TREATMENT-AND-DIAGNOSTICS AND PROGNOSTIC SIGNIFICANCE OF CLINICAL PRESENTATIONS OF PATIENTS WITH PILORODUODENAL ULCERS
E.A.RUSTAMOV, K.B.MAMEDOV, N.J.ZEYNALOV, A.R.HASANOV, A.M.ALIYEVA
Scientific Center of Surgery named after acad. M.A. Topchubashov, Baku, AZERBAIJAN
The clinical material for the detection of prognostic risk factors significant for the selection of treatment tactics of ulcer diseases was studied in 2 groups. The first group included 743 (29,9%) patients with noncomplicated form of piloroduodenal ulcer, and the second group included 1677 (67,5%) patients with complicated form of ulcer disease. Bleeding constituted 23,4%, perforation -7,7%, penetration - 12,4%, and piloroduodenal stenosis - 56,5% of complications. Higher occurrence of complications was observed in patients at the age of 46-60 (42,6%). Such patients had ulcer within 10 years or more (30,1%). In patients with up to 10 years ulcer anamnesis, prevailed noncomplicated form of the disease (20,2%). In such complications as pilorostenosis, ulcer anamnesis was higher (30,1%). The analysis of the dependence of the form of clinical course of ulcer disease on the sex of patients found out prevalence of the both complicated and noncomplicated forms of the disease in males (92,4% and 83,2% respectively). Comparative analysis of the occurrence rate of complicated and noncomplicated ulcer disease specific for males determined prevalence of complicated form. In the female patients prevalence of the noncomplicated form of the ulcer disease was detected. Statistically exact difference between the complications of the ulcer disease specific for males was not determined based on the simultaneously conducted analysis. Analysis of the manifestation time of pains determined statistically exact increase of late pains in the complicated form of ulcer disease (55,2%), and increase of pains on an empty stomach (27,3%) and night pains. Study of the effectiveness of earlier conservative treatment was of high prognostic significance in the assessment of the severity of the course of ulcer disease. During acute complicated form the ulcer disease, self-disappearance of pains and other manifestations without conservative therapy was observed only in 9.9% of patients, disappearance of such manifestations after conservative therapy occurred in 49,8% of cases. Ineffectiveness of conducted conservative therapy was possible in 40,3% cases. Thus, the age of patients over 50 years, more than 10-year ulcer anamnesis, belonging of patients to male sex and 0 (I) blood group, frequent seasonal nature of the disease, association of the disease with lancinating, burning and severe pain (mainly on an empty stomach, late and night pains, resistance to modern antihelicobacterial, antiulcerogenic treatment in patients with piloroduodenal ulcers can be considered prognostic risk factors of complication of the disease. The prepared prognostic factors provide conduct of preventive operations (SPV) and improvement of results of treatment before the occurrence of prognostic criteria.
Date: 2014-12-28; view: 365