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THE EFFICIENCY OF ENDOHEMOSTASIS IN BLEEDING GASTRIC ULCERS

Y.R. MALIKOV, A.A. AZIMOV, B.A. YANGIEV, O.A. MADAMINOV

Branch of the Republican Scientific Center for Emergency Medical Care,

Navoi, UZBEKISTAN

 

The aim - study the efficacy of endohemostasis in patients with bleeding gastric ulcers (BGU) and to assess its capabilities in phases of medical emergency. Were analyzed the results of examination and treatment of 124 (29.4%) patients (2001-2009). After completion of endoscopic hemostasis, patients with high risk of the relapse of BGU received antisecretory therapy with proton pump inhibitor omeprazole (Losek). Our study has reliable shown a sharp decrease of the number of operated patients with endohemostasis (31, 25.0%), while without surgery there were (93; 75,0%) (Pχ2 <0,001) patients with endohemostasis. The most reliable hemostasis was achieved by combination of two methods - the infiltration of solution and electrocautery. In applying the combined method in the first stage the source of bleeding was cut away in order to reduce the intensity and location of the source. In the second stage the final hemostasis by electrocoagulation was carried out. If the risk of recurrence of bleeding persists haemostasis is carried out in two stages. Combined hemostasis was applied in 57 (46.0%) patients. The immediate efficacy of therapeutic combined endoscopy was 100.0%. Therefore, in patients with BGU application of endogemostasis was successful in 114 (91.9%) and unsuccessful - in 10 (8.1%) cases. Haemostatic effect occurred within first- second attempts in 47 (88.9%) (the 2nd attempt was taken after electrocoagulation and cutting away of an ulcer - in 2, after cutting away of an ulcer - in 7 cases). Surgical approach in 124 patients with endogemostasis was as follows. In all cases was observed hemostatic effect, but in view of large ulcers, fraught with recurrent bleeding, 31 (25.0%) patient underwent surgery: 10 (32.2%) - emercently, 8 (25.8%) - urgently because of the risk of repeated bleeding from large-sized ulcers and 13 (41.9%) - in a delayed manner. According to the results of our study, endohemostatic manual conducted prior to operation positively influence the surgical operative intervention and postoperative course.

 

SHORT LOOP GASTRIC RESECTION IN THE TREATMENT OF ULCER DISEASE

 

Y.R.MALIKOV, B.A.YANGIEV, A.A.AZIMOV, K.S.MAMATOV

Branch of the Republican scientific center for urgent medical care, Navoi, UZBEKISTAN

 

Among the majority of methods of surgical treatment of peptic ulcer gastric resection takes a significance place. We have analyzed the results of gastric resection in the treatment of peptic ulcer for the period from 1995 to 2010. Surgical intervention (gastric resection) was performed in 321 patients. Among them there were 273- men, 48 - women. According to the results of endoscopic and radiological examination it was found that 56 patient had gastric ulcers, and 265 - duodenal ulcers. The following operations were performed: gastric resection by Billroth 2 on short loop - 141, gastric resection by Billroth 2 on a long loop - 110, gastric resection by Billroth 1 - 37, resection of the stomach by Billroth 1 in L.G. Khachiyev modification - 32 and stem vagotomy with antral gastric resection - 14.



Resection of the stomach on a short loop is performed by modified method by Neuber 1927 type. To make the loop maximum short we dissect Treytsev ligament and straighten duodenojejunal angle. After gastric resection we sutured the duodenal stump and continue to impose retrocolic gastrojejunostomy.

This surgical intervention, in our view has the following advantages: in difficult-to-suture duodenal stump it allows its decompression, provides better passage of food from the gastric stump and its digestion, as compared to gastric resection on long loop – is less by one anastomosis and shorter by the time of execution.

The overall incidence of postoperative complications was 10.6%, and among patients which were performed gastric resection on short loop, it was 8 times lower than for other methods of resection and was constituted 2.1%. In 3 patients there were observed complications associated with bronchopulmonary system, conservative therapy in all cases was successful. Fatal outcome were observed in this group of patients. The overall mortality after all types of resection was 3.9%.

 

OUR EXPERIENCE IN THE CHOICE OF TACTICS OF SURGICAL METHOD OF TREATMENT OF PATIENTS WITH NEGLECTED PERFORATED GASTRIC AND DUODENAL ULCERS ON THE BACKGROUND OF DIFFUSE PURULENT PERITONITIS

 

K.B. MAMEDOV, E.A. RUSTAMOV, N.J.ZEYNALOV, R.A. GASIMOV, A.R. HASANOV

Scientific Center of Surgery named after acad. M.A. Topchubashov, Baku,AZERBAIJAN

 

So far in choosing the tactics of surgical method of treatments for this pathology many authors has attached great importance to the time factor. Usually at the early stages (6 to 24 hours), subject to the ability of the surgeon, the response of stomach or other organ-saving operations are recommended. In later periods, when diffuse peritonitis occurs, choice of surgical method is very difficult. In this regard, we consider it reasonable to share our experience.

