Ankara Üniversitesi Tıp Fakültesi Mecmuası 0365-8104 1307-5608 Ankara University General Surgery Genel Cerrahi Marginal Ulcer Problem - Prevention Measures and Surgical Treatment Marginal Ülser Problemi - Önleme Çareleri ve Cerrahi Tedavisi Tatlıcıoğlu Ertan ANKARA UNIVERSITY, ANKARA FACULTY OF MEDICINE 03 31 1973 26 1 95 116 01 01 1973 02 28 1973 Copyright © 1947, Ankara Üniversitesi Tıp Fakültesi Mecmuası 1947 Ankara Üniversitesi Tıp Fakültesi Mecmuası

1962 - 1972 yılları arasında kliniğimizde tedavi gören 15 Marginal ülser vakası incelendi. Marginal ülserasyon, daha önce duodenum ülseri tedavisi için yapılan ameliyatın başarısızlığını ortaya koyar. Marginal ülserin komplikasyonları ile birlikte yüksek oranda mortalite göstermesi konuya bir kat daha önem kazandırdığı görüldü. Marginal ülser oluşması ile direkt ilişkisi nedeniyle Mide fizyolojisi ve peptik ülser etyolojisi kısaca özetlendi.Vakalarımızda, yetersiz mide rezeksiyonu, antrumun duodenum stumpunda bırakılması, ve tek başıqa uygulanan gastro-enterostomi en önde gelen Marginal ülser sebebleri olarak bulundu. Bu vakadan hiçbirine önceki ameliyatlarında vagotomi uygulanmamıştı. 15 vakamızdan 4 ünde perfore veya penetre ülsere rastlandı. Bu tip komplikasyonlar peritonit ve ölüme sebeb olmaktadır.Gerek duodenum gerekse Marginal ülser tedavisinde, ülserin en büyük etkenlerinden Olan yüksek asitin bertaraf edilmesi, bunun yamnda antrumun görevinin dikkate almarak uygulanan ameliyatlarm yiiksek oranda iyilesme sažladlžl görüldü.

The Marginal Ulcer problem-Prevenfion ad Their Surgical Treatment15 Marginal ulcer cases hasbeen analysed, treated between 1962 - 1972 in our Clinic. Marginal ulcer formation indicated the failure of the surgical method used for the preciding duodenal ulcer treatment.The complications of Marginal ulcers, with high modbidity and mortalitiy rate has been found that has increased the importance of thisproblem. Gastric physiology and ethio-pathogenesis of peptic ulceration has been summerized because of direct relationship between them and Marginal ulceration.In our cases, insufficient gastric resection, antrum reserved on the duodenal stump and gastro-enterostomy without vagotomy were the most outstanding reasons for Marginal ulceration. None of these cases had been vagotomized before.4 of the 15 cases show perforation or penetrated ulcers. This type of complica tions causes high rate of peritonitis and mortality. In the treatment of either duodenal or Marginal ulcers, the high acid secretion and the role of antrum upon acid secretion must be borne in mind. The surgical procedures, parallel to this concept has shown favorable results.

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