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"Emergency medicine" 1 (56) 2014

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Rationale gastroduodenal anastomosis with economical resection stomach in surgery of duodenal ulcer

Authors: Nazirov F.G., Nishanov M.F. - Andijan city. Republic of Uzbekistan.

Categories: Medicine of emergency

print version

The authors investigated the prevalence of BU in Ferghana Valley , which amounted to 131.3 per 100,000 to which the 3 region (Uzbekistan) –  Andijan, Fergana and Namangan - with a total population of 10 million. In 98.5 % of cases set duodenal ulcer localization.

In the process of the analysis of various approaches to the choice of methods of surgical intervention for the period from 1959 to 2009, which are periodically changed. In this regard, divided into 3 periods conditional.

First. The years 1959–1975 – the period of the "classic" resection with primary formation of GDSs. Second. 1976–1989 years – the period of "vagotomy " (from the stem to the extended selective proximal vagotomy) with draining stomach operations. Third. 1990–2009 years – a period of small gland excision with antrumrezektsiey and the formation of the GDSs.

During the first period of 1878 patients operated on DU (duodenal ulcer), with mortality rates of up to 4 %. Post-resection syndromes are set at 15 % of the operated and ulcer recurrence in 4%.

In the second period, 1247 patients underwent surgery. Recurrences of ulcers was 8.4 %, gastroplegiya - 2.3 %, other syndromes postvagotomicheskie - 5.7%, with a mortality rate of 1.3 %. Dissatisfaction with the results led to the abandonment of vagotomy in favor of excision of the lesser omentum with antrumrezektsiey and the formation of the GDSs.

For the third time, in our clinic, implemented and widely used small gland excision with antrumrezektsiey (in 2782 patients). The formation of the GDSs. in different modifications made ​​in 2316 patients, representing about 80 % of the observations from all underwent gastric surgery. The anastomosis is applied using a single-row suture.

In the survey process, the patients underwent an objective clinical trial, the clinical and biochemical analyzes of blood and urine, the study of gastric secretion (basal acid output (BOD), the maximum production of acid (IPC), pH meters, acidic and alkaline components of the gastric juice, pepsin), motor - evacuation function of the stomach (by X-ray: Continuous electrogastrography (NEGG), continuous radiogastrografiya (NRGG), and a study of the functional state of physiological cardia before and after various operations using radiologic, endoscopic and ionomanometricheskih techniques.

After analyzing the immediate and late results of excision of the lesser omentum with antrumrezektsiey and gastroduodenoanastomozom (in 2316 patients) using a single row silk suture Ator concludes.

 Significant reduction of various complications during surgery and in the postoperative period, and mortality (1.0 %), mostly excellent and good results (more than 90 % of cases) in the long-term period can be considered a small gland excision with antrumrezektsiey and gastroduodenoanastomozom using the direct -row suture, as the most feasible method of surgical treatment of PUD.

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