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급성취장염에 대한 임상적 고찰

Other Titles
 Clinical analysis of acute pancreatitis 
Issue Date

1964년부터 1973년까지 10년간 연세대하교 연세 의료원에 입원하였던 급성취장염 환자 550명중에서 확진된 363예를 택하여 임상적 관찰을 통해 다음과 같은 결론을 얻었다.

1. 연령분토는 과반수 이상이 30~50세 사이에서 발생하였으며 남녀 비는 동일하였다.

2. 원인은 담도계질환(26%), 폭식(14%) 알콜(8%), 기생충(5%), 복부외상(4.4%)순이었으며 원인불명이 40%나 되었다.

3. 진단은 대부분 병력, 이학적 검사 , 검사실 소견에 의해서 이루어졌으며 수술로 확인된 예는 83예(23%)이었다.

4. 괴저성취장염은 9.4%, 취장농양은 3.5%에서 발생하였다. 괴저성취장염에서 농양 합병율은 20%이었다.

5. 출혈성 및 괴저성취장염은 노년층에 많았고 가성낭종은 외상성취장염이 많은 젊은층에 많았다.

6. 부종성취장염은 주로 보존요법으로 치료하였으며 증상 재발율은 약 30%이었다.

7. 괴저성 및 화농성취장염, 외상성취장염, 담도계질환이 원인이 된 부종성취장염은 거의 외과적으로 치료하였다. 수술은 전체예의 23%에서 실시되었다.

8. 수술예의 28%는 재발하였다.

9. 전신 합병증은 폐부전증, 쇽크, 위장관출혈, 패혈증 순이었다.

국소 합병증은 가성낭종(6.3%), 농양형성(3.5%) 누공형성(1.3%) 순이었다.

10. 사인은 폐부전증, 쇽크, 패혈증, 위장관출혈 신장부전증 순이었다.

11. 전체 치사율은 4.6%이었다. 비수술군의 치사율은 4%, 수술군의 치사율은 7%이었다.

12. 출혈성 및 괴저성취장염의 치사율은 35%이었으며 괴저성취장염이 농양화한 예의 치사율은 45%이었다. 그러나 수술이 실시된 괴저성취장염 및 취장농양의 치사율은 22%이었다.


During 10 year period from 1964 to 1973, about 550 patients had been recorded as acute pancreatitis at Yonsei University Medical Center. Of these,363 cases fulfilled our diagnostic criteria for acute pancreatitis.

The results of the analysis of the 363 cases are as follows:

1. Over one half of these was between 30 and 50 years of age, and sex ratio of male to female was equal.

2. The associated etiologic factors were unknown in 40% of the cases and biliary tract diseases in 26%, gluttony in 14%, alcohol in 8%, helminthes in 5% and trauma in 4.4%.

3. In the majority of the cases, the diagnosis was made on the basis of history, physical examination and various labaratory data. In only 23% of the cases, diagnosis was confirmed by the exploratory laparotomy.

4. Among various forms of acute pancreatitis, necrotizing pancreatitis was estimated about 9.4% and pancreatic abscess was about 3.5%.

5. Necrotizing form was progressed to abscess in about 20%.

6. The edematous pancreatitis predominated in all age group. The hemorrhagic-necrotizing form predominated in the elderly group, while the pseudocyst predominated in the younger group.

7. Acute edematous pancreatitis could be successfully treated by non-operative supportive therapy with recurrent rate of about 30%.

8. Majority of necrotizing or suppurative pancreatitis, traumatic pancreatitis and edematous pancreatitis with biliary tract diseases were treated with surgical intervention.

9. Complications were pulmonary insufficiency, shock, gastrointestinal bleeding and septicemia.

10. Chief causes of death were pulmonary insufficiency, shock, septicemia, gastrointestinal bleeding and renal failure.

11. The over-all mortality rate was about 4.6%. That of the non-operated group was about 4%, while that of the operated group was as high as 7%.

12. Over-all mortality rate of hemorrhagic-necrotizing pancreatitis was about 35% and that of the pancreatic abscess arising from necrotizing pancreatitis was as high as 45%. Mortality of the necrotizing pancreatitis and abscess which had

undergone operation was as low as 22%.
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