非貫通性 腹部外傷으로 因한 脾臟破裂의 臨床的 觀察

睦敦相(Don Sang Mok),崔弘益(Hong Ik Choi) 대한외과학회 1970 Annals of Surgical Treatment and Research Vol.12 No.4

肝 “디스토마” 成蟲에 依한 總膽管 閉鎖의 2例

金漢仲(Han Joong Kim),崔弘益(Hong Ik, Choi),任東安(Dong An Lim),金觀洙(Kwan Soo Kim) 대한외과학회 1968 Annals of Surgical Treatment and Research(ASRT) Vol.10 No.9

糞石으로 因한 小腸閉鎖症 2例

韓相弼(Sang Pil Han),金武觀(Moo-Known Kim),金龍吉(Yong Kil Kim),崔弘益(Hong Ik Choi),權泰升(Tae Sung Kwon) 대한외과학회 1967 Annals of Surgical Treatment and Research Vol.9 No.11

穿孔性 胃·腸管系疾患의 統計學的 觀察

崔弘益 우석대학교 의과대학 1969 우석의대잡지 Vol.6 No.1

This reports a clinico-statistical review of experience with 232 cases of gastrointestinal perforations which were treated surgically at the Woo Sok University Hospital from January, 1960 to August, 1968. 1) Gastric ulcer perforation was the most common incidence, 95 cases (40.9%), and the remaining cases included 58 cases (23.0%) of abdominal traumatic intestinal perforation, 26 cases (11.3%) of duodenal ulcer perforation, 20 cases (8.6%) of typhoid fever intestinal perforation, 10 cases (4.3%) of gastric cancer perforation, 8 (3.4%) cases of iatrogenic intestinal perforation, 6 cases (2.6%) of Meckel's diverticulum perforation, 5 (2.2%) cases of mechanical ileus perforation, and 4 cases (1.7%) of other perforation including 2 cases of colon cancer perforation, and esophageal rupture and regional enteritis perforation, 1 case respectively. 2) The sex and age distributions are 201 males and 31 females with ratio of 6.3 to 1 and predominant in 4th decade (33.2%). 3) The seasonal distribution was predominant in Summer (30.6%), and the monthly distribution, predominant in July (12.9%). 4) The cases who operated between 13 hrs. and 24 hrs. after onset were 52 cases (25.3%) which were greatest numbers among the time interval groups. 5) Demonstration of free air by plain X-Ray was noted in 172 cases (85.9%), of the patients. 6) Among 219 cases checked C. B. C., hemoconcentiation and anemia were noted in 68 cases (31.5%) and 27 cases (12.3%) respectively, and the leucocytosis and leucopenia, in 137 cases (62.6%) and 57 cases (26.0%) respectively. 7) The commonest size of the perforation opening was within 5 mm(54.6%). 8) As for the operative fashion in 232 cases; 176 cases (75.9%) were for simple closures and 56 cases (24.1%) for immediate resections. 9) The early postoperative complications were noted in 52 cases (25.6%) and the most common complication was operative wound infection (14.8%). 10) The postoperative mortality rate was 11.2%. 11) In pathological gastroduodenal perforations, 131 cases (55.5%) ; The ratio of gastric ulcer perforations and duodenal ulcer perforations was 3.7:1 and that of gastric ulcer perforation and gastric cancer perforation, 9.5:1. The sex ratio was 15:1 with prevalence in male, and in gastric ulcer perforations, the ratio, 15:1, in duodenal unlcer perforations, the ratio, 25:1, and in gastric cancer perforations, the ratio, 9:1. In peptic ulcer perforations of stomach and duodenum, the age distribution indicates a predominant incidence in 4th decade, and in gastric cancer perforations, in 5th decade. The monthly distribution in gastric ulcer perforations was 34 cases (35.7%) in October, November and December ; in duodenal ulcer perforations, 11 cases (42.4%) in July, August and September. The duration of symptoms in 131 cases showed that the duration between 1 year and 5 years was most frequent in the majority group (44.8%). In gastroduodenal peptic ulcer perforations, the perforations were less frequent in eating time of 10 hours in a day (20%). The cases who operated within 24 hrs. after onset were most common (72.6% ). The demonstration of free air by plain X-ray was noted in 98.1% in gastroduodenal ulcer perforations, and 100% in gastric cancer perforations. The most frequent location of perforation was anterior wall of stomach(92.3%) in gastric ulcer perforations, anterior wall of duodenum (83.8%) in duodenal ulcer perforations and anterior wall of stomach in all cases of gastric cancer perforations. The size below 5㎜ of perforation orifice was 63.2% in gastric ulcer perforation, 87.5% in duodenal ulcer perforation, and in gastric cancer perforation, the size between 5.1-10㎜ was 75%. As for the operative fashion; For simple closures, 95.5% were in gastric ulcer perforations, 88.5% in duodenal ulcer perforations and 50% in gastric cancer perforations. For immediate resection, 9.5% in gastric ulcer perforation, 11.5% in duodenal ulcer perforations, 50% in gastric cancer perforation. The early postoperative complication; 17.5% in gastroduodenal ulcer perforations, 37.5% in gastric cancer perforations. The postoperative mortality; 5.3% in gastric ulcer perforations, 3.8% in duodenal ulcer perforations, 20% in gastric cancer perforations. 