggested that a totalcolectomy with an ileorectostomy is better than an endorectal ileal pull-through operation, in view of easiness of surgical technique, lower incidence of complications and reoperation and excellence of continence.
日本小児外科学会の論文
1983-10-20

小児潰瘍性大腸炎の外科療法(全国アンケート調査並びに文献考察)

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