Postoperative reflux-gastritis in patients operated by a perforative ulser
DOI:
https://doi.org/10.11603/2414-4533.2017.4.8258Keywords:
peptic ulcer, perforated ulcer, operative treatment, vagotomy, distant results, reflux gastritis.Abstract
Problem statement and analysis of recent researches and publications. To date, reflux gastritis is the least studied complication of the postoperative period of patients operated on perforated pyloroduodenal ulcer.
The purpose of the work is to improve the results of surgical treatment of patients with perforated ulcers.
Materials and methods. We have operated 204 patients with perforated ulcers in the period from 2005 to 2015. The patients performed organ-saving operations in combination with one of the types of vagotomy, as well as the excision of the ulcerous substrate with one type of pyloroplastyс without vagotomy and perforation of the perforation, both from the traditional access and the laparoscopic.
Research results and their discussion. When throwing duodenal contents into the stomach, it interacts with the contents of the stomach to form free ions of hydrogen H +, which in turn leads to a sharp increase in acidity in this area. In the future, the reverse perfusion of H + ions occurs in the mucous membrane. In patients with reflux of degree II revealed plane erosion and erosion of mixed type, the rest of the patients noted the presence of small-color erosion. Patients with recurrent peptic ulcer had a reflux II-III degree. The analysis of the causes of recurrence of peptic ulcer and the development of esophagogastroduodenitis showed that these diseases develop not only against the background of increased acid production due to incomplete vagotomy in 2 (1.9%) patients, but also with normal acid production in 3 (2.9%) patients.
Conclusion: The reflux of duodenal contents in the stomach cavity is a trigger point both in the development of recurrence of peptic ulcer and erosive gastroduodenitis. The most effective measure aimed at its prevention is the preservation of the locking function of pyloric pulp during surgery. All patients who have undergone pylorus-destroying surgery should from the first day prescribe drugs that normalize the stomach and duodenal motility. In the presence of contraindications, taking into account the intraoperative pH greater than 2,0 and the expression of the antigen Ki-67 of more than 20%, it is recommended to suture the perforated ulcer with laparoscopic or laparotomic access without vagotomy, followed by therapy with proton pump blockers.
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