DUODENAL ÜLSER PERFORASYONLU HASTALARDA PRÝMER RAFÝ SONRASI ÜLSER TEDAVÝSÝ

Duodenal ülser toplumun büyük bir kýsmýný etkileyen bir hastalýktýr ve Helicobacter Pylori(HP) ile sýký bir iliþkisi vardýr. Perforasyon duodenal ülserli hastalarda en sýk cerrahi tedavi gerektiren komplikasyondur. 1.5.1997 tarihinden itibaren Dr. Lütfi Kýrdar Kartal Eðitim ve Araþtýrma Hastanesi Acil Cerrahi Ünitesine duodenal ülser perforasyonu sebebiyle baþvuran 52 hasta primer kapama tekniðiyle öpere edildi. Operasyon sonrasýnda HP serolojileri (+) olan hastalar (Grup 1, n=35) 7 gün boyunca Clarithromycin ve Amoxicilline ile 28 gün süreyle Omeprazole kullandýlar. HP serolojileri (-) olan hastalar ise (Grup 2, n=17) 28 gün Omeprazole tedavisi aldýlar. Grup " hastalardan 29'una, grup2 hastalardan 6'sýna tedavi bitiminden 4 hafta sonra endoskopi uygulandý. Grup 1 hastalardan 6'sýnda (%20.7) aktif ülser gözleniyordu. HP eradikasyonu sadece 12 hastada (%41.4) baþarýlmýþtý. Grup2 hastalarda ise tamamen iyileþme saðlanmýþtý. Sonuç olarak primer rafi ile tedavi edilen duodenal ülser perforasyonlu hastalarda eðer seroloji (+) ise bir haftalýk üçlü eradikasyon tedavisi yeterli olamamaktadýr. Serolojisi (-) olan hastalarýn ise bir aylýk Omeprazol tedavisiyle tamamen iyileþtikleri gözlenmektedir.

ULCER THERAPY FOR PERFORATED DUODENAL ULCER PATIENTS TREATED WITH PRIMARY RAPHY

Duodenal ulcer effects a great number of people in the society and has a close relationship with Helicobacter Pylori(HP). Perforation is the most frequent complication that requires surgery. 52 patients admitted to Dr. Lütfi Kýrdar Kartal Training and Research Hospital Emergency Unit till 5.1.1997 with duodenal ulcer perforation were treated with primary raphy technique. After operations, the patients were instructed to use Clarithromycin and Amoxicilline for 7 days and Omeprazole for 28 days if they have (+) HP serology (Groupl, n=35) or only Omeprazole for 28 days if they have (-) HP serology (Group2, n=17). 29 patients in group 1 and 6 patients in group2 had an endoscopic examination 4 weeks after the treatment had ended. 6 patients in group 1 (20.7%) had still active duodenal ulcer. Eradication was achieved only in 12 patients (41.4%). All patients in group2 were successfully treated. As a conclusion, one-week tripple eradication therapy is not a suitable choice for the perforated duodenal ulcer patients treated with primary raphy if they have (+) HP serology. But patients with (-) serology can be treated with Omeprazole for 4 weeks.