The effectiveness of surgical treatment of gastroduodenal ulcer bleedings on the background of comorbid diabetes mellitus
DOI:
https://doi.org/10.11603/2414-4533.2018.4.9708Keywords:
peptic ulcers, gastroduodenal bleeding, diabetes mellitus, treatment, surgical methodsAbstract
The aim of the work: to analyze the results of different methods of surgical treatment of gastroduodenal bleeding on the background of comorbid DM, to distinguish the prognostic criteria.
Materials and Methods. 319 patients with ulcerative gastroduodenal bleeding undergone hemostatic drug therapy were operated and they formed the main group of the follow-up. The comparison group included 623 patients receiving only similar medical treatment. Comorbid DM was diagnosed in 15 % of the patients of the main group and 18 % of the comparison group. 34 % of the operated patients had ulcers of the stomach and 58 % – duodenal ulcers, the other 9 % – the combination of both. The average age of the observed patients was 49 years old, the duration of the disease manifestation – 7 years, the duration of bleeding – 44 hours, the severity index – 6 r.u., the severity of bleeding – 2.5 points.
Results and Discussion. Comorbid DM determines a more pronounced severity of ulcerative gastroduodenal bleeding, a greater frequency of its jet character, wall blood leakage from ulcers and the development of hemorrhagic shock before surgical treatment, it is a risk factor for the recurrences of bleeding in the postoperative period and it significantly worsens the survival of patients. Thus the operations of choice in such patients with DM include excision of ulcers with parallel application of sympathetic proximal vagotonia, resection by Bilrot-1 and Barry-Hill, and, the initial level of glycosylated hemoglobin more than 9 % has prognostic significance in relation to the lack of effectiveness of further surgical measures. In the context of the prognostic criterion of the recurrences of gastroduodenal ulcerative bleeding in the patients with comorbid DM after surgery, it is recommended to use an insulin resistance index of more than 30 r.u., a predictive criterion for the patients’ life is the level of glycemia more than 17 mmol/l.
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