12) Abdominal traumatic intestinal perforations, 58 cases (25%), was divided in non-penetrating injuries, 44 cases (19.8%) and penetrating injuries, 14 cases (6.1.%). And in non-penetrating injuries, the commonest cause was traffic accident (50%). Penetrating injuries were included stab wound, 10 cased, and gun shot wound, 4 cases. The sex distribution assumed a ratio of 5.4:1 with 49 males and 9 females. The age distribution indicated a predominant incidence in 3rd decade (31.0%), and 47 cases(80.9%) between 21-40 in years of age, were involved out of all cases and especially in stab wound was all in 11-30 in age. The seasonal distribution indicated a remarkable predominant incidence in Summer(41.4%) and least incidence in Winter (6.8%). The cases who operated within 6 hrs. from onset was most common (39.1%), and within 24 hrs., 80.4%. Demonstration of free air by plain X-Ray was noted in 82.9%, and in non-penetrating wound, in 89.7%, and in stab wound, in 50%. The locations of perforations in nonpenetrating injury were in small intestine (95.5%) and stomach (4.5%), and the most frequent location of non-penetrating injuries was in small intestine within 1m from ileocecal junction or Treitz ligament(72.7%). Among all 44 cases of non-penetrating injuries, associated injuries of other abdominal parts were 44.7%, and especially the rupture of mesenterium were 47.6% in small intestinal perforetions, and the stab wound, 10 cases, all were in stomach except for 1 case in colon. The commonest size of perforation opening was between 5.1-10㎜ (41.4%) in nonpenetrating wound, and in stab wound, within 5㎜ (62.5%). As for the operation ; 67.3% was for simple closures, 37.2% for immediate resections. The early postoperative complication was 23.9%, and most common complication was operative wound infection (15.2%). The post-operative mortality was 10.3%. 13) In typhoid perforations, 20 cases (8.6%) : the sex ratio was 9:1. The most common decade in incidence was in 3rd decade (45%), and the most common age group was 11-40 age (85%), the most common occurrence in season was in Summer (40%), and the duration of fever before the perforation was most common between 11-20 days (52.9%). but the cases below 10 days was 29.5%. The cases who operated above 49 hrs. from onset was 61.1%. The positive Widal test was in 27.8% of all cases. The demonstration of free air in plain X-ray was in 70.6%. The number of perforation openings was one in majority of cases (95.2%) and all were located within 90㎝ from ileocecal junction and the size of perforation was most common in that within 5㎜ (57.1%). As for surgical procedures; simple closures in 80%, resections in 20%. The early post-operative complications were in 27.9%. The post-operative mortality was 30% . 14) Iatrogenic perforations, 8 cases (3.4%); the sex ratio was 1:7 with 1 male and 7 females and peak in 4 the decade. The cases who operated more than 24 hours after onset were 83.3%. Demonstration of free air in plain X-Ray was in 75%. The intestinal perforations after malapplication of curettage for abortion (D&C), 7 cases, were located in ileum within 30㎝ from ileocecal junction(3 cases), cecum (2 case), rectum (1 cases), and sigmoid colon (1 cases). The szfe of perforation openings were all within 10㎜. in diameter. The post-operative complications were in 75.0% and the post-operative mortality, 37.5%. 15) Perforations of Meckel's diverticulum, 6 cases (2.6%); the 3 cases in males less than one year of age, the other 3 cases in female in 3rd decade. All the patients were undergone operation more than 25 hours. after onset. And the locations of perforation were all in ileum within 60㎝ from ileocecal junction. The post-operative mortality was 50%. 16) Perforations due to mechanical intestinal obstruction, 5 cases (2.2%); volvulus of ileum(1 cases), post-operative intestinal adhesion of ileum (3 cases), internal hernia of jejunum (1 case).