外科診療와 獸因性疾患

睦敦相 최신의학사 1975 最新醫學 Vol.18 No.10

膽道減壓術에 關한 實驗的 硏究

睦敦相 고려대학교 의과대학 1974 고려대학교 의과대학 잡지 Vol.11 No.2

膽道減壓術에 關한 實驗的 硏究

睦敦相,金世民 고려대학교 의과대학 1974 고려대 의대 잡지 Vol.11 No.2

As one of researches on biliary tract, authors at the department of general surgery performed 13 kinds of biliary decompression, 1. cholecysto-jejunostomy, 2. cholecystojejunostomy with enteroenterostomy, 3, cholecysto-jejunostomy Roux-en-Y, 4. cholecystoduodenostomy, 5 . cholecystogastrostomy, 6. choledochoduodenostomy, 7 . choledochojejunostomy, 8. choledochojejunostorny with enteroenterostomy, 9. choledochojejunostomy, Roux-en-Y 10. choledochoduodenostomy and cholecystectomy, 11. choledochojejunostomy and cholecystectomy, 12. choledochojejunostomy with enteroenterostomy and cholecystectomy, 13. choledochojejunostomy Roux-en-Y and cholecystectomy in 105 mongoreal adult dogs in 10 days after complete ligation of common bile duct. Changes of hematologic values, liver function tests, and histopatboloogical findings of hepatobiliary system were observed in normal group, and these results were further observed on the 10th day after common bile duct-ligation and on the 42nd day after biliary decompression. Bacteriological findings of bile, changes of the size of an anastomotic stoma, and biliary-intestinal reflux were observed on the 42 nd day after biliary decompression. The results obtained are as follows: 1. Changes of hematologic values There were leukocytosis in the groups of common bile duct-ligation and 13 kinds of biliary decompression. Hemoglobin was decreased after common bile duct ligation and returned to normal level in 42 days after biliary decompression. There were no remarkable changes in R.B.C. and hematocrit. 2. Liver function test In liver function test, total protein in serum was slightly decreased in the ligated common bile duct group and common bile duct-ligation and cholecystectomy group compared with the control group, but returned to normal level in 42 days after biliary decompression. A/G ratio was more slightly decreased in the common bile duct-ligation group than in the common bile duct-ligation and cholecvstectomy group. It returned to normal level in 42 days after biliary decompression, but the grade of recovery was delayed in choledocho-enterostomy and cholecystectomy group. Compared with control group, the ligated common bile duct group and the common bile duct-ligation and cholecy stectomy group revealed a remarkable increment of alkaline phosphatase in l0 days after common bile duct ligation; the increment was more remarkable in the common bile duct-ligation and cholecystectomy group. It returned to normal level in 42 days after, biliary decompression, but the grade of recovery was delayed in choledochoenterostoniy and cholecystomy group. Total cholesterol in serum was more increased in the common bile duct-ligation and cholecystectomy group than in the common bile duct ligation group, but in 42 days after biliary decompression the two groups returned to normal level similarly. S-GOT was commonly increased in the common bile duct ligation group and the common bile duct-ligation and cholecystectomy group. On the 42nd day after biliary decompression it returned to normal level, but the grade of recovery was delayed in choledochoente rostomy and cholecystectomy group. S-GPT was higher in the common bile duct-ligation and cholecystectomy group than in the common bile duct-ligation group, but in 42 days after biliary decompression the former group returned to normal level more rapidly than the latter. Thymol turbidity and the total bilirubin were higher in the common bile duct-ligation and cholecystectomy group than in the common bile duct-ligation group, but in 42 days after biliary decompression the two groups returned to normal level similarly. 