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GASTROENTEROLOGY

INVENTION
Patent of the Russian Federation RU2143221

METHOD FOR PREDICTING THE RECONDITION OF DUODENAL YELLOW IN PATIENTS TRANSPLANTED BY ISOLATED RADICAL DUODENOPLASTICS

METHOD FOR PREDICTING THE RECONDITION OF DUODENAL YELLOW IN PATIENTS TRANSPLANTED BY ISOLATED RADICAL DUODENOPLASTICS

The name of the inventor: Onopriyev VI; Kokuyeva OV; Korochanskaya N.V.
The name of the patent holder: Republican Center for Functional Surgical Gastroenterology; Vladimir Onopriyev; Kokueva Olga Vasilievna; Korochanskaya Natalya Vsevolodovna
Address for correspondence: 350063, Krasnodar, St.Sedin St., 4, KGMA, Patent Department, Doronina TA
Date of commencement of the patent: 1998.10.06

The invention relates to medicine, namely to gastroenterology, and can be used in surgery in the postoperative period after isolated radical duodenoplasty (RDP). The method is characterized by the fact that in addition to clinical and social risk factors, complex psychometric testing is carried out, risk factors are calculated and under the condition of an average risk factor of more than 2.1 determine a high risk of early relapse, from 1.6 to 2.0 - Risk, and with a risk factor of 0 to 1.5 - a low probability of recurrence of duodenal ulcers. The method provides greater accuracy of the forecast.

DESCRIPTION OF THE INVENTION

The present invention relates to medicine, namely gastroenterology, and can be used in surgery in the postoperative period after an isolated RDP.

One of the main tasks of clinical medicine is the timely diagnosis of recurrence of the disease, the forecasting of possible clinical course options and the selection of adequate treatment tactics. The wide introduction of mathematical methods for solving prediction problems (EV Gubler, 1978, A. Afifi, S. Eizen, 1982) has proved its worth for more than two decades. School of Professor VI. Onopriyev has been developed and since 1977 radical diodenoplasty (RDP) has been applied, which allows eliminating complicated ulcers and cicatrical and ulcerative deformities, and decreasing the lethality in such complications of YaD PDK as stenosis, perforation, bleeding and penetration. After an isolated RDP, one of the main problems in the postoperative period is preventing the recurrence of AD. In order to individualize rehabilitation schemes and objectify the "targets" of anti-relapse measures, we proposed a method for quantitative assessment of the predictive informative value of clinical, social and psychological parameters.

In the work of A.Yu. Baranovsky, TL. Tsvetkova. Choice of tactics for treatment of gastroduodenal ulcers on the basis of predicting the variants of the clinical course // Proceedings of the conference "The fate of patients after hospital treatment and surgical interventions." - Smolensk-Moscow, 1996. - p. 8-14 .:

1. The presence of clinical prognostic factors was determined in non-operated patients with PKD.

2. Clinical signs were ranked according to their differential informativity, calculated according to S. Kulbak's formula.

3. Set threshold values ​​for decision making.

4. The forecast was established when the threshold value was reached.

The drawback of this study is that it was used only in therapeutic gastroenterological patients (not undergoing surgical treatment), included complex quantitative methods that require special computer programs, which limits its use in the clinic.

In the study, V.G. Pleshkova, N.V. Zaprudinoy. Prediction of late complications of perforated gastroduodenal ulcers and indications for their surgical treatment. Proceedings of the conference "The fate of patients after hospital treatment and surgical interventions." - Smolensk-Moscow, 1996. - p. 172-176 .:

1. The presence of clinical prognostic factors was determined in patients with duodenal ulcer after suturing perforated ulcers.

2. For each patient, coefficients K were calculated for each characteristic.

3. The total prognostic coefficient R was determined as the sum of the prognostic coefficients of K.

4. If the R coefficient ranged from 1.2 to 3.7, the patients needed a re-operative intervention.

The disadvantage of this method of forecasting is the lack of consideration of social and psychological risk factors, which reduces the accuracy of the forecast.

Prototype . In the study, O.V. Kokuyeva, L.V. Bender, N.V. Korochanskaya, M.L. Rogal. Long-term results of isolated radical duodenoplasty in patients with complicated forms of peptic ulcer of the duodenum // Proceedings of the Republican Center for Functional Surgical Gastroenterology. - Krasnodar, 1995. - with. 165-170 .:

1. After isolated RDP, the presence of clinical and social risk factors was determined.

2. The value of the risk factor for each characteristic was calculated. The disadvantage of this method of forecasting is that the study did not take into account the results of psychometric testing of patients, the average risk factor was not calculated, based on the gradation of which it would be possible to isolate groups of patients needing differentiated treatment regimens. This reduces the prognostic value of the proposed method and its socio-economic effectiveness.

