CREATION OF END-TO-END ANASTOMOSIS BETWEEN INTESTINAL LOOP, ISOLATED BY RU METHOD AFTER GASTRIC RESECTION, AND DUODENUM

K.B. MAMEDOV, E.A.RUSTAMOV, SH.A.NOVRUZOVA, KH.T.ABBASOVA

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

Insufficiency of duodenal stump differs for it danger among the complications of gastric resections that is considered to be one of the difficult operations of abdominal surgery. Despite numerous method, sometimes reliable tying of duodenal stump is not possible by neither of the methods. This is considered to be a high risk from the point of view of suture insufficiency in post-operative period. On the other hand, a number of complications known as postgastroresection syndrome in long-term post-operative period increase undesirable results of the operation (reflux-gastritis, damping syndrome, guiding loop syndrome etc).

To prevent the abovementioned near and long term results of gastric resection were offered a new method. The essence of the method is to create end-to-end anastomosis between intestinal loop, isolated by Ru method after gastric resection, and duodenum instead of blind closing in cases the it is technically difficult to close duodenal stump. For this purpose, distal end of the small intestine loop cut at the distance of 15 cm from the Trace ligament after gastric resection is end-to-end anastomosed with the duodenal stump with one end left open. Doble drainage of duodenal stump in both proximal direction, and distally along the guiding loop, decreases intraduodenal pressure and significantly reduced the danger of duodenojejunoanastomosis sutures. Therefore, insertion of anastomosis with one line of sutures is sufficient. Intestinal pantecy is restored by creation of end-to-side gastroenteroanastomosis with the same intestinal loom at about 10-15 cm distance from duodenojejunoanastomosis, and end-to-side enteroenteroanastomosis – 50 cm lower.

The offered method, was applied in 5 patients that underwent gastric resection, not complications were observed in postoperative period.

Therefore, the offered method eliminates the necessity of complete closing of difficult duodenal stumps. At the same time, the offered method increases the opportunity to reduce occurrence of such complications as reflux-gastritic, damping syndrome, guide loom syndrome, to avoid repeated reconstructive complex operations in connection with mentioned complications, and improve the quality of life working ability of patients.

EFFECTIVENESS OF ERADICATION TREATMEN IN ULCER DISEASE IN PRACTICE OF A FAMILIY DOCTOR

A.P.MAMMADOVA, M.S.SALIHOV, E.AFANDIYEVA, SH.A. HAJIYEVA, L. ALIZADE

Azerbaijan Medical University, Baku, AZERBAIJAN

According to researches carried out in recent years 70% of development factors of stomach ulcers are Helicobacter Pylori. According to researched literature sources in treatment of stomach ulcer combination of macrolides with PPI was much more effective. Rusiya We used leader macrolide - clarithromycin and PPI lansoprazole in our research recommended by Gastroenterologic association of Russia for helicobacter pylorin eradiction.

During the experiment we examined 56 patients of ages between 31 – 49 (26 women, 30 men) and 50% of these patients diagnosis was round ulcer of stomach. We divided our patients into 2 groups. In patients belonging to the first group as an eradiction treatment Clarithromycin 500 mg 2 times a day + Lansoprazole 30 mg 2 times a day are used. In patients belonging to the 2nd group 1gr amoxicillin 2 times a day + pantaprozol 30 mg 2 times a day + metronidazol 500 mg 2 times a day are used. Treatment course was applied in both 2 groups for the period of 14 days. So combination of preparations used in eradiction treatment in both two group of patients had a positive effect according to researches we carried out. In both 2 groups 90% recovery within 2 weeks has been observed. But effect of combination of Clarithromycin-Lansoprazole with strong antihelicobacter influence between PPI and macrolide - clarithromycin distinguished as for its acid persistence character we used in in patients belonging to the first group was stronger and impacted repidly. Synergism is observed in relation with more than 50% of in vitro helicobacter pylori stocks in combination of Clarithromycin-Lansoprazole preparations. No such synergism has been determined among antibacterial preparations used in eradictional treatment and PPI. Clarithromycin-Lansoprazole combination without a doubt has an advantage among eradiction medicinal preparation and is recommended to be applied in treatment.

STUDY OF THE RESISTANCE OF HP AND APPROACHES TO THE TREATMENT OF ULCERS IN KYRGYZSTAN

M.S. MOLDOBAEVA, N.T. TOLOMBAEVA, R.M. ATTOKUROVA, A.A. ELISTRATOV

Kyrgyzstan State Medical Academy, Bishkek, KYRGYZSTAN

Introduction: High rates of emergency hospital admissions of patients with PU, complicated with perforated ulcer and gastrointestinal bleeding indicate a lack of efficiency and timeliness of preventive and curative interventions conducted by general physicians among population of Kyrgyzstan.

Materials and methods: General clinical researches were carried out in 84 patients from different regions of the Republic. The previous intake of metronidazole and macrolides and time-barred of their admission were taken into account. All patients underwent esophagogastroduodenoscopy. Fence biopsy was performed in 3 places. Primary diagnosis of H. pylori-infection was carried out by a bacteriological method. Antibiotic susceptibility was determined by disc-diffusion method.

Results: H. pylori was identified in 74 patients, indicating high infection rates of the population. Absolute resistance of HP to clarithromycin was present in 16.2% of patients (12 patients), moderate resistance - in 6.8% (5 patients). Among the 12 patients with absolute resistance in 9 patients eradication therapy was conducted recently, 3 patients mentioned previous intake of clarithromycin for other diseases, the rest patients could not remember. Thus, the primary absolute resistance of HP-infection to clarithromycin was observed in 12.2% (9 patients). The number of resistant strains to metronidazole made 44.6% (33 patients). The initial 100% resistance to metronidazole was detected in 40.5% of patients.

Conclusion: At present in Kyrgyzstan the 20% frontier of resistance to clarithromycin has not yet been overcome, that makes it possible to ­maintain a triple therapy based on clarithromycin as a first step of eradication schemes and to recommend its widespread use in the treatment of the diseases associated with H. pylori. Metronidazole should be excluded from the scheme of triple therapy of H. pylori, as HP resistance to metronidazole in Kyrgyzstan makes more than 40%. However, metronidazole may be included in kvadroterapy and alternative triple schemes based on products of bismuth, as preparations of bismuth tripotassium ditsitratom due to their properties help to overcome the resistance to metronidazole. Recommendations of Consensus Maastricht-3, 2005 for the treatment of HP infection were adapted to Kyrgyzstan, taking into account the results of the study of resistance of HP to clarithromycin and m­etronidazole.

Date: 2014-12-28; view: 1060