Peptic ulcer disease in the world - a therapeutic problem. But can we fully migrate to Western standards of our healthcare? Apparently not. This must happen gradually, with the formation of the priorities of drug therapy.
What is going on here? In the past 10 years there has been a steady downward trend in the number of planned operations in 2-2,5 times, and in specialized surgical departments of this dynamic is even more pronounced - in the 6-12 times. At the same time, according to most authors (A. Greenberg, 1997; VF Saenko, 2002; PE Donahue, et al., 1996; J. Herman, et al., 1998), the number of urgent surgical intervention that perforated and bleeding ulcers, mortality, under which varies from 5,6 to 20,4% (NH Chou et al., 2000; A. Garripoli et al., 2000; T. Sillakivi et al., 2001). According to our data, the number of perforated gastric and duodenal ulcers is increasing annually by 5-8% over the past 10 years their number increased in 3,7 times.
Hardly changed the number of patients operated on at such a formidable BU complications such as bleeding (0.6 per 10 thousand population) due to the development and implementation of effective methods of minimally invasive local hemostasis in the ulcer, while quantitatively, in patients requiring hospitalization connection with this complication continues to grow. The importance of this problem is caused by the fact that the mortality in this group of patients is 10-12 times higher than during elective treatment of peptic ulcer.
In our daily practice we distinguish absolute and relative indications for surgical treatment. Absolute indications are urgent: perforation of an ulcer, profuse bleeding not stopped by a conservative, and deferred: decompensated stenosis of the output of the stomach, unstable hemostasis or recurrent bleeding. Relative indications - ulcers refractory to medical therapy or frequently recurrent (more than 2 times per year during the combined treatment), with the presence of complications in history, as well as ulcers in the cardia, greater curvature and privratnikovoy part of the stomach, not amenable to surgical treatment for 8 weeks.
Experience in planning surgical treatment of peptic ulcer disease, based on more than 5 thousand operations, allowed us to develop specific approaches to the surgical treatment of BU. The main task of the planned surgical treatment of peptic ulcer disease is the creation of postoperative conditions for the elimination of factors of aggression in the gastroduodenal region with a simultaneous reduction in mortality and a maximum reduction of side effects. When duodenal ulcer - it impacts on acidogenic zone, the efficiency of the operation depends on the level of suppression of gastric secretion, gastric ulcer - an impact on the area of ulcerative infiltration, which further helps to normalize trophic disturbances and create conditions for stabilizing gistostrukturnyh changes in the gastric mucosa.
It should be noted that the main purpose Urge surgery for perforated brand viagra gastric ulcer or duodenal ulcer - saving the life of the patient. The choice of method and operational benefits of its radicalism is largely dependent on the specific clinical situation - the patient's age, comorbidities, degree of operational risk.
In the structure of surgical intervention for duodenal ulcer is most justified by the dominance of the nervous mechanism of regulation of acid are selective proximal vagotomy or selective proximal vagotomy with different variants duodenoplasty. The prevalence of humoral mechanisms of regulation, which is expressed in hyperplasia gastrinprodutsiruyuschih cells antrum with a simultaneous decrease in the number somatostatinprodutsiruyuschih cells was observed in 10% of patients. In this case demonstrates the subdiaphragmatic vagotomy stem from antrumektomiey as operations acting directly on the two mechanisms for the regulation of acid in the stomach: nervous and humoral. The main operation for gastric ulcer remains a resection with a tendency to reduce its volume and the preservation of the pylorus and the passage of the duodenum.
An integral step in preparing patients for surgery is to conduct the course antiulcer therapy, contributes not only to reduce the irritants in the mucosa of stomach and duodenal acid-peptic factor, but also aimed at the elimination of helicobacter colonization.
In the preoperative H. pylori colonization of the mucous membrane antrum we found in 78% of cases of gastric and in 94% of cases with duodenal ulcer site. According to E. M. Perkin et al. (1995), bacterial contamination after the operation, not only conforms to the initial level, but also tends to increase in the antral stomach and in the vault. Failure to eliminate bacterial invasion into the postoperative period contributed to the development of erosive antral gastritis and duodenitis, reduced physiological resistance of surface epithelium, hampered repair processes.
With the introduction of minimally invasive laparoscopic surgery becomes an alternative to open methods, taking a real place in the surgical treatment of peptic ulcer. P. Goh and C. Kum in 1992, the world's first successfully performed a laparoscopic gastric resection. In recent years the leading surgical centers around the world have been widely introduced different methods of laparoscopic vagotomy. Sufficiently effective and technically feasible today is a modified laparoscopic operation J. L. Hill and C. J. Barker - anterior selective proximal and posterior truncal vagotomy. Long-term results of these operations with tangible benefits are not inferior in quality and reliability operations using routine methods. At the same time, it should be noted that a prerequisite for laparoscopic surgery (organ with the use of vagotomy or resection) is a sound material-technical base and highly qualified personnel.
Thus, the results of basic research and the successes of the pharmaceutical industry suggest medication main method of treatment of gastric ulcers and duodenal ulcers. However, practical experience and long-term observation of patients allows us to conclude that at present the complete abandonment of the planned surgical treatment of patients with severe peptic ulcer disease leads to an increase in the number of complicated forms of the disease, threatening the lives of patients and contributing to the development of postoperative complications, which reduces the effect of surgery and worsens the health of the population as a whole.
many years
life moves
wrong interpretation
complications
placebo
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