Læknablaðið - 01.08.1975, Page 20

50
LÆKNABLAÐIÐ
TABLE 15
Age at Death post op.
Age at Death Men Women
20-29 years 3 1
30-39 — 5 1
40-49 — 4
50-59 — 3
60-69 — 3 4
70-79 _j—_____________________2
18 8
Total
4
6
4
3
7
2
26
þeirra er (late results). Við vitum ekki,
hversu margir þessara sjúklinga fá sár á
ný. Það er heldur ekki vitað, hver er tíðni
alvarlegra meltingartruflana eftir þessar
aðgerðir, hvorki er varðar ,,Dumping“
syndroma né „resorptions“ truflanir.
Þegar fyrir liggur skýrsla (statistic) um
frambúðarárangur (late results) þessara
aðgerða, þá getum við lagt ákveðnari plön
varðandi aðgerðir við maga- og skeifu-
garnasárum í framtíðinni.
Við megum þó aldrei gleyma því, að
það er ekki nóg að velja úr þá sjúklinga
með maga- eða skeifugarnarsár, sem við
álítum að þarfnist aðgerðar, heldur er
vandinn ekki síðri að velja réttu aðgerðina
fyrir hvern sjúkling.
HEIMILD
1. Hjartavernd, 1. tbl. 7. árg., bls. 7. 1970.
SUMMARY
All patients with the diagnosis of peptie ulcer
of he stomach and duodenum (ulcus ventri-
culi or ulcus duodenl) admitted to the Sur-
gical Department of the University Hospital,
Landspitalinn, Reykjavik, during the period
1931-1965 are accounted for. This is a total of
1037 patients, 749 men and 288 women (men:
women ratio = 2.6:l). With both sexes ulcus
ventriculi is more common than ulcus duo-
deni. Among men the ratio is 1.13:1 and with
women 1.34:1. This ratio is not known in
other hospitals in Iceland. Neither is the total
frequency of this disease in Iceland known,
but it is, however, seen from the Hjartavernd
report that just over 10% of all men examined
there (1970) have been in hospital owing to
ulcus ventrieuli or uicus duodeni before
reaching the age of 55 years.
Out of these 1037 patients 880 underwent
surgery, 660 men and 228 women (2.9:1).
An account is given of symptoms, age-
groups, indications for surgery, types of sur-
gery, complications and post-operative mor-
tality. 99 patients were admitted acute due to
perforatio ulceris, 81 men and 18 women
(4.5:1). 71.7% entered the ward within 12
hours after perforation but 28.3% later, and
with a third of them over 24 hours had passed
since perforation. In the case of 1 patient 4
days had passed and he survived after sur-
gery.
Out of the men having perforation 61.7%
had ulcus ventriculi, 34.6% ulcus duodeni
and 3.7% multiple duodenal ulcers.
Out of the women having perforation 72.2%
had ulcus ventriculi, but 27.8% ulcus duodeni.
Post-operative mortality in the group with per-
forations was 2%.
279 patients or 26.9% (28.4% of men and
22.9% of women) had a history of a major
bleeding, hematemesis and/or melena once or
more often.
Emergency operations on account of bleed-
ing were performed on 14 patients, 7 men
and 7 women (1:1) or on 5.1% of the patients
who had developed major bleeding.
3 of these 14 patients died after surgery
(21:4%) all of them being women. The average
age of the women who were operated acute on
account of bleeding was considerably higher
than that of the men.
In 4.8% of those cases who underwent elec-
tive operation the indication for surgery was
major bleeding without there being a case of
acute operation.
4 patients died of bleeding before it was
possible to resort to surgery.
During this period 760 eleetive resections
were performed on 560 men and 200 women
(2.8:1). These were 326 Billroth I Operations
and 421 Billroth II. Throughout the period 21
patients died, representing 2.8% mortality.
During 1932-1945 post-operative mortality was
15.7%, but during 1946-1955 1.1% and during
1956-1965 the post-operative mortality was 1%.
But during this period, i. e. 1946-1965, 666
gastric resections were performed or just over
88% of the total.
Follow-up studies are now being conducted
after these operations. When these are com-
pleted a good comparison will i. a. be obtained
of the results of Billroth I, on the one hand,
and Billroth II surgery, on the other, as
Billroth II is the main type of surgery from
1931 till 1954, but Billroth I thereafter.
Since 1965 we have performed more and
more of anthrectomies and vagotomies or
vagotomies + some drainage operation.
It is emphasized that it is not sufficient to
select the patients having ulcus ventriculi or
ulcus duodeni whom we consider should be
operated, but the problem is no less that of
selecting the right type of surgery for each
individual patient.