消化管穿孔の臨床的検討

Clinical Study on Perforation of Alimentary Tract

　消化管の外科的疾患のうち，急性腹症として最も重要な地位を占めるのが，いわゆる消化管穿孔である．これはその大多数が良性の潰瘍性および炎症性疾患により起こるものであるが，広い意味よりみれば，最近とみに普及してきた内視鏡検査による穿孔や，手術による消化管吻合後の縫合不全などもこの範疇に含まれることになる．一方，胃をはじめとする消化管各部の診断学の進歩により穿孔を起こす原因となる諸疾患の早期発見，早期治療によりその発生頻度は理論的には減少の傾向を示すものと考えられ，また，もし穿孔を起こしても外科的立揚よりみれば，抗生物質の進歩，適切なる術後処置の進歩などによりその死亡率は減少しつつあるものと考えられる．これらの観点より，本稿においては消化管各部の穿孔例を昭和35年より昭和45年までの11年間の統計的観点より発生頻度の推移と，その治療成績の変遷を中心として考察したい．なお表1に教室での消化管穿孔例数を示した．

　Authors have described miscellaneous cases of gastrointestinal perforation at various parts on which surgery has been performed for the past 11 years since 1960.

　Perforation of the esophagus occurred in 2 cases by gastroendoscopic examinations; one by flexible gastroscope and the other by gastrocamera, both owing to unskilful manipulation by young doctors. The latter was cured by suture of the perforated site.

　In this series, 3 cases of perforation of gastric ulcer and 25 of that of duodenal ulcer were operated on, equal to 0,5 per cent of gastric, and to 7.8 per cent of duodenal ulcer cases treated in our clinic in this period. Perforation due to duodenal ulcer is approximately ten times as often as that of gastric ulcer, although the former also has increased recently.

　Of 7 cases of gallbladder perforation surgically intervened, 2 were due to gallbladder malignancies, both dying after cholecystectomy.

　Perforation of the appendix was seen in 53 cases among 1,399 of acute appendicitis. It is increasing in old persons over sixty.

　Resection of a segment of the small intestine following perforation was performed in 4 cases, which was either caused by trauma, obrtruction after gastrectomy, tuberculosis of the small bowel, or adhesion obstruction.

　Two cases of perforation of the large intestine were due to romanoscopy and barium enema examination. Perforation caused by diverticulitis, trauma or malignancies of the large intestine was not handled in the authors' clinic.