SOME SURGICAL ASPECTS OF ULCEROUS GASTRODUODENAL BLEEDING
Objectives. To carry out the comparative assessment of surgical tactics’ options during the treatment of ulcerous gastroduodenal bleeding depending on activity of its source. Methods. The prospective analysis of treatment results of 719 patients with ulcerous gastroduodenal bleeding is presented. The study enrolls the patients with the defect (0,5-3 cm) of gastric or duodenal mucosa with the lesion to muscular and more deeply lying layers, having the roll-like, dense and straight edges disrupted in the proximal and flat in the distant direction with a smooth fundus. The patients were subdivided into 2 groups: the 1st one consisted of 285 patients in whom medical and diagnostic algorithm included active surgical actions. While treating 434 patients the restrained tactics with a priority of an endoscopic guide and complex medical treatment of the gastric ulcer with the reached primary hemostasis had been performed in 252 patients. Results. Among patients of the first group in a case of inability to stop bleeding by the endoscopic method and at high risk of its recurrence, in 104 patients the urgent surgical operations were performed, more often the stomach resections (58%). The postoperative lethality made up 10,6%. In 181 patients the conservative treatment was applied with a lethal outcome in 5,5% of all patients. Among patients of the second group after primary endoscopic hemostasis the recurrence of bleeding developed in 45 cases. In 40 from them endoscopic hemostasis was recurrented and completed successfully in 32 patients. In general during conservative treatment the inefficiency of endoscopic hemostasis was in 17 observations (3,9%), 15 patients (3,5%) died. From 35 operated patients the lethal outcome developed in 9 cases (postoperative lethality – 25,7%) in patients of advanced and senile age with the serious accompanying pathology. Conclusions. In case of ulcerous gastroduodenal bleeding the priority of an endoscopic hemostasis (numerous performance of this procedure) reduces operative activity from 36,6% to 8,1%. The tendency to reduce the general mortality from 7,4% to 5,3% is observed.