Supraselektivna vagotomija i gastrojejunostomija u lečenju stenoze pilorusnog kanala uzrokovane peptičkim ulkusom

  • Nebojša Radovanović Clinic for Digestive Disease – The First Surgical Clinic, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Aleksandar Simić Clinic for Digestive Disease – The First Surgical Clinic, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Ognjan Skrobić Clinic for Digestive Disease – The First Surgical Clinic, Clinical Center of Serbia, Belgrade, Serbia
  • Milutin Kotarac Clinic for Digestive Disease – The First Surgical Clinic, Clinical Center of Serbia, Belgrade, Serbia
  • Nenad Ivanović Clinic for Digestive Disease – The First Surgical Clinic, Clinical Center of Serbia, Belgrade, Serbia
DOI: https://doi.org/10.2298/4716
Ključne reči: peptic ulcer||, ||želudac, ulkus, pyloric stenosis||, ||pilorus, stenoza, vagotomy, proximal gastric||, ||vagotomija, proksimalna, gastrička, digestive system surgical procedures||, ||hirurgija digestivnog sistema, procedure, treatment outcome||, ||lečenje, ishod,

Sažetak


Uvod/Cilj. Incidencija stenoze pilorusnog kanala uzrokovane petičkim ulkusom u stalnom je padu. Cilj ove studije bio je da prikaže naše rezultate u hirurškom lečenju stenoze pilorusnog kanala supraselektivnom vagotomijom i gastrojejunostomijom. Metode. Retrospektivnom studijom bilo je obuhvaćeno 13 bolesnika sa stenozom pilorusnog kanala uzrokovanom peptičkim ulkusom kod kojih je učinjena supraselektivna vagotomija i gastrojejunostomija. Sprovedeno je trogodišnje praćenje, koje se sastojalo od kliničkog ispitivanja i endoskopije gornjeg dela digestivnog trakta, jednu i tri godine nakon operacije. Rezultati. Najčešći preoperativni simptom bilo je povraćanje, kod 92,3% bolesnika. Srednja vrednost preoperativnog indeksa telesne mase bila je 16,3 ± 3,1 kg/m2, pri čemu je 9 bolesnika preoperativno klasifikovano kao pothranjeno. Nije bilo intraoperativnih komplikacija ili mortaliteta. Nakon trogodišnjeg praćenja nije bilo rekurentnih ulkusa. Odloženo gastričko pražnjenje uočeno je kod jednog, bilijarni refluks kod dva, a erozivni gastritis kod jednog bolesnika. Kod dva bolesnika bili su prisutni simptomi “dumping” sindroma. Zaključak. Supraselektivna vagotomija kombinovana sa gastrojejuno anastomozom je bezbedna hirurška procedura i dobro rešenje za bolesnike sa stenozom pilorusnog kanala uzrokovanom peptičkim ulkusom. U dugoročnom praćenju mogu se očekivati dobri funkcionalni rezultati i niska incidencija kasnih komplikacija.

 

Reference

Schwesinger WH, Page CP, Sirinek KR, Gaskill HV, Melnick G, Strodel WE. Operations for peptic ulcer disease: paradigm lost. J Gastrointest Surg 2001; 5(4): 438−43.

Chung SC, Li AK. Helicobacter pylori and peptic ulcer surgery. Br J Surg 1997; 84(11): 1489−90.

Ellis H. Pyloric stenosis complicating duodenal ulceration. World J Surg 1987; 11(3): 315−8.

Behrman SW. Management of complicated peptic ulcer disease. Arch Surg 2005; 140(2): 201−8.

Barksdale AR, Schwartz RW. The evolving management of gas-tric outlet obstruction from peptic ulcer disease. Curr Surg 2002; 59(4): 404−9.

Khullar SK, DiSario JA. Gastric outlet obstruction. Gastrointest Endosc Clin North Am 1996; 6: 585−603.

Chowdhury A, Dhali GK, Banerjee PK. Etiology of gastric outlet obstruction. Am J Gastroenterol 1996; 91(8): 1679.

Awan A, Johnston DE, Jamal MM. Gastric outlet obstruction with benign endoscopic biopsy should be further explored for malignancy. Gastrointest Endosc 1998; 48(5): 497−500.

Lau JY, Chung SC, Sung JJ, Chan AC, Ng EK, Suen RC, et al. Through-the-scope balloon dilation for pyloric stenosis: long-term results. Gastrointest Endosc 1996; 43(2 Pt 1): 98−101.

Kuwada SK, Alexander GL. Long-term outcome of endoscopic dilation of nonmalignant pyloric stenosis. Gastrointest Endosc 1995; 41(1): 15−7.

Lam Y, Lau JY, Law KB, Sung JJ, Chung SS. Endoscopic balloon dilation and Helicobacter pylori eradication in the treatment of gastric outlet obstruction. Gastrointest Endosc 1997; 46(4): 379−80.

Dragstedt LR, Owens FM. Supradiaphragmatic section of the va-gus nerves in the treatment of duodenal ulcer. Proc Soc Exp Biol (NY) 1943; 53: 152−4.

Mistiaen W, van Hee R, Bortier H. Current status of proximal gastric vagotomy, one hundred years after Pavlov: is it finally history. Acta Chir Belg 2005; 105(2): 121−6.

Griffith CA, Harkins HN. Partial gastric vagotomy: an experi-mental study. Gastroenterology 1957; 32(1): 96−102.

Amdrup E, Jensen HE. Selective vagotomy of the parietal cell mass preserving innervation of the undrained antrum. A pre-liminary report of results in patients with duodenal ulcer. Gas-troenterology 1970; 59(4): 522−7.

Debas HT. Peripheral regulation of gastric acid secretion. In: Johnson LR, editor. Physiology of digestive tract. New York: Raven Press; 1987. p. 931.

Donahue PE, Griffith C, Richter HM. A 50-year perspective upon selective gastric vagotomy. Am J Surg 1996; 172(1): 9−12.

Donahue PE. Highly selective vagotomy. Operat Techniq Gen Surg 2003; 5(2): 101−5.

Gibson JB, Behrman SW, Fabian TC, Britt LG. Gastric outlet ob-struction resulting from peptic ulcer disease requiring surgical intervention is infrequently associated with Helicobacter pylori infection. J Am Coll Surg 2000; 191(1): 32−7.

Csendes A, Maluenda F, Braghetto I, Schutte H, Burdiles P, Diaz JC. Prospective randomized study comparing three surgical tech-niques for the treatment of gastric outlet obstruction second-ary to duodenal ulcer. Am J Surg 1993; 166(1): 45−9.

Objavljeno
2015/04/24
Broj časopisa
Vol. 71 Br. 11 (2014)
Rubrika
Originalni članak