This journal is
indexed in Scopus
Year 2012 Vol. 20 No 2
GENERAL AND SPECIAL SURGERY
S.V. ZHAROV 1, D.V. NAREZKIN 2, S.N. ROMANENKOV 1
OPERATIVE TREATMENT RESULTS OF ELDERLY AND SENILE PATIENTS WITH COMPLICATED GIANT ULCERS OF THE STOMACH AND DUODENUM
Nefteyugansk city hospital 1,
SEE HPE “Smolensk State Medical Academy”2,
The Russian Federation
Objectives. To improve the treatment results of elderly and senile patients with giant ulcers of the stomach and duodenum.
Methods. Operative treatment analysis of 61 patients (22,3%) out of 274 patients with giant stomach and duodenum ulcers was performed. The patients were divided into 2 groups. The main group included 148 patients, 133 (89,9%) of them were of old age and 15 (10,1%) – of senile age correspondently. 126 patients of young and mean age were included in the comparison group. The average age in the main group made up 66,1±5,6; in the comparison group – 46,4±9,4. 75 (50,6%) patients in the main group had ulcers of the stomach; in the comparison group 62 (49,2%) patients had it. Duodenum ulcers in the main group were revealed in 73 patients (49,4%), and in the comparison group – in 64 patients (50,8%).
Results. The main indications for the operation in both groups were hemorrhage and perforation.
25 (16,9%)out of 148 patients underwent surgical treatment: 18 patients (72%) with duodenum ulcer and 7 patients (28%) with gastric ulcer. There were 7 planned operations (28%) and 18 emergent operations (72%). The choice of operation volume in elderly patients depended on condition severity grounded by the character of the accompanying pathology, the degree of poly-organ insufficiency expression and blood loss degree.
In the comparison group 36 patients (28,6%) out of 126 were operated on. 11 patients (17,7%) out of 64 with duodenum ulcers underwent surgical interventions. 25 patients (40,3%) out of 62 with gastric ulcers were operated on. The majority of patients were operated on emergently – 23 patients (63,9%) and urgently – 7 patients (19,4%); there were 6 (16,7%) planned operations.
Postoperative lethality in the main group made up 16%, 4 out of 25 patients died. Postoperative lethality in the comparison group made up 2,8%, 1 patient died.
Conclusions. Minimal according to their volume surgeries in elderly and senile patients with severe accompanying pathology in case of life-threatening complications are less risky and should be the method of choice in the given category of patients.
1. Vakhidov VV, Kalish IuI, Berezovskii AG. Gigantskie iazvy zheludka [Giant gastric ulcers]. Khirurgiia. 1990;(4):17–19.
2. Zhantalinova NA. Vybor khirurgicheskoi taktiki pri gigantskikh iazvakh zheludka i dvenadtsatiperstnoi kishki [The choice of surgical tactics in giant gastric and duodenal ulcers]. Khirurgiia. 2005;(12):30–32
3. Pantsyrev IuM, Mikhalev AK, Fedorov ED. Khirurgicheskoe lechenie probodnykh i krovotochashchikh gastroduodenal'nykh iazv [Surgical treatment of perforated and bleeding gastroduodenal ulcers]. Khirurgiia. 2003;(3):43–49.
4. Pantsyrev IuM, Mikhalev AK, Fedorov ED, Kuzeev EA. Lechenie iazvennykh gastrododenal'nykh krovotechenii [Treatment of ulcer gastroduodenal bleeding]. Khirurgiia. 2000;(3):21–25.
5. Shevchenko IuL, Korznikova AA, Stoiko IuM, Badurov BSh. Differentsirovannoe lechenie iazvennykh gastroduodenal'nykh krovotechenii [Differential treatment of gastroduodenal ulcer bleedings]. Khirurgiia. 2006;(11):18–23.
6. Asadov SA. Khirurgicheskoe lechenie «trudnykh» i oslozhnennykh gastroduodenal'nykh iazv [Surgical treatment of "difficult" and complicated gastroduodenal ulcers]. Khirurgiia. 2002;(11):64–69.
7. Bashniak VV. Narushenie krovosnabzheniia kul'ti dvenadtsatiperstnoi kishki i ego profilaktika [Circulatory disorders of the duodenal stump and its prevention]. Vestn Khirurgii. 1984;134(6):33–36.
8. Grubnik VV, Zaichuk AI, Grubnik IuV, i dr. Khirurgicheskoe lechenie bol'nykh s gigantskimi iazvami zheludka [Surgical treatment of giant gastric ulcers]. Klin Khirurgiia. 1992;(8):6–8.
9. Kuzin MI. Aktual'nye voprosy khirurgii iazvennoi bolezni zheludka i dvenadtsatiperstnoi kishki [Actual surgery problems of gastric and duodenal ulcers]. Khirurgiia. 2001;(1):27–32.
10. Nikitin NA. «Trudnaia» duodenal'naia kul'tia v urgentnoi khirurgii iazvennoi bolezni dvenadtsatiperstnoi kishki ["Difficult" duodenal stump in emergency surgery of duodenal ulcer]. Khirurgiia. 2001;(5):36–39.
11. Stoiko IuM, Bagnenko SF, Kurygin AA. Iazvennye zheludochno-kishechnye krovotecheniia [Ulcerative gastro-intestinal bleeding]. Khirurgiia. 2002;(8):32–35.
12. Kharaberiush VA, Kondratenko PG. Khirurgicheskoe lechenie bol'nykh s gigantskoi krovotochashchei iazvoi zheludka i dvenadtsatiperstnoi kishki [Surgical treatment of giant gastric and duodenal bleeding ulcers]. Klin Khirurgiia. 1991;(8):3–7.
13. Asadov SA, Salekhov IaS, Aliev EE. Formirovanie duodenal'noi kul'ti pri rezektsii zheludka po povodu «trudnykh» iazv dvenadtsatiperstnoi kishki [Formation of duodenal stump in gastric resection in the case of the "difficult" duodenal ulcers]. Khirurgiia. 2004;(2):78–81.
214019, Rossiiskaia Federatsiia g. Smolensk, ul. Frunze, d. 40, GBOU VPO “Smolenskaia gosudarstvennaia meditsinskaia akademiia“, kafedra fakul'tetskoi khirurgii,
Narezkin Dmitrii Vasil'evich
Zharov S.V., a surgeon of the department of surgery, Nefteyugansk city hospital.
Narezkin D.V., doctor of medical sciences, associate professor, a head of the chair of faculty surgery, SBEE HPE "Smolensk State Medical Academy," the Ministry of health and social development.
Romanenkov S.N., a surgeon of the department of surgery, Nefteyugansk city hospital.