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上部 胃腸管 大出血患者에 關한 臨床的 考察

A Clinical Review of 91 Patients with Massive Upper G.I. Hemorrhage

대한외과학회지 1968년 10권 2호 p.73 ~ 83
鄭源石, 金子勳, 李恩雨,
소속 상세정보
鄭源石 (  ) - 서울대학교 醫科大學 外科學敎室
金子勳 (  ) - 서울대학교 醫科大學 外科學敎室
李恩雨 (  ) - 서울대학교 醫科大學 外科學敎室

Abstract


A total of 91 patients of massive gastrointestinal hemorrhage, who was admitted in Seoul National University Hospital filling past 7 yesrs, was reviewed.
Thr results obtained are as follows:
1. Massive bleeders were 61%(91 cases) of 143 patients with upper G.I. bleeding, of which causative diseases were peptic ulcer (63.7%), stomach cancer (16.5%), rupture of esophageal varix (15.6%), gastritis (2.2%) and unknown (2.2%) in order.
2. The age incidence ranged from 17 to 70, and 4th and 5th decade were the most prevalent, with a ratio of 6 male to 1 female.
The seasonal distribution show the peak with 40% in Autumn and the least with 17% in Winter.
3. Fifty-five patients (60%) were with the first single episode of bleeding, 25(27%) with the second episode and 11(12%) with the third or more.
In all these patients but one (99%), bleeding occured prior to admission and it recurred only in 27 patients (30%) during hospitalization.
4. The ulcer history was noted in 74 patients (81%), with an incidence of 100% in peptic ulcer and gastrits, 70% in stomach cancer and 21% in varix rupture.
The duration of the history was less than 5 years in most cases.
5. Conservative treatment was done in 50 patients (55%) and operative in 41(45%), of which 27(66%) were elective surgeries and 14(34%) emergencies.
The procedures applied were hemi-or subtotal gastrectomy (24), total gastrectomy (3), simple closure of stomach perforation (1), gastrojejunostomy (1), exploratory laparotomy (1), splenorenal shunt (8), portocaval shunt (2), and splenectomy (1).
6. Postoperative bleeding was the most frequent complication after surgery, and pneumonia and pulmonary atelectasis were the next.
Two cases of hepatic coma were also noted after shunt operation for varix rupture.
7. Death of cured in 8 patients, with a mortality rate of 8.7%. of which 5(10%) were conservative group and 3(7.3%) operative group.
The causes of death were mainly loss of blood or preexisted associated diseases in conservative group, whereas postoperative bleeding, pneumonia and hepatic coma in operative group.

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