THE FREQUENCY OF HEMORRHAGE IN PATIENTS WITH LARGE AND GIANT GASTRIC AND DUODENAL ULCERS
N.A. ZHANTALINOVA, S.B. RAKHOV, S.M. ABUOV,
R.B. KALIMBETOV, E.Sh. BAIBEKOV
Kazakhstan State Medical University after S.D Asfendiyarov, Almaty, KAZAKHSTAN
Introduction: Large and giant gastric and duodenal ulcers are classified as severe peptic ulcer disease. It is caused by the aggressiveness of the disease and the development of a number of serious combined complications, such as penetration and bleeding, penetration, bleeding and perforation. According to many researchers, bleeding is one of the most common acute complications. Several authors distinguish giant gastroduodenal bleeding ulcers as a special a form of peptic ulcer disease [Chernov V.N et al. 1992; Martirosov Y.K, 1997, Petukhov V.M et al., 2000].
Materials and methods: We have observed 409 patients with large and giant gastric and duodenal ulcers. Males were 184 (74.2%), females - 64 (25.8%), at the age from 21 to 78 years. Bleeding was observed in 248 patients, accounting in 60.6%.
Results and discussion: In 128 (51.6%) of the total 248 patients hospitalized with bleeding the source of bleeding was gastric ulcer, in 119 (48.0%) - duodenal ulcer and in one (0.4%) patient - a combination of gastric and duodenal ulcers. In 66.4% of patients ulcer was localized on the posterior wall of small curvature, at 16.4% - in the antral, at 7.8% - in the proximal parts. Localization of ulcer on the posterior wall of the bulb of duodenum was found in 63.9% of patients. All patients were hospitalized urgently. Terms of hospitalization were different from moment of the bleeding episode. Thus, 36.7% of patients had applied within 2 - 12 hours, 48.4% - within 24 - 48 hours, and 2.8% of them had recurrent bleeding at home. In 15.3% of patients, applying 3 days later, the endoscopic picture testified the arrest of the bleeding. Ulcerative anamnesis , which ranged from 1 to 20 years, was found in 47.2% of patients and at the same time in 40.3% of cases a short anamnesis (from 1 to 4 years) was recorded. 9.3% of patients had episodes of bleeding in anamnesis. In 51.2% of cases bleeding was the first manifestation of the disease.
Conclusions: Thus, the bleeding was in the lead in the spectrum of the all developed complications both in single (124), and combined (124) variants, which accounted for 60.6% of the total number of observations. Frequent localization of large and giant bleeding gastroduodenal ulcers was the back wall of stomach and duodenum.
INDICATIONS AND CONTRAINDICATIONS FOR COLONIC ESOPHAGOPLASTY
Sh.Sh. JURAYEV, E.U. SHAYKHIYEV, T.A. BAYTILEUOV,
T.A. MAMETOVA, E.R. RAKHIMOV
National Scientific Center of Surgery named after A.N. Syzganov, Almaty, KAZAKHSTAN
Introduction::At present, cases of chemical damage of the esophagus do not tend to decrease.
The aim of the study: was to develop indications for colonic esophagoplasty.
Materials and method: From 1980 to 2009, the shunting esophagoplasty for postburn cicatrical strictures of the esophagus was performed in 109 patients. There were 52 men (47.7%), and 57 (52.3%) women aged between 16 to 71 years, with average age of 45 years. Reconstructive interventions in all patients were performed 4 - 5 months after the first stage of treatment. Formation of artificial esophagus was carried out by the known method from the left half of the colon on the nutrient middle or left colonic arteries. Colotransplantat was placed retrosternally on the anterior mediastinum.
Results and discussion: It is widely known that the majority of patients with extensive post-burn cicatricial strictures of the esophagus was performed esophagoplasty, which includes resection or extirpation of the affected esophagus from the abdomino-cervical access (or intrapleural access) and the restoration of the continuity of the gastrointestinal tract by the formation of artificial esophagus from the stomach. Given our own experience, we consider, that the disadvantage of application of the method in patients with consequences of caustic esophageal burns is its traumatism, as the identification and removal of the esophagus from posterior mediastinum in such cases is technically difficult and fraught with the emergence of serious intra-operative complications, and therefore is unjustified. In this situation, we consider shunting esophagoplasty as operation of choice.
Failure of colo-colar, colo-gastric anastomoses was not observed. The failure of the anastomoses in the neck was observed in 11 (10.1%) cases. Stenosis of anastomosis on the neck was observed in 20 (18.3%) patients. Patency of the anastomosis was restored by bougienage. Four patients died after esophagoplasty, mortality rates constituted - 3.7%.
Conclusion. Thus, objective indicators for a particular type of reconstructive and restorative treatment allow achievement of positive results in almost all cases. The share of adverse outcomes after treatment is extremely low at present.