RESUMO
Complex examination and surgical treatment, using various organ-preserving operations, was done in 54 patients, suffering recurrent postoperative complicated duodenal ulcers. Performance of pathogenetically unsatisfactory volume of the first operation, technical faults, absence of pathogenetically substantiated therapy in postoperative period had constituted the causes of unsatisfactory results of the first operation. Reconstructive organ preserving intervention, consisting of impact on all chains of recurrent ulcerogenesis, with subsequent pathogenetically substantiated rehabilitation of patients, were consider the operation of choice.
Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Úlcera Duodenal/cirurgia , Úlcera Duodenal/complicações , Úlcera Duodenal/metabolismo , Úlcera Duodenal/microbiologia , Helicobacter pylori/isolamento & purificação , Humanos , Mucosa Intestinal/irrigação sanguínea , Mucosa Intestinal/metabolismo , Mucosa Intestinal/microbiologia , Secreções Intestinais/metabolismo , Isquemia/complicações , Recidiva , Reoperação , Vagotomia/efeitos adversos , Vagotomia/métodosRESUMO
Duodenogastric reflux (DGR) was revealed in 52.6% patients, suffering recurrent postoperative complicated duodenal ulcers (RPOCDU). Pylorodestructive operations performance, pyloric involvement into ulcerative infiltrate and absence of chronic duodenal impassability (CHDI) correction during the first operation done had constituted the DGR occurrence causes. While establishing the indications for elective operation performance as well as choosing the surgical method of the RPOCDU treatment it is necessary to take into account the presence and severity degree of DGR. Surgical treatment of DGR must obligatory include not only the pyloric preservation and strenghtening, but the CHDI correction as well. Selective periarterial sympathectomy of duodenum constitutes an effective method, improving her tone without pyloric innervations disturbing.
Assuntos
Úlcera Duodenal/complicações , Úlcera Duodenal/cirurgia , Refluxo Duodenogástrico/etiologia , Duodeno/cirurgia , Complicações Pós-Operatórias/etiologia , Bilirrubina/análise , Úlcera Duodenal/fisiopatologia , Refluxo Duodenogástrico/diagnóstico , Refluxo Duodenogástrico/epidemiologia , Refluxo Duodenogástrico/fisiopatologia , Duodeno/inervação , Duodeno/fisiopatologia , Eletromiografia , Endoscopia Gastrointestinal , Trânsito Gastrointestinal/fisiologia , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Recidiva , SimpatectomiaRESUMO
After performance of organ preserving operations the cytotoxic stamms of H. pylori were revealed in 47 (94%) patients with recurrent ulcer. after gastric resection--in 27 (58.6%). The conduction of antihelicobacteric therapy is indicated to all the patients, in whom recurrent ulcer had occurred after organ preserving operations performance, its indication after gastric resection performance must be individual, after the patient examination succession. Application of a combined preparation, consisting of 20 mg of omeprazol, 500 mg of clarithromycin, 1000 mg amoxicillin, in a standard dosage of 3 tablets twice a day during 7 days have permitted to achieve the H. pylori cytotoxic stamms eradication in 94.2% of the patients. The preparation is well endured by the patients, the adverse reactions are minimal, temporary, their occurrence does not necessitate the preparation abolition.
Assuntos
Antibacterianos/uso terapêutico , Antiulcerosos/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Úlcera Péptica/cirurgia , Amoxicilina/administração & dosagem , Amoxicilina/efeitos adversos , Amoxicilina/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Antiulcerosos/administração & dosagem , Antiulcerosos/efeitos adversos , Claritromicina/administração & dosagem , Claritromicina/efeitos adversos , Claritromicina/uso terapêutico , Esquema de Medicação , Combinação de Medicamentos , Infecções por Helicobacter/microbiologia , Helicobacter pylori/isolamento & purificação , Humanos , Omeprazol/administração & dosagem , Omeprazol/efeitos adversos , Omeprazol/uso terapêutico , Úlcera Péptica/complicações , Úlcera Péptica/tratamento farmacológico , Úlcera Péptica/microbiologia , Recidiva , Resultado do TratamentoRESUMO
The results of treatment of 53 patients, suffering an acute gastro-intestinal bleeding of the ulcer etiology are adduced. The proton pump inhibitor Omez infusion have promoted the improvement of the patients treatment results.
Assuntos
Hemorragia Gastrointestinal/tratamento farmacológico , Omeprazol/uso terapêutico , Inibidores da Bomba de Prótons , Úlcera Gástrica/complicações , Doença Aguda , Adulto , Idoso , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/metabolismo , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Omeprazol/administração & dosagem , Úlcera Péptica Hemorrágica/tratamento farmacológico , Úlcera Péptica Hemorrágica/etiologia , Úlcera Péptica Hemorrágica/metabolismo , Resultado do TratamentoRESUMO
There were revealed the occurrence risk factors for an early recurrence of hemorrhage of ulcer etiology, the method of mathematical prognosis was suggested with 78.8% authenticity. The programm of computeric prognosis, basing on "neuronic nets" with 91% authenticity was elaborated. It was established that computeric prognosis is more authentic and perspective method in comparison with mathematic one.