The goal is to increase the reliability of predicting the recurrence of duodenal ulcers after isolated radical duodenoplasty.

Tasks

1. Conduct a comparative analysis of the clinical and social characteristics of patients with early relapses AE after and without RDP.

2. To conduct complex psychometric testing of patients with early relapses of AD after and without RDP.

3. Calculate the risk factors for early relapse for a number of clinical, social and psychological parameters.

4. Set thresholds for the average risk factor, based on which to identify the three groups of risk.

SUMMARY OF THE INVENTION

In addition to clinical and social risk factors, comprehensive psychometric testing is carried out, risk factors are calculated and, with an average risk factor of more than 2.1, a high risk of early relapse, 1.6 to 2.0, an average risk level, and a A risk factor from 0 to 1.5-small probability of recurrence of duodenal ulcer (AH). The method is carried out as follows: Complete the standard map of clinical and social indicators in patients with YaD PDK. Conduct a comprehensive psychometric testing with an assessment of individual-personality types and types of attitude towards the disease. For the prediction of early relapses of AE, a sequential Wald analysis is used, based on probabilistic methods of comparing the frequency of each of the analyzed indicators (symptoms) in the compared states-the presence or absence of AE relapse. For each indicator (symptom), calculate the prognostic factor (K).

Retrospectively, the outpatient observation maps of 58 patients who had undergone an isolated RDP for a period of 1 to 5 months (an average of 3.4 ± 0.5 months), in II of them (19%) in the postoperative period, a relapse of AE was diagnosed. Patients are presented standard forms of psychometric testing, developed by L.N. Sobchik (1990), including modified tests of Lusher's color choice, Leary's interpersonal relations and standard multifactorial method of personality research (SMIL). 23 signs (clinical, social and psychological) were assessed on a comparative basis, and for each of them K. was calculated. Then a prognostic table was compiled, which included indicators that, according to our data, contain prognostic information, i.e. Significantly different in groups with recurrence of duodenal ulcer and without it (p <0.05). Such indicators after screening remained 12. The location of the signs in the table was carried out as their prognostic value increased.

We give examples of predicting early relapses of AE after RDP for specific patients. Patient K-o, 28 years old, 17/10/1995 transferred the RDP. Re-examined on 11/21/95.

Average risk factor K = 1,14 - low probability of early relapse AJ. 29.11.95 Esophagogastroduodenoscopy (EFGDS): Condition after RDP. Focal antrum-gastritis.

Patient S., 46 years old, 20.10.95 moved to the RDP. Re-examined on 25.12.95.

K = 1.67 (medium risk). 25.12.95 EFGDS - state after the RDP. Erosive duodenitis.

The patient R-o, 55 years old, on August 6, 1995, underwent the RDP. Re-examined on 13.12.1995.

K = 3.03 - high degree of risk. 12.12.1995 EFGDS-state after the RDP. Relapse AJ.

Testing of the prognostic table was conducted by us in 58 patients. It was established that the correct prognostic conclusion was made in 51 patients (88%). Therefore, the use of the prediction method allows predicting relapses of AJ with a high degree of accuracy. This method is simple, accessible and takes a little time.

Medico-social effectiveness

The allocation in the postoperative period of groups of high, medium and low risk of early relapse AJ after RDP will allow individualizing the scheme of postoperative management of patients. Persons with a high risk of recurrence are shown to perform an antacid operation - SLE, patients with an average risk should be treated with eradication and antisecretory treatment, and in the third group, pharmacotherapy can be reduced to a minimum. Such a differentiated approach will give an undoubted economic effect.

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CLAIM

A method for predicting recurrences of duodenal ulcers in patients who underwent isolated radical duodenoplasty, including the detection of clinical and social risk factors, characterized by the addition of comprehensive psychometric testing, calculating risk factors, and assuming an average risk factor of more than 2.1 determine a high degree of development of early Relapse, from 1.6 to 2.0 - the average degree of risk, and with a risk factor of 0 to 1.5 - a low probability of recurrence of duodenal ulcers.

print version
Date of publication 28.03.2007gg