Assuntos
Antiulcerosos/uso terapêutico , Famotidina/uso terapêutico , Antagonistas dos Receptores H2 da Histamina/uso terapêutico , Omeprazol/uso terapêutico , Úlcera Péptica Hemorrágica/tratamento farmacológico , Úlcera Péptica Perfurada/tratamento farmacológico , Pirenzepina/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Antiácidos/administração & dosagem , Antiácidos/uso terapêutico , Antiulcerosos/administração & dosagem , Famotidina/administração & dosagem , Humanos , Omeprazol/administração & dosagem , Úlcera Péptica Hemorrágica/fisiopatologia , Úlcera Péptica Hemorrágica/cirurgia , Úlcera Péptica Perfurada/fisiopatologia , Úlcera Péptica Perfurada/cirurgia , Pirenzepina/administração & dosagem , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de TempoRESUMO
Data of 363 patients operated on for perforated gastric or duodenal ulcers were analyzed. Immediate and follow-up results were obtained after simple suture plication, Jadd's ulcer excision combined with stem vagotomy and after distal gastric resection. Predictors of the unfavourable outcome were determined. These are: Mannheim peritonitis index >20, surgical risk of IV-V grade, signs of multiple organ failure and symptomatic character of the ulcer. The comparison of long-term results revealed that patients after suture plication experienced the ulcer recurrence in 78,4% and necessity of further operation occurred in 21,5%. Every third patient after stem vagotomy experienced postvagotomic disorders and ulcer recurrence. Primary gastric resection demonstrated the best long-term results concerning ulcer disease. The algorithm of treatment modalities of the perforative ulcer desease was worked. The algorithm is based on stage-by stage determination of indications and contraindications to gastric resection.