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The Recurrent Postoperative Bleeding Ulcer


Author: Gheorghe Popa
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Year:2005
Scientific adviser: Evstafie Cicala
doctor habilitat, professor
Scientific consultant: Isac Şroit
doctor habilitat
Institution:
Scientific council:

Status

The thesis was presented on the 9 March, 2005
Approved by NCAA on the 21 April, 2005

Abstract

Adobe PDF document – 0.36 Mb / in romanian

Keywords

recurrent postoperative bleeding ulcer, surgery tactics, gastric resection roux, reconstructive gastric reresection roux, follow up results, local immunotherapy

Summary

The study comprises 95 patients with recurrent postoperative bleeding ulcer (RPBU) investigated and treated in municipal clinical hospitals Nr. 4 and Nr. 1 of Chisinau during the period of time 1987-2003. All the patients from the reference batch were examined anamnestico-clinically, instrumentally and undertook laboratory as well as some other special investigations that permitted a diagnostic algorithm elaboration. Depending on the previous operations performed on the stomach and the causes of the recurrent postoperative ulcer, complicated with bleeding, there were proposed optimal variants of ulcer surgery treatment. On the basis of follow up results analysis through the repeated clinical-paraclinical investigation and examination of the patients there was demonstrated that the reconstructive gastric resection Billroth-II-Roux applied in cases of ulcer occurred after vagotomy-29 cases, and the reconstructive gastric resection Billroth-II-Roux in cases of ulcer that reappeared after different types of gastric resection-19 cases, showed good and satisfactory results.

There was proposed and implemented a new method of treatment of RPBU, inactive faze through local immunotherapy with supernatant liquid of autologic lymphocyte culture activated out of the body that permitted to avoid the operation and led to a local regeneration speeding up and reduction of ulcer healing period up to 7-9 days. The complex study of the immune statute till the immunologic stimulation and dynamically after the local immunotherapy of ulcer showed a positive dynamic of immunological indexes.

On the basis of this study there was elaborated a diagnostic and treatment algorithm of recurrent postoperative bleeding ulcer.