Biomedical subjects
Publications and source records attributed to A I Gorbashko.
A new method of duodenal closure in stomach reconstructive resection in patients with pathologic disturbances after vagotomy with drainage operation is worked up. 6 patients have been operated. No postoperative complications were observed. All the method advantages are evident.
Based on findings of general diagnosis in 62 patients the authors have determined indications for using Roux resection of the stomach which was used as primary operation in 22 patients and repeated operation--in 40 patients. Main indications for Roux resection were chronic disturbance of duodenal patency, chronic pancreatitis, afferent loop syndrome, reflux-gastritis. The work describes technical peculiarities of the Roux resection of the stomach with necessary observation of 6 pathogenetically substantiated rules. Results of Roux resection of the stomach are good, no evacuatory disorders of the gastric stump were noted.
The article deals with questions of pathogenesis, diagnostics and treatment of postvagotomy diarrhea which was found in 6 (3.5%) of 174 patients with postvagotomy syndromes. The leading place in the development of diarrhea belongs to the disturbed regulatory function of the pyloric sphincter after vagotomy with pyloroplasty. In 3 patients with the II-III degree diarrhea medicamentous treatment was not effective and the patients were operated on. A new original method of surgical treatment of postvagotomy diarrhea is described. For the first time in the world the author has performed plasty of the vagus nerve with the help of epineural sutures in combination with true pyloroplasty with a good outcome.
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An analysis of results of transgastric selective proximal vagotomy in 90 patients with ulcer disease of the duodenum enabled the authors to conclude that seromyotomy of the lesser curvature of the stomach when performing transgastric selective proximal vagotomy fails to ensure valuable parasympathetic denervation of the zone in question which results in a number of cases in preservation of uninterrupted gastric acid formation of high intensity and in the development of recurrent ulcer.
The influence of transgastric selective proximal vagotomy (TSPV) on the cardia functional state was studied in 120 patients with ulcer disease of the duodenum. It was established that seromyotomy in the zone of cardia and lesser curvature of the stomach when performing TSPV resulted in disturbance of the constrictor-valvar mechanism of the esophago-gastric passage. Fundoesophagography does not allow the insufficient closure of the cardia to be adequately corrected. The significance of fundoplication is stressed in order to restore the mechanism of cardia closure after TSPV.
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An analysis of treatment of ulcer disease of the stomach and duodenum with the help of helium-neon lasers has been made. The pathological focus (ulcer) was influenced in two ways: through the endoscope and by means of biologically active points. Positive effects were obtained in 96.9% of the patients. Operations were performed on 3.1% of the patients where laser therapy failed to give good effects. Contraindications to laser therapy were considered to be bleeding, callous and malignant ulcers.
The method of operative treatment of high ulcers of the posterior gastric wall has a number of advantages and is technically less difficult than other available methods. The use of the method includes preservation of blood supply of the gastric stump and pyloric sphincter, resection of the posterior gastric wall with ulcer, creation of the gastric tube from the anterior wall and putting a direct anastomosis with the preservation of the pyloric sphincter which allows avoidance of incompetence of the anastomosis sutures and such late disturbances as dumping syndrome, gastric stump gastritis and reflux-esophagitis. The method was used in operations on 6 patients and gave good results.
The work generalizes results of diagnostics and treatment of 2662 patients with acute gastrointestinal bleedings, in 1470 of them (55,3%) hemorrhages of ulcerous etiology were found. Ways to improve results of diagnostics and treatment are analyzed both at the prehospital period and in the hospital. Operations were performed on 841 patients (57%). After emergent and early urgent operations 96.5% of the patients recovered, planned operations were followed by recovery in 97.3% of the patients.
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An experience with the operative treatment of 1620 patients has shown that incidence of postoperative complications can be reduced by using active aspiration of the gastric stump content, early intestinal feeding, autohemotransfusions for the substitution of the intraoperative blood loss.
The method of roentgen planimetry was used in 79 patients with pyloroduodenal ulcer at different terms after selective proximal vagotomy (SPV) with/without draining operations in order to study the rate of emptying the stomach. It was shown that the evacuatory function of the stomach in remote periods after isolated SPV was determined by the state of the closing function of the pylorus, after SPV with drainage of the stomach--by a draining operation. Alterations of the duodenal passage not corrected during operation manifested themselves in remote periods after SPV as slower emptying of the stomach.