[Surgical treatment of perforative gastroduodenal ulcers in elderly and senile patients].
The work is based on experiences with surgical treatment of 206 elderly and senile patients with perforating gastroduodenal ulcers. In 67.5% of cases the perforations took place in duodenal ulcers, in 16%--in the pyloric canal. The gastric body and antral portion ulcers were perforative more rarely--9.8% and 4.8% respectively. Perforations of the cardial and retrobulbar ulcers were found in 1.9% and 1% respectively. At early terms after operation 67 patients (33.5%) died. After suturing the perforative opening 38 out of 98 patients died (38.8%), after dissection and suturing the ulcers died 7 out of 19 patients, after Oppel-Polikarpov operation died 7 out of 11, after resection of the stomach died 4 out of 6, after truncal vagotomy with pyloroplasty died 11 out of 72 patients (15.3%). The main cause of lethal outcomes is thought to be complications of the coexistent diseases, totally responsible for 46.2% of deaths. Truncal vagotomy with a dissection of the ulcer and pyloroplasty performed in 60-70 year old patients gave the least indices of lethality and early postoperative complications, so the indications to radical organ-saving operations in patients of this age must be wider. This method of treatment for perforative ulcers in patients of 71-80 years of age should be used with restrictions due to not bad long-term results of suturing the ulcers (good and excellent results took place in 53.8% of cases). In patients older than 80 radical operations are not indicated. In such cases the ulcer should be better dissected and sutured, the posterior wall of the organ being examined for a "mirror" ulcer.
Peregudov
S I
SI
Kurygin
A A
AA
D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D004381:Duodenal Ulcer / Q000150:complications* / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D010439:Peptic Ulcer Perforation / Q000209:etiology / Q000601:surgery*; D013276:Stomach Ulcer / Q000150:complications* / Q000401:mortality / Q000601:surgery; D016896:Treatment Outcome; D014629:Vagotomy, Proximal Gastric / Q000009:adverse effects / Q000401:mortality