J.Jpn. Surg. Soc.. 60(3): 493-511, 1959
CLINICAL STUDY ON GALLSTONE (Report I.)
SECTION I.
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Department of Surgery, Nippon Medical School (Director: Prof. Saburo MATSUKURA) Minoru YOSHIDA |
1. Of the 317 cholecystitis patient operated up to the end of 1956, 202 cases had stones and 115 did not.
The ratio between the two is 1.75 : 1.
2. Of the 202 stone cases 89 were male and 113 were female. The proportion is 1: 1.27, but the ratio for cholesterin stone patients is 1: 2.1.
3. There were no constant co-efficiency between married women and pregnacy.
4. The first attack of the bilirubin type and the cholesterin type was mostly between the ages of 41 and 50. In the bilirubin cases 24% were under the age of 40, and 42% over the age of 50, a contrasting age relation is observed in cholesterin type. There was only one case where the disease set in under the age of 20.
5. As to the trias of the gallstone, 89.5% of those cholesterin types and 100% of those bilirubin types had upper abdominal pains and as a whole they were in 94%.
Cholesterin types, 55.0% and bilirubin types, 65.8%, or 62.1% of the whole, had fever. Jaundice was 63.6% with 62.1% for cholesterin types and 75% for bilirubin types. Jaundice was more in cholesterin cases and although there was more choIecystolithiases there, the frequency of jaundice was high. As regards to cholecystolithiasis alone, 60% were cholesterin types and 50% bilirubin types, and the cholesterin type showed a higher frequency of jaundice. There were 30.6% of cholesterin type and 47.6% of bilirubin type that had the trias at the same time.
6. Gastric juice of the cholecystitis patients, regardless of the kind of stones, was either anacid or hypoacid approximately in 70%.
7. At Laparotomy the cholecyst showed no relations to the number of white blood cells. Of the 20 cases of necrotic cholecystitis, 7 did not show leukocytosis. This should be remembered at clinical examinations.
8. The position of the stone is, in th case of the cholesterin type mostly the gall bladder. Of the 96 cholesterin 80 or 83% were cholecystolithiasis. In case of the bilirubin type, it was mostly choledocholithiasis. Only 25 of 79 cases or 32% showed cholecystolithiasis.
9. Seventeen cases of 18% of all 94 cholesterin types and 54 caces or 73% of all 74 of bilirubin types soowed bile duct dilatations at laparotomy. There were few instances where cholecystolithiasis showed bile duct dilations.
10. In 94 instances that had stones, 76.5% of the biliary juice taken from the cholecyst at laparotomy showed bacteria. Here the bacteria were overwhelmingly, 86%, of the coli group. It was apparent that the proportional difference of the bacilli related to the type of stone ; 92% bilirubin types and 57.8% of cholesterin types.
11. The most popular complication in cases of gallstone was chronic appendicitis with 19 in 94, or 20.2%, for choresterin stones; and 8 in 74, or 12.5% in bilirubin stones. Pancreatitis were seen in 7.5% of the cholesterin types and 6.5% in bilirubin types. There was one case of acute pancreatitis complicated with bilirubin stone. Gastroduodenal ulcer was in 5.3% of cholesterin cases and 5.4% of bilirubin cases. There were only two instances of parasite complication.
II. Diagnosis of Gall stone
1. Of the 202 cases, 190 cases or 84% were properly diagnosed at the time of admission. The other 12 cases were wrongly designated as the ulcer, carcinoma or perforation of the stomach and as intestinal invagination or abscess on the abdominal wall.
2. Examining 94 gallstone cases by our telepaque-biligraphin combination, 86 cases or 92% were diagnosed correctly. We also noticed that this combination was effective to find not only gallstones but for other ailments of the digestive system.
III. Therapeutic Results of Gall Stones.
1. As a result of examinations conducted in 3 different times, i.e., 1936-1944, 1946-1948, 1948-1956, the 3rd period showed the best record with the improvement of operation.
The death rate was 4.6% in those that had stones and zero in those that did not have stones. Upon 7 autopsies in the 3rd period, we found 2 with acute cardiac insufficiency. The E.C.G. of 57 gallstone cases out of 84 showed abnormality. From these facts we found in treating gallstones, it seems necessary to give special protection to the heart before and after operation. End resuits for the complete cure in bilirubin cases were 81.2% and in cholesterin cases 52.0%. Postoperative complaint for dull epigastralgia was 62.5%, for poor appetite 27.6%, for general lassitude 24.1%, nausea 20.7%, jaundice 20.7% and fever 10.3%. We saw toat dull epigastralgia to be the most common.
(author's abstract)
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