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膽囊炎에 對한 臨床的 考察

Clinical Study of 254 Cholecystitis

대한외과학회지 1970년 12권 12호 p.37 ~ 45
朴建春, 金鏞日, 金晋煥,
소속 상세정보
朴建春 (  ) - 서울대학교 醫科大學 外科學敎室
金鏞日 (  ) - 서울대학교 醫科大學 外科學敎室
金晋煥 (  ) - 서울대학교 醫科大學 外科學敎室

Abstract


254 consecutive cases of various cholecystitis which had been treated surgically at the Dept. of Surgery of S. N. U. H. from Jan. 1963 to July 1970 were analized.
1. Patterns of the 254 cases were acute cholecystitis in 6% and chronic in 94%, 74% of the cases had stones. Associated diseases were empyema gall bladder (24%), peritonitis (4%), cholangitis (10%), ascaris migration into the biliary tracts, clonorchiasis, biliary fistula, liver abscess, hepatitis, biliary cirrhosis, pancreatitis and diabetes.
2. No significant difference in sex distribution was noticed, and the highest incidence was found in 5th and 6th decades of their lives.
3. The locations of stones were gall bladder in 64%, biliary tract in 60% and intrahepatic ducts in 9%.
4. Average period of ´ remote onset was over 5 years, and average period from recent onset to entry 4 days. The prominent symptoms and signs were right upper quadrant abdominal pain and tenderness, radiating pain, fever, jaundice, vomiting, leukocytosis, hyperbilirubinemia and increased serum alkaline phosphatase level.
5. Types of operations comprised cholecystostomy (7 cases), choledochotomy (7), simple cholecystectomy (45) and cholecystectomy with choledochotomy (198), and in rare cases which had special problems choledochoduodenostomy, choledochojejunostomy, left´ hepatic lobectomy had been also performed.
6. Bile cultures disclosed coliform bacilli (80%), alpha-hemolytic streptococci, staphylococci most frequently, and salmonella typhi in single case.
7. Complications occurred in 28% of the total cases, and 30% of them needed reoperations. Such as residual stones, bile leakage, ascaris remigrations into the biliary trees and wound infections were frequent and important complications.

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