Diagnostics and surgical treatment of penetrating duodenal ulcers
Objectives. Improvement of the immediate results of surgical treatment of penetrating duodenal ulcers (PDU). Methods. The analysis of diagnostics and surgical treatment of 74 patients with PDU was carried out. There were 42 (56,7%) males and 32 (43,3%) females. Ulcer history in 45 (60,8%) patients continued more than 10 years, and in 29 (39,2%) it made up over 15 years. Most patients (57/77%) were repeatedly treated ineffectively by different specialists for the liver and kidneys diseases as well as for chronic pancreatitis and cholecystitis. In 42 observations PDU combined with other complications of the ulcerous disease. Thus, in 20 (47,6%) patients the combination of penetration with stenosis was noted; in 16 (38,1%) - the combination of penetration and bleeding; in 6 (14,3%) patients the duodenal ulcer penetration combined with ulcer perforation. In 48 (64,8%) cases in patients with PDU, the duodenal passability with varying degrees of severity demanding surgical correction took place. X-ray, endoscopic and ultrasound investigations, CT and endoscopic ultrasound sonography were carried out to diagnose PDU; and the acid-producing function of the stomach and dumping predisposition were studied If indicated the contrast study of the duodenum, biliary tracts was performed; pancreatic enzyme activity and the level of bilirubin were determined. Results. The research results show that PDU together with an atypical clinical course and presence of severe complications is often accompanied by chronic disturbances of duodenal passability (64,8%) of various kinds, by chronic pancreatitis (32,4%), and a high degree of acid production and the dumping predisposition. Conclusions. Surgical tactics in case of PDU is not standard; that is why the primary gastric resection after Roux in the combination with the stem vagotomy and corrective interventions on the extrahepatic bile ducts under strict indications significantly improve the treatment immediate results of these severe patients.