Особливості хірургічного лікування виразкової хвороби дванадцятипалої кишки, ускладненої кровотечею, у хворих з надмірною вагою тіла

Основна характеристика виразкової хвороби дванадцятипалої кишки та її особливості. Стан пацієнтів з дуоденальною кровотечею в поєднанні з надмірною вагою тіла. Комплекс вивчення клініко-лабораторних показників для оцінки зміни систем гомеостазу.

Рубрика Медицина
Вид автореферат
Язык украинский
Дата добавления 06.07.2014
Размер файла 49,9 K

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Ключевые слова: язвенная болезнь двенадцатиперстной кишки, кровотечение, избыточная масса тела, хирургическое лечение, индекс массы тела

Tabiri Stephen. Peculiarities of surgical management of duodenal ulcer bleeding in overweight patients. - Manuscript.

Thesis for Ph.D degree in specialty 14.01.03 - surgery. - Kharkov State Medical University, Ukraine. - Kharkov. 2003.

The thesis is based on studying of results of surgical treatment 106 overweight patients with duodenal ulcer bleeding, underwent treatment in the Kharkov Scientific Research institute of General and Urgent Surgery, Ukrainian Academy of Medical Sciences. The results were compared with 51 patients with duodenal ulcer bleeding in patients with normal weight.

The complex investigation of clinical and laboratory data allowed evaluation of changes in homeostasis. Greater disturbances were observed in cellular immunity, lung function test, acid-base balance, and coagulation mechanism. Depth of these changes depends on both degree of bleeding and overweight.

Distinctive feature of ultrastructural changes in the zone duodenal ulcer in overweight patients were dystrophic changes in mitochondria, endoplasmic reticulum, Golgi apparatus, expressed in the form of lyses of membrane and destructive changes in boarders. This creates conditions for bacterial translocation and is a risk factor for recurrence of duodenal ulcer.

In overweight patients, Helicobacter pylori detected in 72,7 %, while in patients with normal body weight Helicobacter pylori observed in 58,3 %. Frequency of detection was found to be directly proportional to Body Mass Index. Helicobacter pylori was observed in 83,3 % of patients with III degree overweight.

The proposed method of surgical treatment of duodenal ulcer in the dissertation the in overweight patients, eliminates not only the etiology of acute gastrointestinal bleeding, but also effective for treatment of obesity.

The maximal changes in investigated parameters were observed in 1 - 3 day postoperative period with the subsequent normalization at the 7-th postoperative day in patients with normal body weight and I degrees acute gastrointestinal bleeding, stabilization and normalization on 14-th postoperative day up to initial values in overweight patients with I degree acute gastrointestinal bleeding. However, in II-III degree overweight patients with II and III degree acute gastrointestinal bleeding at the time of discharge (14-th postoperative day) initial values were not observed.

The developed algorithm of diagnosis and differential strategy and choice of surgical intervention in duodenal ulcer complicated acute gastrointestinal bleeding in overweight patients enabled us to reduce immediate postoperative complications and mortality from 27,8 and 19 % to 11,7 %, 6,3 % respectively.

Keywords: duodenal ulcer, bleeding, overweight, surgical treatment, body mass index

Підписано до друку 15.09.03. Формат 60х84/16

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