[A method for the diagnosis and surgical treatment of a diverticulum of the gastric fundus].
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Biomedical subjects
Publications and source records attributed to O Kh Batchaev.
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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.
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An experience with pylorus-preserving resections of the stomach in 27 patients with duodenal ulcer and very high acid production is described. Specific technical features of this operation, immediate and long-term results are analyzed. Rhythmic evacuation was preserved in addition to a reliable drop of the acid production. Gastroduodenal reflux was prevented. Positive results were noted in all the examined patients in the remote follow-up.
The article describes main principles of the operative treatment of 42 patients with postbulbar ulcers. Choice of the surgical method was individualized: resection for the "exclusion" was used in 25 patients, gastric resection with the excision of the ulcer--in 11 patients, organ preserving operations--in 5 patients. The operations made for the "exclusion" gave most favourable immediate and long-term results. Technical details of the operations are described.
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Based upon the experience with the treatment of 2312 patients with ulcer disease of the stomach and duodenum the authors analysed the major tasks which must be solved for obtaining better immediate and long-term results of the surgical treatment. In 1880 (81,3%) of the patients with a gastric ulcer and a complicated ulcer of the duodenum the stomach resection gave favorable outcomes in 98,6%. In 432 patients (18,7%) organ-preserving operations were made, in 185 of them it was vagotomy. The vagotomy was followed by recovery of 99,5% of the patients. Longterm results were studied in 1486 patients. Bad outcomes were noted in 34 patients (2,4%) after stomach resections and in 16 patients (11%) after vagotomy.
An experience with the treatment of 429 patients with postgastroresection syndrome was generalized, in 231 out of them (53,8%) associated pathological conditions had been revealed. The selection of the method of treatment was dependent on clinical manifestations of the syndrome and its causes. The surgical treatment was used in 226 patients (52,7%). Resections occupied the first place (69,5%) among the reconstructive operations. Long-term results in 95,2% of the examined patients were excellent, good and satisfactory.
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The work describes and presents original illustrations of specific features of the technique of selective proximal vagotomy developed in anatomo-surgical examinations and successfully used in 108 patients with duodenal ulcer. The follow-up investigation of remote results later than 3 years showed good results in 94% of the patients examined.
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The authors describe an original variant of gastric resection which was performed in 65 patients with ulcer of the cardial portion of the stomach with good immediate and remote results.
Technical peculiarities of a new method of gastric resection are described. Mobilization of the portion being removed was performed without an injury of main vessels and nerves. The secondary branches running to the part being resected should be subjected to parietal ligation or dissection. Operations were made on 52 patients for gastric ulcer or polyps. Immediate and remote results were good.
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The authors observed 353 patients with acute gastro-intestinal hemorrhages of tumorous etiology. It was shown that modern methods of diagnosis could reveal the correct cause and localization of the source of hemorrhage in 97.5% of patients and objectively estimate the degree of blood loss. The individual methods of treatment enabled the general lethality to be reduced to 29.8% and after radical operations to 7.5%.
Experience with the treatment of 224 patients with acute ileus is described. Direct correlation has been established between outcomes of the treatment and terms of staying at the hospital and surgery. Due to late consultation with a physician and diagnostic errors 29% of patients were admitted to the hospital later than in a day. The causes of errors, risk and complications are analyzed. Ways for their prevention are proposed. Lethality after the surgical treatment of acute ileus was 9.3%.
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