Twenty year experiences of the stones in the hepatobiliary system
일반적으로 담석증은 민족적 지방적 차이가 있으며 한국인의 담석증이 구미의 담석증과 다른 것은 주지의 사실이다. 최근 우리의 생활수준의 향상과 함께 담석증의 양상도 서구와 차이가 줄어들 것이라는 관점에서 본 연구를 시작하였다. 담석부위별 발생빈도의 변화와 지역적차이, 동반질환의 변화, 진단방법과 수술적치료, 합병증 및 사망율의 변화를 관치하여 현재 한국인의 담석증양상을 정확히 파악하여 치료와 예후의 향상을 기하고자 1966년 1월부터 1985년 12월까지 연서대학교 의과대학 의과학교실에서 치험했던 2,103 예의
간담도계 담석증과 그 동반질환을 임상분석하여 다음과 같은 결과를 얻었다.
1) 간담도계 담석증은 발생빈도가 전기보다 후기에 증가하였다. (P < 0.01)
2) 담석부위별 발생빈도는 담낭석은 증가하였고, 총수담관석, 간내담석 및 비결석성 담낭염의 빈도는 감소하였다. (P < 0.01)
3) 남녀의 비는 1:1.54였고 연령별 발생빈도는 50대가 가장 많았으며 점차 고령화하는 추세였다. (P < 0.01)
4) 지역별로는 도시와 시골환자간에 차이가 있어서 시골환자에서는 담낭석의 발생빈도가 낮았고 간내담석의 발생빈도는 높았으며 도시환자는 그 반대였다. (P < 0.01)
5) 진단방법중 역행성 담취관조영술과 초음파검사가 도입된 이래 진단율이 80 ∼ 90 %로 향상되었고 그 시행횟수도 급격히 증가하였으며 경구담낭조영술과 경정맥담도조영술은 그 시행횟수가 크게 감소하였다.
6) 동반질환중 췌장염과 회충미입증은 감소하였고 상행성담도염, 패혈증, 당뇨병등은 증가하였다. (P < 0.01)
7) 수술방법의 변화는 담낭석의 경우, 초음파검사, 역행성 담취관조영술과 수술중 담도조영술등의 사용으로 시험적 담도절개의 비율이 감소하였으며 총수담관석의 수술은 총수담관장관문합술이 증가하였고 간내담석의 수술은 간엽절제 및 Longmire술식, 총수담관장
관문합술등의 적극적 치료방법이 증가하였다. (P < 0.01)
8) 사망율과 합병율은 감소하였으나 통계적의의는 없었다. (P > 0.05)
9) 잔류담석은 총 7.8%였으며, 총수담관석에서 7.5%, 간내담석에서 37.3 %였다.
이상의 결과로 근래20년을 전후기로 나누어 볼때 담석증의 발생양상이 발생부위와 거주지역에 따라 변화가 있을 뿐 아니라 동반질환과 진단방법 및 수술방법의 변천이 있었다. 그러나 간내담석과 총수담관석의 높은 발생율등은 아직도 서구와 많은 차이가 있다.
It has been reported that the clinical pictures of cholelithiasis in Korean were different from that of Occidentals. The difference were thought to be due to inherent racial difference and acquired habit of Living. During the pact twenty years, our standard of living has been markedly improved so that we suspected that the clinical pictures of gallstone in Korean were altered and the differences from Occidenta1s were reduced.
This study nab done to determine the features of the changed clinical patterns of hepatobiliary stones and to evaluate our experiences of hepatobiliary stones with the associated diseases during the past twenty years (1966-1985). The results are summerized as follows:
1) The 2,103 cases we analysed were overall 4.6% of 45, 463 patients who had been admitted in our general surgery department during the same period arid the incidence of gallstones increased from 3.5% to 5.2% during the pas? twenty years (P < 0.01).
2) The male to female sex ratio was 1:1.54 and there was no significant change during the twenty years. The aged patients were increased and the mean age was increased from 48.2 to 50.7 years during the twenty years (P < 0.01).
3) The incidence of gallbladder stone was increased from 67.1% to 75.2% during twenty yeara, and that of the others, CBD stoned intrahepatic stone and acalculous cholecystitis, were reduced (P < 0.01).
4) In rural patients the incidence of gallbladder stone was lower than that of urban patients (34.1% : 48.5%). In contrast, the incidence of intrahepatic duct atone baa higher than that of urban patients (23.6% : 13.2%) (P < 0.01).
5) In 1960s, oral cholecystography and intravenous cholangiography were main diagnostic methods in gallstones but the accuracy was very poor. In mid 1970s, PTC and ERCP were introduced and the accuracy was markedly improved to abort 90% and the ultrasonography was developed in late 1970s, whose diagnostic accuracy was very excellent so as to make it the main diagnostic tool of the gallstone nowadays.
6) The meat common associated disease was cholecystitis, and the pancreatitis was slightly reduced from 5.7% to 3.2%. The ascariasis in CBD was markedly reduced and the sepsis and ascending cholangitis were slightly increased during the twenty
years (P < 0.01).
7) The operative procedures were changed during the twenty years as fellows. In gallbladder stone the negative common duct exploration was reduced from 42.5% to 23.7% during the twenty years, and in the common bile duct stone, the use of 7-tube
choledochostomy was reduced and the bypass surgery was increased. In the intrahepatic stone, the liver resection, Longmire procedure and the choledochoenterostomy were increased. In acalculous cholecystitis the CBD exploration was reduced from 53.6% to 44.8% during the twenty fears (P < 0/01).
8) The postoperative mortality and complication rates were reduced during the twenty rears 1 and the most common cause of death was sepsis (P > 0.05).
9) The residual stone in CBD occurred in ,44 cases(7.5%) and in intrahepatic stone, 120 cases (37.3%).