Biomedical subjects
Publications and source records attributed to A I Startsev.
Operations for gastric and duodenal ulcers were performed in 1123 patients. Injuries of the spleen were found in 16 patients. Attention is called to special care necessary during manipulations on the upper part of the stomach.
The authors analyse 59 cases with giant gastric ulcers (measuring 3 cm or more in diameter) treated by surgery, which accounted for 10.7% of all the operations conducted for gastric ulcers. It is shown that giant gastric ulcers are complicated and recur most frequently. Planned operations were performed on 56 patients, 3 patients underwent emergency operations at the peak of hemorrhage, the stomach was resected in all of them. Total postoperative mortality was 3.4%, no fatal outcomes occurred in emergency operations. The authors conclude that giant gastric ulcers should be treated by operation after 2-3-week course of preoperative management. Resection of the stomach is the operation of choice.
Out of 1364 patients operated on in the Central Research Institute for Gastroenterology for ulcer, 130 (9.53%) appeared to have giant gastroduodenal lesions. The latter were gastric in 59 patients (more than 3 cm in diameter), duodenal in 71 (more than 2 cm in diameter). Surgical treatment of the giant ulcers is a valid therapeutic measure in view of frequent complications, uneffective conservative treatment, common recurrences. Billroth I gastrectomy was performed in 2 patients. Billroth II gastrectomy in 110 with additional bilateral subdiaphragmatic or selective vagotomy in 8 cases, Roux' operation in 2 patients. Gastroenteroanastomosis was established in 16 cases of inflammatory infiltrate, disturbed gastric evacuation, no evidence of hemorrhage from the ulcer; in 15 cases of truncal bilateral subdiaphragmatic vagotomy. Lethality reached 3.07% (4 patients), which is a relatively low rate achieved due to appropriate preoperative preparation and early surgical intervention.
Questions concerned with the penetration of bile into the abdominal cavity are discussed. The observation of 9 patients was used. The effusion of infected bile into abdominal cavity results in the development of bile peritonitis requiring urgent surgical measures. If the bile is not infected, bile ascites is developing, its clinical picture being obliterated and the patients often remaining in satisfactory condition for a long time.
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