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KMID : 0438219740110010565
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Korea University Medical Journal
1974 Volume.11 No. 1 p.565 ~ p.573
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Clinical Observation of the Surgical Biliary Tract Disease
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Abstract
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This report is a review of our experience with 231 cases of biliary tract diseases which underwent Surgery at Korea Medical College Hospital during past 14 years from July 1959 to June 1973.
The pathological conditions requiring surgical interventions in these 231 patients were 132 (57.1%) cases of cholecystitis with stone 51(22.1%) cases of cholecystitis without stone respectively.
Among the 231 cases, 24 (10.4%) cases had ascariasis and clonorchiasis in common bile duct. The above report shows special aspect of biliary. tract diseases in Korea.
The sex ratio was 1 male to 1.26 female, average being 44.5 years of age and the youngest was 21 months old female who was complicated by bile peritonitis.
During operations, stones were found in 132 (57.1%) cases, 33 (25.0%) were in gall bladder alone, 63(47.7%) were both in gall bladder and common bile duct.
Common bile duct stones were found twice as frequent as stones in gall bladder. The symptoms and signs and obtained were pain, nausea and vomiting, chill and fever, jaundice, tenderness, rigidity, and palpable mass.
Almost 70% of the 231 reported offered a history of two or more previous attacks of biliary colic. Our statistical study in this investigation proved that 33.8% of all the cases had two to five month´s duration since thefirst episode of attack. 96(52.5%) and 93 (50.8%) cases out of the 231 cases showed elevated bilirubin values, ranging from 1.6mg% to 3mg% and alkaline phosphatase, 4 to 10 Bassay-Lowry unit respectively.
Eithty point six percent were operated within 72 hours after admission.
Oral and IV cholangiography were performed in 105 (45.5%) cases. Nonvisualization of gall bladder and common bile duct was noted in 84 (80%) cases, 66 (66.7%) cases respectively.
By IV cholangiography, visualization of the common bile duct without showing gall bladder was -n noted in 33 (33.7%) cases.
The incidence of false negative cholecystogram was considerably high (19.4%)
Dilatation of common bile duct was revealed in 126 (54.6%) cases of all the cases macroscopically at the time of laparotomy.
Among 24 cases in this study, ascaris and clonorchis sinensis in common bile duct were present eighteen_ cases had simultaneous stones.
Among 189 cases of cholecystectomies common bile duct exploration was done, cholecystostorly { only was done in 18 cases (7.8%) becaucse of poor general doncition.
Eleven patients had severe wound infection; 9 cases (3.9%) of residual stones; 5cases (2.2%) of bile peritonitis were the major complications. The mortality was 5.2%
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