3. Bacteriological findings of bile On the 42nd day after biliary decompression in the direct smear of bile, bacteira were demonstrated throughout the whole groups, but somewhat less in the biliary decompressed group operated after common bile duct-ligatior. and cholecystectomy. Gram negative bacilli were mostly. In bacterial culture, bacteria were demonstrated in all groups, where E. Coli, enterococcus, and Proteus species were seen. 4. Changes of the size of an anastomotic stoma On the 42nd day after biliary decompression in all groups, the size of anastomotic stomas was decreased by the range from 25.9% to 50%. 5. Biliary-intestinal reflux On the 42nd day after biliary decompression, the biliary-intestinal reflux was more remarkabley revealed in cholecystogastroenterostomy group than other groups and the slightest in choledochoenterostomy and cholecystectomy group. Comparing with each biliary decompressed group, the authors observed the slightest reflux in choledochoduodenostomy group and choledochojejunostomy Roux-en- Y group and choledochojejunostomy Roux-en-Y and cholecystectomy group; the result was the best in choledochojejunostomy Roux-en-Y and cholecystectomy group among them. 6. Histopathological findings of hepato-biliary system In the common bile duct-ligation group, bile-pigmented granules in Kupffer's cells and hepatic cells (more remarkable in Kupffer's cells), bile plugs in canaliculi, and centrilobular bile stasis were moderate; decreased glycogen amount, ductular dilatation, and ductular proliferation were moderate; centrilobular necrosis was slight; dilatation of central veins and sinusoids and Kupffer's cell mobilication were slight; increase and thickening of collagen fibers in amount and lynphocytic, histiocytic, and neutrophilic infiltration were severe. In the common bile duct-ligation and cholecystectonny group, the histopathological findings revealed similar result with the foraer except that the bile plugs i n canaliculi and centrilobular bile stasis were more severe; the ductular dilatation and proliferation were more severe; the centrilobular necrosis was moderate; Kupffer's cell mobilization was moderate. In general, the histopathological findings on the 42nd day after biliary decompression revealed more remarkable recovery to normal level in the 13 groups of biliary decompression than in the common bile duct-ligation either with or without cholecystectomy. And though bile pigmented granules, stasis, ductular dilatation and proliferation, decreased glycogen amount, necrosis of hepatic cell, dilatation of central vein and sinusoids, and the inflammatory reaction were slightly demonstrated in the 13 groups of biliary decompression, they returned to normal level remarkably. There were not any significant differences among (gall bladder in situ), B. Choledochoenterostomy group (gall bladder in situ), C. Choledochoenterostomy and cholecystectomy and group, but the groups of gall bladder in situreturned to normal somewhat slowly with respect to the inflammatory reactions and hepatic cell alteration. Especially in choledochoduodenostomy and choledochojejunostomy Roux-en-Y group revealed excellent grade of recovery, on which biliary decompression was operated after common bile duct-ligation and cholecystectomy.

外傷性 肝 損傷

睦敦相,金道植(Kim, D.S.),韓應(Han, E.J.),裵金龍(Bai, K.R.),柳斗烈(D.Y. Yoo) 대한외과학회 1970 Annals of Surgical Treatment and Research Vol.12 No.9

乳兒 腦水腫의 外科的 經驗

睦敦相,金淳郁 醫藥係社 1958 綜合 醫學 Vol.3 No.3

中樞 神經病變이 腸運動에 미치는 影響에 關한 臨床的 및 實驗硏究

睦敦相 醫藥係社 1961 綜合 醫學 Vol.6 No.7

一般外科領域에 있어서의 四肢痛

睦敦相,金世民 亞洲藥品 1987 臨床 醫藥 Vol.3 No.8

穿孔性腹膜炎을 이르킨 S 狀結腸癌의 二 治驗例

睦敦相,宋榮冕,李通勳 醫藥係社 1960 綜合 醫學 Vol.5 No.8

外科的 疾患과 糖尿病

睦敦相 대한의학협회 1976 대한의학협회지 Vol.19 No.3

最近 一般外科의 槪略

睦敦相 韓國醫藥雜誌社 1961 韓國醫藥 Vol.4 No.2