外科手術患者の心身医学的考察 : 腹部手術患者を中心として

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We performed a psychosomatic study on 50 subjects who were not making favorable progress after laparotomy. It was assumed that 29 of the 50 subjects had not had proper indications for the operation. Many were operated on for the so-called chronic appendicitis. The symptoms seemed, however, to be attributable to irritable colon, abdominal bloating and aerophasia, etc. Among the pcst-operative symptoms in the cases with unfavorable progress were many psychoneurotic , and psychosomatic symptoms in addition to those which had existed prior to the operation. Five subjects developed their symptoms in connection with narcosis ; the so-called operative syndromes were found in 9 cases ; and polysurgery in 7 cases, 4 of which were characterrized with low intelligence. A comparative study was made in terms of psycho-social problems in 50 cases with favorable progress and 50 others with unfavorable progress after the operation. It was found that many in the latter group had been under perpetuating stress around the time of the operation and often in a series of stressful situations. A significant difference was found in the above two groups where Cornell Medical Index and Y-G Personality Test were compared. Electroencephalographical examinations were per-formed to 30 subjects with unfavorable progress, 10 of whom manifested paroxymal bilateral slow waves and 14 & 6 cps positive spikes. However, to some subjects whose electroencephalographical findings were abnormal, a psychosomatic approach seemed to be more suitable. Psychosomatic problems in the field of surgery may be summarized as follows : l. Neurotic and hysterical symptoms are taken for surgical disorders and operated on as such. 2. Common abnormalities in site and form are taken for unknown abdominal disorders and operated on as such. 3. Symptoms which had existed prior to the operation are erroneously interpreted as pcst-operative symptoms. 4. With a stressful situation, the operated region becomes a "locus minoris resistentiae" where the symptom is to arrest and develop, 5. No attention is paid to the distortions of the patient's personality or of his emotional life. 6. Only surgical treatment is performed to psycho-somatic disorders. 7. Psychosomatic problems in narcosis. In this study psychosomatic problems of surgically treated patients were explored. We are of the opinion that both internists and surgeons need to cooperate in the solution of these problems.
日本心身医学会の論文

外科手術患者の心身医学的考察 : 腹部手術患者を中心として

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