For the period from 1973 to 2010, 126 patients with perforated gastric and duodenal ulcers were operated in our clinic, in 50 of them perforation were located in the stomach, in 76in duodenum. The following surgical interventions were performed: suturing of ulcers according to Polikarpov, to Ostrovsky, the procedures were performed in total of 67 patients.

Initial reaction was performed in 16 patients, in four of them gastric resection was performed on the background of diffuse purulent peritonitis. Such risk-taking desperate step had to be resorted due to the impossibility to use another method because of the expressed destructive changes in the wall of the distal stomach and it was not possible to apply less risky method of surgical treatment. Due to this risk, we managed to save the doomed patients, although it required to make serious efforts and use many means of treatment.

Thus, our limited experience suggests that time factor shall no be main criterion in the selection surgical tactics in such a severe pathology, during surgery and changes it is necessary to proceed from the stomach and duodenum.

Such tactic should not have stereotype nature and each operating surgeon should consider his ability, availability of good intensive care service, where an adequate treatment of this severe category of patients can be carried out.

 

 

THE PROBLEM OF RELAPSE OF THE GASTRODUODENAL ULCER BLEEDINGS

 

A.M. MAMMADOV., SH.KH. ALIYEV., K.A. EYVAZOVA., J.N. RAMAZANOV

Azerbaijan Medical University, Baku, AZERBAIJAN

Significance of the research is diagnosing and treatment of the helicobacterial infection in the piloroduodenal ulcer desease complicated by bleeding, as well as prediction of relapse of bleeding and its influence on lethality indicators taking into account the classic prognostic criteria.

Materials and methods. 231 patients treated with the diagnosis of the ulcer desease complicated by bleeding were included in the research. 177 of the patients were the men (76,6%) and 54 were the women (23,4%). Age grade was between 29-62, average age was 43,4±7,9. According to location: 80 patients (34,6%) had pyloric ulcer, and 151 (65,4%) had duodenal ulcer. As a whole 205 (88,74%) out of 231 patients who participated in the research had a surgeal operation. At 81 (35.06%) patients the reason of conduction of the surgeal operation was relapse of bleeding. At 146 (63,2%) patients the bleeding was for the first time, and at 87 (37,7%) it was repeated. It was observed that at 58 (66,7%) patients the repeated bleeding was one-episode, and at 29 (33,3%) patients it was the second time and more. During FGDS biopsy materials were taken from antral part and body of the stomach and heliko-bacter infection was examined by histological and sitological methods, and at the same time sensitivity, specificity and precision of these methods was learned. As a result it was determined that cytologic method would be more informative in diagnostics of helico-bacter infection. It was detected that high colonization of helico-bacter infection in artral part and body of stomach has special significance in prediction of relapse of bleeding. During hystologic examinaion of the endoscopyc biopsy materials of the operated patients (48) H. Pylori was revealed at 42 patients, but in cytologic examination this infection was revealed at 43 patiens.It was made comparative analysis of microscopic form of preparations got after surgial interventions made when there was suspection on continuing bleeding, its relapse or threat for residive danger. During pathomorphologic research of the material taken after the operation, it was indicated that the ulcers with pyloric location were deep and fair-sized (>2sm), and being related with influence of chronic helico-bacterial infection they had specific significance in relapse of the bleeding. It became clear that at patients with relapsed bleeding intensity of lymphoplasmostar infiltration density of mucous coat of the body and antral part of the stomach has more statistic significance in comparison with the patients with not relapsed bleeding. Such infiltration intensity was observed at the patients with relapsed bleeding mostly in the 1st, 3rd and 7th days. At 81 (35,06%) patients who had relapse of bleeding the lethality indicator was 32,1% (at 26 patients). Common lethality was 13,42% (at 31 patients), and out of them the lethality after operation resulted to 12,99% (30 patients). Above mentioned indicators allow to say that the reason of the high lethality (at 26 out of 31 patients; 83,87%) is relapse of the bleeding. Application of developed treatment-diagnostic measures and prognostic criteria in the practice allowed us to reduce from 35,06% to 17,81% the appearance frequency of the bleeding, and from 13,42% to 7,21% the comon lethality parameter, and from 12,99% to 7,93% the lethality after operation.

Results: the high infection degree of helico-bacterial infection on the body and antral part of stomach, the ulcer accompanied with damage of more than 2/3 part of muscular layer with pyloric location, and having more than 2 sm diameter, intensive expansion of lympho-plasmostar infilration density of mucous coat on the same areas in the 1st, 3rd and 7th days can be considered to be the criteria that make relapse of the bleeding probable.

 


Date: 2014-12-28; view: 963


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LONG-TERM RESULTS OF ENDOSCOPIC STENTING IN PATIENTS WITH CICATRICAL ESOPHAGEAL STRICTURES | CREATION OF END-TO-END ANASTOMOSIS BETWEEN INTESTINAL LOOP, ISOLATED BY RU METHOD AFTER GASTRIC RESECTION, AND DUODENUM
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