The author performed clinical analysis of 127 cases with upper gastrointestinal bleeding at the department of surgery. Pusan National University Hospital during 5years period from March 1989 to February 1994. @ES And the results were obtained:
@EN 1) The incidence of upper gastrointestinal bleeding was 2.1% of all patients admitted to department of surgery during period of this study. The causative diseases were gastric ulcer(30.7%), esophageal varix(24.4%) duodenal ulcer(19.7%),
hemorragic
gastritis(14.9%), stomach cancer(7.9%), Mallory-Weiss syndrome(3.2%) and undetermined(1.6%). The ratio of male to female was 6.5:1 and the prevalent age group was 5th-7th decade955.9%). According to seasonal distributions, the most prevalent
season
was
summer in 42 cases(33.1%).
2) Severity of bleeding was 18.9%(24 cases) in mild, 52.8%(67 cases) in moderate and 28.3%(36 cases) in severe bleeding and the mortality rate was 10.4% in moderate bleeding, 30.6% in severe bleeding,
3) Of all 127 cases, 82 cases(64.6%) had a single episode of upper gastrointestinal bleeding, 30 cases(23.6%) with two episodes, 11 cases(8.7%) with three episodes, 4 cases(3.1%) with four or more bleeding episodes, The mortality rate was 8.5%
in
one
episode, 13.3% in two episodes, 36.4% in three episodes, 75.0% in four or more bleeding episodes.
4) The amounts of blood transfusions were 6~10 units in 43 cases(33.9%), 5 units in 31 cases(24.4%). The mortaity rate was 9.3% in 6~10 units, 13.7% in 11~15 units, 40.4% in 16~20 units and 44.4% in 21 units or more transfusion. Upper G-I series
were
performed in 85 cases(66.9%) and the diagnostic accuracy was 74.1% and the endoscopy in 104 cases(81.1%) and the diagnostic accuracy was 91.3%.
5) Of all 127 cases, 119 cases(93.7%) were performed operation. The subtotal gastrectomy was performed operation. The subtotal gastrectomy was performed in 39 cases(32.8%), modified-Sugiura operation(non-shunt operation) in 28 cases(23.5%),
vagotomy
with pyloroplasty in 21 cases(17.7%), total gastrectomy in 19 cases(15.9%), vagotomy with antrectomy in 8 cases(6.7%), and Warren shunt in 4 cases(3.2%).
6) Postoperative complications were occurred 34 cases in 24 patients(20.2%) and wound complication was most frequent in 12 cases(10.1%), followed by pulmonary complication(8.4%), sepsis(2.5%), rebleeding(2.5%), hepatic coma(1.7%), renal
failure(1.7%).
The overall mortality rate was 14.8%(18 cases). The operative mortality was 9.2%(11 cases) and the mortality of cases performed conservative care was 87.5%(7 cases). The major causes of postoperative death were hepatic coma(1.7%), renal
failure(1.7%),
sepsis(1.7%), pneumonia(1.7%), pulmonary edema(1.7%) and hemorragic shock(0.8%).
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