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KMID : 0371319670090010807
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Journal of the Korean Surgical Society
1967 Volume.9 No. 1 p.807 ~ p.815
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Clinical Observations of Obstructive Jaundice
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秦永燮/Chin, Young Sup
趙明河/金秉洙/金鎭福/閔丙哲/金子勳/秦柄鎬/Cho, Myung Ha/Kim, Byung Soo/Kim, Jin Pok/Min, Pyung Chul/Kim, Ja Hoon/Chin, Byong Ho
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Abstract
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Diagnosis of obstructive jaundice is on occasion very difficult and its management is quite different from that of other hepatobiliary diseases not accompanying jaundice. There are, however, relatively few reports on the subject in Korea.
During the 32 month period, from Jan. 1964 through Aug. 1966, there were 140 patients seen at Seoul National University Hospital, who had obstructive jaundice either clinically or subclinically and in whom the diagnosis was confirmed by surgery.
1. In 67.1 per cent of the cases jaundice was due to benign lesions and in the remaining 32.9 per cent due to malignant lesions. It yielded common bile duct stones in 42.2 per cent of the total cases, while extrahepatic biliary tract cancer was confirmed in 20.8 per cent of the cases.
2. In both benign and malignant groups, male was predominant over female. This was true in the gall bladder cancer group as well as in common bile duct stone group.
3. In 71 per cent of the cases, the age of onset was after 40 years with a peak incidence in the fifth decades.
4. Pain was complained in 65.2 per cent of the patients with malignant lesions in which 20 per cent was colicky in nature. Of the malignant cases, hepatomegaly was observed in 90 per cent whereas the enlarged gallbladder was palpated in only 19.6 per cent.
5. In almost all the cases the direct reacting bilirubin was markedly increased while the indirect reacting bilirubin rose only moderately. This was especially true of malignant obstructions. The highest elevation of total serum bilirubin occurred in the cases with cancer of pancreas head, the average being 17.4 mg % . Alkaline phosphatase was elevated more markedly in the malignant group than the benign group; highest elevation occurred in the cases with carcinoma of the ampulla of Vater, with an average of 28.98 unit. Total cholesterol was normal or decreased in over half the cases in spite of extrahepatic biliary obstruction. Serum glutamic oxalacetic transaminase, cephalin flocculation, thymol turbidity and prothrombin time were all altered if the disease was of long standing.
6. Various operative procedures were performed in the cases; choledochostomy in 84 cases, cholccyste-
ctomy in 80, transduodenal sphincterotomy in 18, by-pass procedures in 21 and pancreaticoduodenectomy in 4.
7. Post-operative complications included 15 cases of lowered renal function with or without acute renal failure and 14 cases of bleeding tendency.
8. Surgical deaths were encountered in 16 cases, or 11.4 per cent of the total. The mortality rate was 3.0 per cent in the benign group and 28.3 per cent in the malignant group.
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