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消化性潰瘍 (胃 , 十二指腸) 및 胃癌의 外科合倂症에 對한 臨床的 觀察

A Clinical Review of Complicationg Gastroduodenal Ulcer and Stomach Cancer

대한외과학회지 1970년 12권 4호 p.31 ~ 46
구범환,
소속 상세정보
구범환 (  ) - 우석대학교 의과대학 외과학교실

Abstract


This report is a clinical review of experiences with 515 cases of comlicating gastroduodenal ulcer, and stomach cancer which were treated surgically at the Woo Sok University Hospital from Oct., 1959 to Cct., 1969.
1) Among the compliating stomach cancer and gastrodenal ulcer group, a group of pyloric stenosis was the most common incidence involving 264 cases (51.26%) and the remaining cases include 189 cases (36.69%) of gastroduodenal perforation, 62 cases (12.03%) of hemorragic complication of gastric cancer and gastroduodenal ulcer.
2) The 183 cases of gastric ulcer group include 146 cases (79.78%) of perforation, 21 cases (11.47%) of pyloric stenosis, and 16 cases (8.74%) of hemorrhage. The 87 cases of duodenal ulcer group include 47 cases (54.02%) of pyloric stenosis, 31 cases (35.77%) of perforation, and 9 cases (10:14%) of hemorrhage. The 245 cases of gastric cancer group include 196 cases (80.0%) of pyloric stenosis, 37 cases (15.1%) of hemorrhage, and 12 cases (4.9%) of perforation.
3) The sex distribution assumed a ratio of 5.6 to 1 with 437 males and 78 females, in perforation group, the ratio, 12:1, in pyloric stenosis group, the ratio, 3.6:1, in hemorrhage, group the ratio, 5.9:1.
4) The age distribution indicated a predominant incidence between the age of 4th to 6th decade (75.13%).
In the group of gastroduodenal perforations, the age distribution indicates a predominant incidence in 4th decade, and in hemmorrhage group in 4th decade, in pyloric stenosis group, in 6th decade.
5) The seasonal distribution indicated a predominant incidence in Autumn (30.28%).
6) Duration of pervious gastric trouble in complicating peptic ulcer and gastric cancer were as follows: 372 cases (72.62%) were below 5 years, and the remainder were over 5 years.
In gastroduodenal perforation, group the duration of gastric trouble, bron 1 to 5 years, wasin 67 cases (35.32%), over 5 years in 44 cases (23.28%).
In hemorrhage group, 6 month to 1 year in 34 cases (54.83%), 1 to 5 years in 14 cases (21.29%) and in pyloric stenosis group, 1 to 5 years in 65 cases (24.62%), 6 month to 1 year in 115 cases (43.56%).
7) The cases who were operated within 24 hours after onset (Except stenosis) were 184 cases (73.21%).
8) The patients with past history include 216 cases (80.59%) of weights loss, 49 cases (18.29%) of hemorrhage and 3 cases (1.02%) of perforation.
9) The patients who required preoperative transfusion were 118 cases (22.91%).
10) Demonstration of pneumoperitoneum by plane X-ray was noted in 164 cases (92.65%). Of the patients with gastroduodenal perforation, gastroduodenal ulcer perforation were in 154 cases and gastric cancer perforation were in 10 cases (90.90%). The most frequent location of perforation was anterior wall of stomach and duodenum (89.7%) in gastroduodenal perforation.
11) In peripheral hemoglobulin value at admission, hemoconcentration and anemia were noted in 126 cases (24.50%) and in 107 cases (20.77%) respectively, and leucocytosis and leucopenia in 214 cases (41.55%) and 62 cases (12.03%) respectively.
12) The commonest size of the perforated orifice was within 5mm in 99 cases (65.62%).
13) As for the operative fashion in 515 cases: Subtotal gastrectomy was done in 226 cases (43.88%), simple closure in 148 cases (28.75%), gastrostomy in 58 cases (11.26%), subtotal gastrectomy with vagotomy in 51 cases (9.9%), open and closure in 19 cases (3.79%), and pyloroplasty with vagotomy in 6 cases (1.16%).
As for commonest operative fashion in each complicating group: Subtotal gastrectomy was done in 44 cases (70.9%) among 62 cases of hemorrhage group, subtotal gastrectomy in 161 cases (62.08%) among 264 cases of stenotic group, simple closure in 148 (78.3%) among 189 cases of perforating group.
14) Early postoperative compaciltions were noted in 88 cases (17.08%), and the most common comlication is operative wound infection in 39 cases (44.3%) of 88 cases.
15) Of the 515 cases, the postoperative mortality rate was 5.43%. In the peptic alcer group, the mortality rate was 4.8% and in the gastric cancer group, the mortality rate was 6.11%.

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