담관계질환에 대한 임상적 고찰

Abstract

[한글]

CLINICAL OBSERVATION OF BILIARY TRACT DISEASE(Excluding Malignant Disease)

Hoon Sang Chi, M.D.

Department of Medical Science, The Graduate School Yonsei University

(Directed by Prof. Choon Kyu Kim)

Clinical observation are made on 751 patients those who are operated on between

from Jan. 1958 to Aug. 1973 at Yonsei University Medical Center.

According to their different disease entities, its classification and incidence

are as follows ;

Cholelithiasis 536 cases(71.4%), biliary ascariasis 75 cases(10%), empyema of

gallbladder and ascending cholangitis 60 cases98.0%), noncalculous cholecystitis 37

cases(4.9%), biliary clonorchiasis 21 cases(2.8%), biliary atresia 10 cases(1.3%),

papellitis 9 cases(1.2%), agensis of gallbladder 3 cases(0.4%).

The age of peak incidence is between 41 to 50 (209 cases of 27.8%). The sex

incidence of male to female is 288 cases to 463 cases, so that the ratio is 1.7

predomination in the female.

There appeared to be little difference in the symptoms and signs according to the

different disease entity.

Except biliary clonorchiases, the most prominent symptoms and signs are pain in

the right upper quadrant of abdomen with or without radiation to the right

shoulder.

The jaundice are encountered more often in Korean than in Occidentals.

Empyemal of gallbladder and ascending cholangitis showed almost Charcot's triad

and its peak age incidence is between 51-60 yrs old.

About less than half of the patients showed some degree of hepatic dysfunction.

among these the most prominent finding is elevated serum bilirubin level.

Similar findings are noted in the common duct, that is, 139 cases had more than

1.0cm of C.B.D diameter from total 192 cases.

Parasitic biliary disease should be treated with antihelminthics preoperatively

and postoperatively.

Time of operation are selected on the individual base, but there appeared to be a

tendency of early intervention except the occasion there is strong contraindication

for surgery.

Due to the fact of high recommended that the routine use of operative

cholangiography.

Treatment for intrahepatic stone are mainly aimed for some kind of by-pass

drainage procedure.

The most common post-operative complication are wound infection(10 cases),

pneumonia(4 cases), excess bile leakage(8 cases), wound dehiscence(4 cases),

pancreatitis(3 cases), subphrenic abscess( 2 cases) and atelectasis(2 cases). There

are 8 deaths in the 751 cases or a mortality of 1.5%.

It is suggested that silent gallstone are recommended to have operation in young

aged people, but above 65 yrs old people are better to treat conservatively.

[영문]

Clinical observation are made on 751 patients those who are operated on between from Jan. 1958 to Aug. 1973 at Yonsei University Medical Center.

According to their different disease entities, its classification and incidence are as follows ;

Cholelithiasis 536 cases(71.4%), biliary ascariasis 75 cases(10%), empyema of gallbladder and ascending cholangitis 60 cases98.0%), noncalculous cholecystitis 37 cases(4.9%), biliary clonorchiasis 21 cases(2.8%), biliary atresia 10 cases(1.3%),

papellitis 9 cases(1.2%), agensis of gallbladder 3 cases(0.4%).

The age of peak incidence is between 41 to 50 (209 cases of 27.8%). The sex incidence of male to female is 288 cases to 463 cases, so that the ratio is 1.7 predomination in the female.

There appeared to be little difference in the symptoms and signs according to the different disease entity.

Except biliary clonorchiases, the most prominent symptoms and signs are pain in the right upper quadrant of abdomen with or without radiation to the right shoulder.

The jaundice are encountered more often in Korean than in Occidentals.

Empyemal of gallbladder and ascending cholangitis showed almost Charcot's triad and its peak age incidence is between 51-60 yrs old.

About less than half of the patients showed some degree of hepatic dysfunction.

among these the most prominent finding is elevated serum bilirubin level.

Similar findings are noted in the common duct, that is, 139 cases had more than 1.0cm of C.B.D diameter from total 192 cases.

Parasitic biliary disease should be treated with antihelminthics preoperatively and postoperatively.

Time of operation are selected on the individual base, but there appeared to be a tendency of early intervention except the occasion there is strong contraindication for surgery.

Due to the fact of high recommended that the routine use of operative cholangiography.

Treatment for intrahepatic stone are mainly aimed for some kind of by-pass drainage procedure.

The most common post-operative complication are wound infection(10 cases), pneumonia(4 cases), excess bile leakage(8 cases), wound dehiscence(4 cases), pancreatitis(3 cases), subphrenic abscess( 2 cases) and atelectasis(2 cases). There

are 8 deaths in the 751 cases or a mortality of 1.5%.

It is suggested that silent gallstone are recommended to have operation in young aged people, but above 65 yrs old people are better to treat conservatively.