RECONSTRUCTIVE-RECOVERY ORGAN-SPARING AND ORGAN- PRESERVING OPERATIONS FOR RECURRENT DUODENAL ULCERS

Анотація

Aim. Development of modern and effective methods of organ-sparing and organ- preserving operations in case of recurrence of duodenal ulcer.

Materials and methods. The results of treatment of 119 patients with duodenal ulcer disease who had previously undergone surgery were analyzed: suturing of perforated duodenal ulcer - 70.7%, suturing of bleeding ulcer - 12.6%, SPV, STV with pyloroplasty - 10.0%, isolated SPV - 6.7%. Among the complications of recurrent ulcers were: pyloroduodenostenosis - 52.9%, ulcerative hemorrhage - 20.3%, re-perforation - 9.2%, combined complications of recurrent ulcer 17.6%.

Additional research methods that were used: dynamic EFGDS control; ionobalonotensiokinesiography; local gastric circulation by the method of L.Ya. Kovalchuk (1984, 1987), tetrapolar rheogastrography; research of general and local hemostasis in conditions of hemorrhage (tissue thromboplastin); study of morphological changes in peritonitis.

Results. The reasons for the recurrence of ulcers were: underestimation of indications for radical and conditionally radical surgical interventions during the first intervention; inadequate drainage operation; leaving an ulcerative substrate within the digestive tract; defects of operating equipment.

The list of reconstructive operations from 119 patients whom previously were performed non-resection surgery: SPV + ulcer excision + duodenoplasty - 70 patients (58.8%), revagotomy + pyloro or duodenoplasty - 14 (12.7%), SPV + segmental corporate resection stomach + pyloro- or duodenoplasty - 25 (21%), gastrectomy by Bilrot-1 - 5 (4.2%), gastrectomy by Gakker-Balfour - 5 (4.2%). organ-sparing and organ- preserving operations were performed in 109 patients - 91.6% of cases.

In patients with decompensated duodenostenosis after previous surgery, the clinic has developed organ-sparing surgery after a preliminary study of changes in the thickness of the muscular layer of the body and the antrum of the stomach in simulated decompensated pyloroduodenosis. Resection of the gastrodilated, non-functioning segment of the stomach involved preservation of the antral segment with duodenoplasty and gastro-gastroanastomosis.

In recent years, the frequency of suturing perforated ulcers has decreased significantly and is only 3.8% of all operations for perforated ulcers. This is justified by the expansion of indications for conditionally radical surgical interventions based on the results of an experimental researches of comparative assessment of morphological changes of tissues and organs under conditions of 18 or more hours of peritonitis. In 17.6% of combined complications, this type of organ-sparing operation has been developed, which includes excision of the ulcer with duodenoplasty, segmental-corporal resection with gastro-gastroanastomosis. Given the types of activity of the ulcer process in the conditions of bleeding, we have developed organ-preserving operations such as the extraterritization of the ulcer, followed by Tanner-Kennedy plastics. Long-term results according to A.N. Visick-Komorovsky: excellent (no complaints) - 77.5%; good (minor dyspepsia, which is detected only by detailed questioning and corrected by diet) - 13.5%; satisfactory (there are symptoms that cause discomfort) - 5.6%; unsatisfactory (recurrence of the disease, change of profession, disability) - 3.4%.

Conclusions. Organ-preserving and organ-sparing approach in reconstructive surgery is an essential means of preventing diseases of the operated stomach. Organ-preserving and organ-sparing operations allow to preserve the pacemaker regulation of the stomach and duodenum, which in the long run creates conditions for the prevention of dysmotorics of the pyloro-duodenal area.