抄録
The follow up study of treatment of the cholelithiasis is quite useful on making choice of surgical or medical procedure on handling the patient at the time of admission. We have been studying the cases of gallstones from 7 months to 15 years after treatment by postcard examination, and we had 85 answers of the surgically treated cases (86.9%) and 15 answers of the medical cases (50%).
The incidence of the disease is slightly higher in females, The stone in gallbladder is more frequent than the cystic-duct-stone. Six patients became disabled post-operatively (7.7%), this would be better than the published report in past (10%), whereas two medically treated cases lost their activities (14%).
The subjective symptomes after treatment are rather few in the medical cases, but 22% of the operated cases complain of slight stiffness of the back. About 10% of the patients relapsed and 39% (33 cases) recovered completely. We agree with the opinion of Hayashida, who stated 2/3 of the cases had some complaints post-operatively. Considering of the patient's activities and the subjective symptomes, complete recovery would be figured as 74% and incomplete would be 7.2%, these would be the same figure as reported in past. Many relapses occured from one to five years after operation, and recovery rate is 87% more than five years after surgery. There were quite few cases, however, had no complaints, this could be responsible to the most of cases were aged. On the contrary, the young surgical and medical cases had been doing well. There are many relapses in the cases of cystic-duct-stone, in which prognosis would be related with number of stones.
Jaundice itself did not have any specific relation with prognosis, but severity of the liver damage had a great influence upon prognosis. Even during treatment of preoperating period, repeated liver function test is necessary for determination of adequate time and procedure of operation. Dilatation of the cystic duct and shape of the gallbladder through the X-ray examination are considered to be of no values on surgery.
There were 6 mortal cases; 4 of them died of the other kind of diseases, one died of malignant change and the other diseased by myocardial infarction. We must pay attention on the biliary tract cancer caused by cholelithiasis and coronary diseases.
Six cases were reoperated and 2 cases were recovered well with the successful treatment by making the outer fistula, Among the relapse cases after removal of the gallstone we often found another stones in the cystic duct, that is probably characteristic feature of cholelithiasis in Japan. Therefore it is quite necessary to adopt after-care of the patient as a prudential method.
