The organpreserving and organsparing surgical interventions in treatment of the ulcer disease of stomach

І .Ya. Dzubanovskiy, Yu.M. Futuyma, L. Ye. Viytovych

Abstract


ntroduction. The choice of surgical treatment of patients with complicated forms of peptic ulcer disease, according to a number of authors, is very important. In the surgical treatment of gastric ulcer in practice usually preferred resection methods. Select the method and extent of surgery is an important factor that affects the direct distance and the results of treatment of patients. When choosing surgical treatment is not considered the type of peptic degradation and severity of comorbidity particularly acute bleeding. These points contribute to the search for new solutions and improve existing methods of surgical treatment of peptic ulcer.
The purpose of the study. Determine the tactics of surgical treatment of gastric ulcer with a predominance of organ and organpreserving approach.
Materials and methods. The work is based on a study of 106 patients with gastric ulcer type I-III treated at the 2nd city and university hospitals of Ternopil, which made organpreserving and resection methods of surgical correction. We made endoscopy research with exress biopsy of ulcer and nearby infiltranion to each patient for specification of diagnosis and tipe of ulcer with successive imunomorphological study of biopsy, determination the stage of dysplastic process and stomach mucosa bacterial contamination. Analyzed the clinical symptoms, depending on the type of ulcers by Johnson (1965). For the surgical correction of this disease we made 67 organpreserving and organsparing approach and 39 organ resection treatments. Statistical analysis of the material was carried out using the software package "Microsoft Excel" (Microsoft Office 2003). For a deeper analysis of survey indicators to predict complications of the disease used neural network approach using the add NeuroXL Classifier for Microsoft Excel.
Results and discussion. The analysis of efficiency of surgical treatment of the ulcer disease of stomach with preference of organpreserving and organsparing approach was performed. Choosing the method of surgical treatment of the ulcer disease of stomach we took into account the localization of ulcer, the results of imunomorphological study of nearby infiltranion, the stage of dysplastic process of stomach mucosa, specifics of motor-evacuation and secretory capacity of the organ, details of each particular situation intraoperative. We found a correlation between the stage of dysplasia and contamination of stomach mucosa with Нelicobacter Pilory.
Indication for organ operations and breakthrough bleeding believe ulcer with normal motor-evacuation and acid-resolution body, absence of epithelial dysplasia of the gastric mucosa. Organpreserving surgery performed: in patients with type I and II gastric ulcers in the absence or moderate severity of epithelial dysplasia of the gastric mucosa, the negative trend in the data for the power imunomorphological monitoring; with bleeding ulcers and type II; recurrence of gastric ulcer after suffering a perforated hole before stitching duodenal ulcer; recurrence of gastric ulcer after suffering earlier stitching breakthrough hole gastric ulcer, pyloric stenosis. Resection was performed under conditions of severe epithelial dysplasia of the gastric mucosa, bleeding ulcers third type penetrations into neighboring authorities and suspected malignancy. Analysis of the survey results of patients with ulcer disease based on correlation indices and multiparameter neuronetwork clasterization to optimize the prognosis of the disease was performed.
Conclusions. 1. In the choice of surgical treatment of gastric ulcer except clinical-anamnestic and local endoscopic data should be considered imunomorphological features around the ulcer stomach area, the degree of dysplastic processes gastric mucosa and functional capacity of the organ.
2. Given absent or moderate dysplasia, maintaining motor-evacuation and secretory function, absence of acute complications in choosing a method should be preferred organpreserving methods of surgical treatment.
3. Analysis of the results from the correlation parameters and multiparameter clustering neural network helps to predict the likelihood of complications, such as malignancy, which can be used in the choice of a method of surgical treatment patients with peptic ulcer.


Keywords


ulcer disease of stomach; the organpreserving and organsparing surgical interventions; neuronetwork clasterization

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DOI: https://doi.org/10.22141/1997-2938.3-4.26-27.2014.83180

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