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上部消化管出血患者의 外科的治療에 對한 臨床的 觀察

A Clinical Review of Gastrointestinal Tract Bleeding

대한외과학회지 1969년 11권 11호 p.725 ~ 734
이종균,
소속 상세정보
이종균 (  ) - 춘해병원 외과

Abstract


A total of 69 cases of upper gastrointestinal tract bleeding were admitted in Pusan National University Hospital and Choon Hae Hospital during past 5 years from March 1964 to March 1969.
The 50 cases among these cases were performed operation.
The results obtained were as follows.
1) The prodominant diseases producing upper gastrointestinal bleeding were duodenal ulcer (34.4%) gastric ulcer (28.9%), stomach cancer (9.8%), esophageal varices (9.8%) and hemobilia (4.2%) in this order.
2) Sex incidence showed that male to female ratio 3.6:1. The greatest incidence of the disease occured in the age group of 41 to 50 which comprised 42%, the next were 51 to 60 years group 26.6% and the 14.5% were among ages of 31 to 40.
3) Among the 69 cases, hematemesis occurred in 20 cases, melena in 11 cases and hematemesis with melena were in 38 cases. On the average, hematemesis occurred more frequently in esophageal varices, hematemesis with melena were observed more frequently among gastric cancer and peptic ulcer cases.
4) Regarding the degree of hemorrhage, the massive bleeding were observed in 57.4%, moderate degree in 15.2% and minimal in 1.4% among 69 cases.
5) Among the 69 cases, 50 cases were operated on; 14 cases on gastric ulcer, 17 cases on duodenal ulcer, one case on gastric and duodenal ulcer, 5 gastric cancer cases, 2 gastritis cases, 5 esophageal varices, 2 postoperative bleeding cases, 2 hemobilia cases and 2 cases were unclassified hemorrhage.
6) The overall mortality rate was 20.0%; 10 cases among 50 operated cases. one case died of gastric ulcer, comprising 7.6% of the 14 cases, 2 death cases of duodenal ulcer comprising 11.7% of the17 cases, 4 death of esophageal varices comprising 80% of the 5 cases, 2death of hemobilia comprising 100% of the 2 cases and one died of unclassified bleeding 50% of the 2 cases.
7) All the death cases were over 40 years of age.
8) All the death cases were occurres among the massive bleeding cases; Among the 25 cases massive bleeding of total 38 subtotal gastrectomy, 3 died, among total 4 massive bleeding of 5 esophageal varices operation cases 4 died and among 2 massive bleeding cases of total 2 operation cases of hemobilia, all 2 patients died.
9) 15 cases comprising 30% among all 50 cases had complication; Hepatic coma in 5 cases, uncontrolled bleeding in 5 cases, combined shock in 3 cases, paralytic ileus in one case and pneumonia in one case.

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