Diagnosis Of Duodeno-Gastronic Reflux In Operated Patients With Complicated Pyloroduodenal Ulcer

Abstract

Operative interventions at the gastroduodenal zone with a violation of the integrity of the pyloric sphincter are accompanied by the development of a whole series of postoperative complications, the main of which are violations of the motorevacuator function of this stomach and duodenum [1]. The lack of a installment income of food, its insufficient digestion due to the loss of the closing function of the pylorus causes the development of the syndrome of malnutrition [2]. In this case, the presence of pathological reflux of bile, in particular lysolecithin, in the stomach, which is known as duodeno-gastric reflux (DGR), leads to increased stimulation of gastric secretion and the dangerous development of gastric ulcer in 60% of cases [3]. Timely diagnosis of moderate and severe DGR is extremely important in this condition [4]. However, screening methods for diagnosing this disease, especially in the early postoperative period after surgical interventions on the upper parts of the digestive tract, are still unknown today. The purpose of the study was to improve the development of methods of screening diagnosis of moderate and severe duodeno-gastric reflux in the early postoperative period after surgical interventions on the upper parts of the digestive tract. Materials and methods of research. The study of the motor-evacuation function of the gastric outlet was conducted in 143 patients with perforated pyloroduodenal ulcers. The main group consisted of 52 patients who underwent duodenoplasty, that is, in this case, the pylorus was not dissected. The comparison group included 35 patients with subpyloric localization of the ulcer, who underwent pylorus-corrective gastroduodenoplasty according to their own methodology, and 56 patients - classic gastroduodenoplasty (pylorus-destructive intervention). During the first two to four days of the postoperative period, before the removal of the nasogastric tube and the start of per os fluid intake, the resence of severe DGR was determined using the method developed by us (Ukrainian utility model declaration patent U46697). The essence of the technique is as follows: gastric contents are aspirated through the nasogastric tube installed before the operation. An assessment of the presence of pathological reflux of the contents of the gastrointestinal tract into the stomach is carried out by immersing a strip of developed (illuminated, fixed) X-ray film in a container with gastric contents for 20 minutes. In the presence of DGR, the film becomes transparent.h is a component of duodenal contents, the gelatin layer of the developed X-ray film dissolves, as a result of which the film becomes transparent. Results of the research. In all 56 patients who underwent hemipylorectomy, the presence of DGR was established, which was later confirmed using other methods. Despite the course of anti-relapse drug treatment, including the use of gastrokinetics, patients complained of aching pain in the upper half of the abdomen, a feeling of distension in the abdomen, nausea, and the urge to vomit. This required long (up to 6 months) courses of conservative treatment, which allowed to improve the condition of 38 patients (67.9%). In the rest of the patients who underwent various variants of duodenoplasty, including those with subpyloric localization of the ulcer, there were no signs of severe DGR. When characteristic complaints of DGR appeared, the symptoms quickly disappeared after short-term (within 2 weeks) use of prokinetic drugs. Conclusions. The proposed screening method for diagnosis of GDR is effective in the early postoperative period after interventions in the gastroduodenal zone. Thus, hemipylorectomy is accompanied by the development of DGR in all patients, and in the early postoperative period, severe forms are recorded in the vast majority. Carrying out long (up to 6 months) courses of conservative treatment, which made it possible to improve the condition of 38 patients (67.9%) of this group. Pylorus-preserving (duodenoplasty) and pylorus-corrective (modified duodenoplasty for subpyloric ulcer of the duodenum) interventions do not cause violations of the motor-evacuator function of the gastroduodenal transition, which positively affects the results of treatment.