Author/Editor		Benedik, Tomaž; Sever, Primož; Benedik, Stanislav
Title		Kirurško zdravljnje bolnikov s krvavečo peptično razjedo
Translated title		Surgery in the acute management of bleeding peptic ulcer
Type		članek
Source		Gastroenterolog
Vol. and No.		Letnik 9, št. 20
Publication year		2005
Volume		str. 53-8
Language		slo
Abstract		OBJECTIVE: Bleeding is a severe complication of peptic ulcer disease of stomach and duodenum. In the past century, many changes have been adopted in therapy of ulcer bleeding, especially by endoscopic therapy, but mortality has been changed little since 1940s. Rockall et al. in 1993 reported ll% mortality rate in 4185 patients admitted with bleeding peptic ulcer. Endoscopic therapy reduces the need for emergency surgery, but bleeding ulcers that fail endoscopic therapy are often "difficult" ulcers that are highly demanding also for surgical treatment. Increasing challenge for treatment of bleeding peptic ulcer is also an ageing population with accompanying disease. Ulcer re-bleeding is an aditional serious problem influencing outcome especially in elderly patients. There has been 2 policies established forsurgical treatment of peptic ulcer bleeding is literature: conservative with "wait and see policy, and agressive with early elective surgery approach. Early elective surgery is treatment of choice in high-risk patients with ulcers likely to rebleed. PATIENS AND METHODS: In the paper, 56 patients admitted to the Department of Abdominal Surgery in 5 years period have been analysed ret rospectively. All patients vere treated with initial endoscopic therapy. Majority of patients were treated prior with endoscopic therapy in Department of Gastroenterology and endoscopic control of bleeding were considered to he failed on insufficient. There were 27 (48%) female a nd 52 (29%) male patients. There were 37 (66%) elderly patients with age over 60 years. Possible factors predicting failure in endoscopic therapy were then analysed with respect to outcome of endoscopic treatment. Surgery was defined as failure outcome in endoscopic therapy. The type of surgery in patients who were operated on is also analysed in respect of outcome. (Abstract truncated at 2000 characters)
Summary		Izhodišče: Krvavitev iz peptične razjede je resen zaplet peptične ulkusne bolezni želodca in dvanajstnika. Kljub številnim pomembnim spremembam v zdravljenju bolnikov krvavečo peptično razjedo želodca in dvanajstnika v preteklem stoletju, med katerimi so najpomembnejše endoskopske metode zaustavljanja krvavitev, se smrtnosti teh bolnikov ni pomembno spremenila od leta 1940. Rockall s sodelavci je v študiji iz leta 1993 poročal o 11% smrtnosti 4185 bolnikov, ki so bili sprejeti v angleške bolnišnice zaradi krvaveče peptične razjede želodca ali dvanajstnika. Endoskopska skleroterapija pomembno zmanjša potrebo po urgentnem kirurškem zdravljenju, vendar pa so krvavitve iz peptične razjede, ki so refraktarne na endoskopsko skleroterapijo pogosto trd oreh tudi za kirurško zdravljenje. Resen izziv predstavljajo starejši bolniki s krvavečo peptično razjedo želodca ali dvanajstnika, ki imajo pogosto pridružene bolezni ter bolniki s ponovno krvavitvijo iz peptične razjede. V zadnjem času v literaturi zasledimo dva kirurško terapevtska prostopa in sicer konservativni pristop z "wait and see" strategijo na eni strani ter agresivnejši pristop z zgodnjim elektivnim operativnim posegom na drugi strani. Zdi se, da je zgodnji elektivni operativni poseg metoda izbora pri zdravljenju bolnikov z visokim tveganjem za ponovno krvavitev iz peptične razjede. Še zlasti je to pomembno pri starejših bolnikih s spremljajočimi boleznimi. Izbira optimalnega operativnega posega je prav tako predmet diskusij. V času sodobnega medikamentoznega zdravljenja pepptične razjede z inhibitorji protonske črpalke in eradikacijo Helicobacter pylori se zdi logična prednostna izbira minimalnih operativnih posegov za kirurško zdravljenje krvaveče peptične razjede (hemostatski šiv) pred resekcijskimi metodami, vendar pa dokazov v prid minimalnega posega v prospektivnih randomiziranih študijah v preteklem desetletju ne najdemo. (Izvleček skrajšan na 2000 znakov)
Descriptors		PEPTIC ULCER HEMORRHAGE SCLEROTHERAPY