It has been suggested that the clinical picture of cholelithiasis in Korean patients may be different to that of Occidentals,as it is reported by the late Professor Ludlow (1930) of Severance Union Medical College. Although a number of gallstone patients are frequently operated by surgeons in Korea, report for systemic evaluation of the Korean cholelithiasis is not fully available yet.
In order to compare a clinical picture of cholelithiasis in Korean with that of other countries; author collected and analyzed records of patients whose gallstone was confirmed after operative intervesion. And the following observations are made and reported.
100 cases of gallstone patient were operated at the Department of general surgery Yonsei-Universtiy Medical Center for the years of 1958 to 1962 inclusive. Total number of patients ´admitted to the hospital at the same period is 22,505, number of general operations is 12,373, and number of laparotomies is 2,674.. Incidence of gallstone to general admission patients is about 0.44%, and frequency of gallstone operations to that of general operation and laparotomies is 0.87% and 3.74 respectively.
The average age of the patients is 43.4 years in male and ´48.6 years in female. The youngest patient was 12 years of age and the oldest was 77 years of age. The age of peak incidence is between 41 to 50 (31 cases, or 31%). There are 62 female and 38 male patients and sex ratio is approximately 1.63:1.
Most of gallstones in Occidentals are found in the gallbladder, whereas in Korean 49%´ of total gall stones are encountered in the bile ducts, including intrahepatic ducts. Choiedocholithiasis is more frequently encountered in male and in the younger age group. All patients under the age of 20 had stones in bilia yrducts only.
Of the 100 cases, gall bladder stones are found in 23, ductal stones are found in 49, and 28cases are the patients who had stones in both gallbladder and bile ducts including hepatic ducts. Among the all cases, 19 patients had stones in their hepatic ducts, 3 in right hepatics, 8 in left, and the other 8 in both sides of hepatic ducts.
The severity and intensity of symptoms and signs of Korean gallstone patients may be caused by predominance of gall-stone in the hiliary duct, The most prominent. symptoms and ´ signs are pain (91%) in right upperquadrant of abdomen with or without radiation to the right shoulder. The jaundice (66%) and fever with or without chill (60%) are encountered more often in Korean than in Occidentals. Twelve cases had ascaris in their common duct associated with stones. Eleven cases of acute obstructive suppurative cholangitis were observed. 10 of them were completely cured after primary or divided operative procedures and one-of--them could not be, cured but expired from the impaired liver functions.
The total number of cholecystectomy was 83, and choledochostomy 81. Relatively high percent of common duct exploration reflects high incidence of common bile duct stones. Discussion for the other operative procedures was mentioned in detail.
There are 4 deaths in the 100 patients or a mortality of 4% Two of them died by early and late complications of acute pancreatitis each. One died from postoperative bleedings, and this was probably caused by markedly impaired liver functions. The other one patient could not be recovered from acute obstructive suppurative cholangitis even after an emergency decompression procedure was carried out.
|