特集名 | 虫垂疾患とその周辺 | |
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題名 | 虫垂疾患の各論 (4) 虫垂憩室ならびにその炎症 | |
発刊年月 | 1999年 10月 | |
著者 | 宇都宮 勝之 | 自衛隊仙台病院外科 |
【 要旨 】 | 虫垂憩室症は欧米の報告は多いが,本邦では186例のみで比較的まれな疾患である.12~85歳(平均46.4歳),男性に多く(男:女=2.8:1),切除虫垂や注腸検査の0.004~2.1%に認められる.真性憩室はきわめてまれでほとんどが仮性憩室である.虫垂間膜側(56%),虫垂中央部(42%),多発例(60%),結腸憩室合併例(72%)が多い.虫垂憩室炎の術前の確定診断は困難で,病態は急性虫垂炎と類似するが,急性虫垂炎に比べ高齢で穿孔率が高い(26~66%).虫垂憩室症の治療は,高い穿孔率のため欧米では手術が第一選択とされるが,本邦では一定の見解がない.虫垂憩室症を診断した場合,患者に十分説明し,虫垂憩室炎が疑われる場合には,手術時期を逸せず治療することが重要と考える. |
Theme | Disease of Appendix and its Allied Condition | |
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Title | Diverticulosis and Diverticulitis of the Appendix | |
Author | Katsuyuki Utsunomiya | Department of Surgery, Self-Defense Forces Sendai Hospital |
[ Summary ] | Diverticulosis of the appendix is a rarecondition. Only 186 cases have been reported in Japan. The average age of patients is 46.4 years(12 to 85). It occurs more commonly in men (male:female=2.8). The incidence ranges from O.004 to 2.1% of all appendectomies or barium studies. Most appendical diverticula are acqured cases. Multiple diverticula are observed in 6O% of patients. Location of the diverticulum is 56% on the mesenteric side, 23% on the antimesenteric side, and 21% on both sides. It is difficult to diagnose diverticulitis of the appendix preoperatively, since the symptoms are slmilar to those of appendicitis. This type is more likely to be perforated than acute appendicitis. The incidence of perforation is reported in the range of 26 to 66%. If patients are diagnosed as having diverticula of the appendix, they should be carefully followed. Also, whenever diverticulitis of the appendix is suggested in these patients, immediate surgical treatment should be performed. |