한국인 담석증의 임상적고찰

Abstract

[한글]

[영문]

Since 1930, it is known that the clinical pattern of cholelithiasis in Korean patients may be different to that of Occidentals, as reported by the late Professor Ludlow (1930) of Severance Union Medical College. Although a number of gallstone

patients are occasionally operated by surgeons in Korea, a systemic report for evaluation of the Korean clolelithiasis is not available yet.

In order to compare a clinical picture of cholslithiasis in Korean with that of other countries, author collected and analysed records of patients whose gallstone was confirmed after operations. And the following observations are made and reported.

Records of 100 cases of gallstone patient who was operated at the Department of general surgery Yonsei University medical Center for the years of 1958 to 1962 inclusive are analysed.

Total number of patients admitted to the hospital at the same period is 22,505, number of general operations is 12,373, and number of laparotomies is 2,674. Incidence of gallstone patients tp general admission patients is about 0.44%, and frequency of gallstone operations to that of general operation and laparotomies is 0.87% and 3.74% respectively.

The average age of the 100 patients is 43.4 years in male and 48.6 years in female. The youngest patient was 12 years of age and the oldest was 77 years of age. The age of peak incidence is between 41 to 50 (31 cases, or 31%). There are 62 female and 38 male patients and ratio is approximately 1.63:1.

Most of gaoostones in Occidentals arise in the gallbladder, where as in Korean 49% or more are encountered in the bkle ducts, including intrahepatic ducts. Choledochloithiasis is more frequently encountered in male and in the younger age group. All patients under the age of 20 had stones in biliary ducts only.

Of the 100 cases, 23 are cholelithiasis, 49 are choledocholithiasis, and 28 are the patients who have stones in both gallbladder and bile ducts including hepatic ducts. Of the all cases, 19 patients had stones in their hepatic ducts, 3 in right hepatics, 8 in left, and the other 8 in both sides of hepatic ducts.

The severity and intensity of symptoms and signs of Korean gallstone may be caused by predominance of choledocholithiasis. The most prominent symptoms and signs are pain (91%) in right upper quadrant of abdomen with or without radiation to the right shoulder. The jaundice (66%) and fever with or without chillings(60%) are encountered more often in Korean than in Occidentals. Twelve cases of the 100 patients had ascaris in their common duct.

Eleven cases of acute obstructive suppurative cholangitis were operated. 10 of them were completely cured after primary or divided operative procedures and one of them could not be cured but expired from the impaaired liver functions.

The total number of cholecystectomy was 83, and choledochostomy 81. Relatively high per cent of common duct exploration reflects high incidence of common bile duct stones. Discussion for the other operative procedures was mentioned in detail.

There are 4 deaths in the 100 patients or a mortality of 4%. Two of them died by early and late complications of acute pancreatitis each. One died of postoperative bleedings following operative procedure, this was probably caused by markedly impaired liver functions. The other one patient could not be recovered from acute obstuctive suppurative cholangitis even after an energency decompression procedure was carried out.