COMPARATIVE EVALUATION OF THE EFFECT OF COMBINED OZONE ON THE SURGICAL TREATMENT OF GASTRODUODENAL ULCERS

I.L. KAZIMOV, E.A. RUSTAMOV, R. GASIMOV, R.KH. SAFARALIYEVA

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

Bactericidal and desensitizing features of ozone, as well as its accelerating action on reparative processes in damaged tissue structures, conditioned the need for the use of ozone therapy in the surgical treatment of gastroduodenal ulcers. Combined ozone therapy was carried out by parenteral method - intravenous injection of ozonized physiological solution, as in the preoperative and postoperative period (with 4 - 6 mg/l concentration). Local ozone therapy was performed after abdominal sanitization through a nasogastric tube with a concentration of 20 - 40 mg/lt. Patients were at the age of 18 - 76 years, total number of patients was - 88. Patients were divided into 2 groups - control and main group, and each group into two subgroups. Patients of the first subgroups was performed vagotomy, and a second – gastric resection. Pathological and biochemical investigations were carried out, and motor-evacuator function of the gastrointestinal tract was studied. The influence of combined ozone therapy on reparative processes in the mucosa of gastric stump or gastroenteroanastomosises before and after surgery was stduied.

At stages of surgical treatment, were carried out additional biochemical and statistical studies. The combined therapy carried out at stages of surgical treatment of ozone therapy allowed to bring indicators of lipid peroxidation and antioxidant protection to normal values ​​at the final stage of examination of patients, whereas none of the patients of the control group reached parameters similar with that of the main subgroups within the specified terms . To assess the effectiveness of the proposed methods at the stages of surgical treatment of gastroduodenal ulcers in all patients, there was carried out a comparative analysis of postoperative early complications. In patients of the control group, such early complications as anastomosis, gastrostasis and wound abscess were encountered 2-3.5 times more than the in the main group. Comparative analysis of the results proved that the combined ozone therapy plays an important role in prevention of complications at the early state after surgical operations during gastroduodenal ulcers.

LONG-TERM RESULTS OF OPERATIONS OF “MINIMAL VOLUME” IN PERFORATIVE DUODENAL ULCERS

F. S. KURBANOV D. A. BALOGLANOV

Russian Peoples' Friendship University, Moscow, RUSSIA

Introduction. Minimal operations in the form of a simple or a plastic closure and resection of ulcers in the surgical treatment of patients with perforated duodenal ulcers (PDU) are dominated in many clinics. However, the published long-term results of these operations are very diverse - from bad to good. This study was undertaken to justify the possibility of improving of long-term results of surgical treatment of patients with PDU by execution of operations of minimal volume, combined with subsequent conservative antiulcer treatment.

Materials and methods. From 2000 to 2009 in the City Hospital № 17 were treated 289 patients with PDU at the age from 15 to 95 years, of them 253 males (87.5%) and 36 females (12.5%). Operations of minimal volume were performed in 277 (95.8%) of the total number of patients. Plastic closure of PDU after Oppel- Polikarpov was preferable to other methods because of the relative simplicity of the operation, no need to impose rough seams on the infiltrated duodenal wall, the reliability of sealing and the absence of danger of stenosis. Such operation was performed in 260 (90%) patients. All patients just after operations of minimal volume were administered modern antiulcer treatment with recommendation to continue the intake in an outpatient setting. The complex treatment included antacids, antisecretoric, antispasmodic, sedative drugs, vitamins, reparants and remedies for normalization of the motility of the upper digestive tract.

Results. Long-term results were studied in 161 (57.5%) of 280 discharged patients in the period from 1 to 10 years. Analysis of the results of operations of minimal volume in 153 patients has shown good follow-up results in 132 of them (86.3%), recurrences of PUD and its other complications were not observed. 110 of these 132 patients strictly followed the recommendations for treatment, diet, work and rest given on discharge. A satisfactory remote result was recorded in 11 (7.2%) patients after all operations of minimal volume. These patients had to be screened regularly and take courses of outpatient medical treatment, including antacids and antisecretory agents. In 10 (6.5%) patients the remote result was unsatisfactory. In 7 patients duodena ulcer recurred in a period from 6 months to 3 years and they were treated for it conservatively. Another 3 patients were re-operated: they all underwent gastric resection. These data suggest that a combination of surgery of minimal volume with a conservative treatment for PDU in the majority of cases (86.3%) give good long-term results.

Conclusion. Today operations of minimal volume are the main in the surgical treatment of patients with PDU, and the omental tamponade of the ulcer after Oppel-Policarpov is one of the best for a plastic closure of perforated aperture. These operations should be combined with a conservative antiulcer treatment for best results. This tactic in perspective allows patients to recover complitely from peptic ulcer disease and to save anatomically and functionally full stomach and duodenum.

Date: 2014-12-28; view: 947