Minimally invasive technology of surgical treatment of perforating pyloroduodenal ulcers without vagotomy
DOI:
https://doi.org/10.15587/2519-4798.2017.105006Keywords:
stomach ulcer, pyloroduodenal zone, perforation, laparoscopy, ulcer closure, vagotomy, immuohistochemistryAbstract
Aim of the work: to study the effectiveness and expedience of the use of videoendoscopic minimally invasive methods of surgical treatment in patients with perforating pyloroduodenal ulcers.
Materials and methods of the research: On the base of the surgical department № 1 of MIHP “Kharkiv city clinical hospital and urgency, named after A.I. Meschaninov” and surgical department of MIHP “Regional clinical hospital – center of urgency and catastrophe medicine” of Kharkiv city in the period 2005 – 2015 were operated 204 patients with perforating ulcer, they were divided in 2 groups: I group (comparison) – 103 (50,5 %) patients, who underwent a vagotomy with an operation, draining the stomach; II group (main) – 101 (49,5 %) patients was divided in subgroups: 1 subgroup 56 patients with a closure or excision of a perforating ulcer without a vagotomy from the laparoscopic access, 2 subgroup – 45 patients, who underwent the same operation volumes from the laparoscopic access. Patients underwent methods of laparoscopic diagnostics and instrumental examination methods. After the operation the remote results were studied in different terms using Visic life quality criteria.
Results: In patients of the comparison group took place post-vagotomy motor-evacuating disorders of the functional character in the remote period. In the main group in the remote period the best results were received in the subgroup, where videolaparoscopic interventions were realized with the further use of modern antiulcer preparations taking into account the immunohistochemical proliferation index, received by the study of KI-67 antigen expression. The most number of complications – 16,2 % was observed in patients, who underwent a trunk and selective vagotomy, combined with the closure of the perforating ulcer. The algorithm of the operative practice at this pathology was elaborated based on the received results.
Conclusions: The realized studies allowed to determine indications for the videolaparoscopic closure of a perforating ulcer without a vagomomy that is replaced by the prescription of modern blockers of a protonic pump
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