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膽石에 依한 膽道閉塞症에 對한 Biliary By-pass患者에 臨床的 考察

The Clinical study in cases of by-pass procedure of common bile duct obstruction, related to cholelithiasis

대한외과학회지 1970년 12권 12호 p.59 ~ 66
金殷漢, 金洪明, 李燦泳,
소속 상세정보
金殷漢 (  ) - 國立醫療院 一般外科
金洪明 (  ) - 國立醫療院 一般外科
李燦泳 (  ) - 國立醫療院 一般外科

Abstract


The report of Cholelithiasis in Korean was firstly reported by Dr. Ludlaw. Thereafter many authors presented about stone of common bile and intrahepatic duct in Korea, among which Huh and Yun (1963) reported most reliable result of cholelithiasis in Korean, finding of common bile duct stone (75%) and intrahepatic stone (18%) of all cholelithiasis.
In the treatment of cholelithiasis eve habe known well, there is no way except surgery as cholecystectomy, choledocholithotomy, wherease many problem of surgery will be arised in case of intrahepatic, common bile duct stone with stricture of Ampulla, recurrent and sandy- or muddy stone in common bile duct
We used to operate of such cases with choledochoduodenostomy, choledochojejunostomy (Rouxen-Y), hepatomy and hepatic lobectomy. However there is not reporting to be an ideal surgery in-cases of intrahepatic stone in the world.
We operated 26 cases of choledochoduodenostomy and 9 cases of choledochojejunostomy for last 12 years (1958~1970), indicating of surgery: intraheatatic stone, 13 cases (37. 1%), benign stricture of Ampulla 11 cases (31. 4%), sandy or muddy stone 7 cases (20%), recurrent stone 4 cases´ (11.4%), and followed 32 cases (91.2%) for post operative one month to 10 years 6 months, to compare result of both groups of surgery.
1. Most common incidence of age distributions is in the group of 3rd decade of age. Minimal age was 18 years old of age, and maximal, 68 year old.
2. In late complication, 7 cases of cholangitis were readmitted to treate conservatively, among which 5 cases (20. 8%) in 26 cases of choledochoduodenostomy and 2 cases (25%) in 9 cases of choledochojejunostomy were found. 7 cases of cholangitis were mostly related to biliary obstruction, finding of laboratory result.
3. 19 cases (78. 1%) of satisfactory result in 26 cases, operated with choledochoduodenostomy and 7 cases (87. 5%) in 8 cases operated with choledochojejunostomy were found.
There has not been good result comparing with both group of choledochoduodenostomy and choledochojejunostomy, being lesser amount of cases.
4. Discussed with several reports of by-pass surgery in cases of intra-hepatic stone.

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