The optimization of complex surgical treatment of elderly patients with perforated gastroduodenal ulcer

Abstract

Introduction: Peptic ulcer disease takes a leading place in structure of diseases of a gastrointestinal tract. One of the most dangerous complications of stomach ulcer is perforation. The complicated forms of peptic ulcer disease in the older age group are the cause of unsatisfactory results of treatment. Materials and methods: The first part of the study consisted of 76 patients with the long-term results of operations according to classification of A.Visick, modified by N.N.Krylov, divided into three clinical groups: patients with distal resections (the first group), palliative care (the second group) and radical organ-preserving operations - gastroplasty and duodenoplasty by V.I. Onopriev (the third group). The second part of the study consisted of 38 patients undergoing operative treatment of peptic ulcer disease, divided into two clinical groups: the patients received traditional treatment (the first group), the patients received the combination of traditional ozonotherapy treatment and system (the second group). Activity of antioxidant enzymes (superoxide dismutase (SOD), catalase) and concentration of NO (nitric oxide) were determined in blood of patients. The data were processed statistically by nonparametric Wilcoxon and Kruskal-Wallis test using Statistics 6.0 software. Results: The excellent long-term results of operations were observed only in the third group. Satisfactory results of treatment prevailed in the first group (78,9%), bad results of treatment - in the second group(54,5%). Clinical symptoms of the patients of the second group included pain, dyspepsia and reflux syndromes. The most common symptoms of the patients of the first group were dyspepsia and diarrhea. Combination of traditional ozonotherapy treatment and system increased catalase activity by 9 times, increased SOD activity by 2,6 times, increased concentration of NO by 2,8 times on the 7th day after operative treatment. Conclusion: Radical organ-preserving operations are preferable for the patients of older age group with complicated forms of peptic ulcer disease, with good long-term results. Combination of traditional ozonotherapy treatment and system is effective for the correction of irregularities in the free-radical oxidation/antioxidant protection system in the patients of older age.