Sushkov S. Surgical treatment of multile gastric and duodenal ulcers

The clinical examination of 1378 patients with peptic ulcer was conducted.Among the total amount of patients with peptic ulcer in 152(11,0 %) MCGDU were found.For the first time in patients with MCGDU features of clinical presentation of peptic ulcer and their influence on the functional condition of organs of digestion and homeostasis of organism were studied. At first in the resected (resection, excision) areas of stomach and duodenum of patients with MCGDU morphofunctional dystrophic changes of intramural nervous apparatus,caused by the phenomena of hypoxia associated with disturbances of microcirculation related to the presence of multiple ulcers of mucosa of stomach and duodenum, were studied. According to the conducted investigation the disturbances of parameters of homeostasis of organism (immunity,excretion of cholecystokinine,concentration of hexoses,associated with the proteins,fructose and sialic acids which provide the barrier function of mucous membrane of gastroduodenal area) and morphological changes of cells and fibers of Auerbach and Meisner plexuses of stomach and duodenum were found.The obtained experience in surgical treatment of patients with peptic ulcer with MCGDU with application of different methods of surgical treatment allowed to develop and implement new operative interventions and surgical tools into the work of clinic.The choice of the most substantiated repeated surgical intervention is determined by localization of ulcers, character of complications of recurrent ulcer,index of gastric secretion and motor-evacuation function of duodenum,adequacy of vagotomy,and also anatomic changes found during operation.The use of the developed medical-tactical program allowed to reduce the number of postvagotomy and postresection complications from 16,4% to 4,6%, mortality from 8,5 % to 1,9%.