RESUMO
AIM: to define the correlation between Mannheim peritonitis index scores and outcomes of different radical and palliative interventions for perforative duodenal ulcer. MATERIAL AND METHODS: Treatment of 386 patients with perforative duodenal ulcer is presented. Different surgical techniques were analyzed including stomach resection, various methods of vagotomy with/without drainage, ulcer suturing and ulcerative edges excision with suturing in patients with Mannheim index scores <21, 21-29 and over 29. Clavien-Dindo classification was used to analyze postoperative complications. RESULTS: In 64.3% of cases mortality was caused by peritonitis and peritonitis-associated complications. Surgical features resulted unfavorable outcome only in 35.7% of cases. Severe complications requiring re-operation were predominantly observed after stomach resection. CONCLUSION: Mannheim peritonitis index is sensitive method allowing prognosis the outcomes in patients with perforative duodenal ulcer. Radical interventions are advisable in Mannheim index scores <21, in other cases palliative surgery for example suturing or edges excision with suturing is preferred. If radical surgery is performed with strict indications (Mannheim index scores <21) volume and type of surgery do not significantly influence on mortality rate.
Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Úlcera Duodenal , Úlcera Péptica Perfurada , Peritonite , Adulto , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/mortalidade , Úlcera Duodenal/complicações , Úlcera Duodenal/diagnóstico , Úlcera Duodenal/fisiopatologia , Úlcera Duodenal/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Moscou , Avaliação de Processos e Resultados em Cuidados de Saúde/métodos , Seleção de Pacientes , Úlcera Péptica Perfurada/complicações , Úlcera Péptica Perfurada/diagnóstico , Úlcera Péptica Perfurada/fisiopatologia , Úlcera Péptica Perfurada/cirurgia , Peritonite/diagnóstico , Peritonite/etiologia , Peritonite/prevenção & controle , Prognóstico , Projetos de Pesquisa , Medição de Risco , Análise de SobrevidaRESUMO
The paper is concerned with original methods of balloon dilatation with high-pressure low-profile balloon catheters of Grüntzig type of pyloric and duodenal stenoses. A new informative method of recording of this procedure and its results with computer for radiography was described. In 10 patients this method was used alone as well as in combination with sparing operation--selective proximal vagotomy. In 80% of cases a positive effect of this procedure was obtained and confirmed by clinical observation and instrumental methods. No complications were noted. Therefore this methods could be recommended for a wider clinical use.