SURGICAL TACTICS FOR TREATMENT OF PATIENTS WITH ULCEROUS GASTRODUODENAL HEMORRHAGES

Aim. To improve the tactics for treatment of patients with ulcerous gastroduodenal hemorrhages by means of grounded choice of indications, terms and surgical technique. Materials and methods. The results of treatment of 4580 patients with ulcerous hemorrhages are presented. Stomach ulcer was diagnosed in 36 %, the rest - duodenal ulcer. At the admission department, urgent clinical analyses and esophagogastroduodenoscopy were performed. In case of continuing hemorrhage from small vessels, hemostasis was reached using alcohol irrigation and argono-plasmic coagulation, from large vessels - adrenalin solution infiltration and coagulation. Complex treatment was directed to stabilization of hemodynamics, blood replacement, inhibition of gastric secretion using proton pump inhibitors. In case of arising suspicion for hemorrhage relapse, repeated gastroscopy was conducted. The number of operated patients was 1880 (43 %). Urgently, 455 patients with continuing bleeding and failure of hemostasis were operated; 393 patients underwent stomach resection, 15 - gastrectomy, 43 - vascular suturing in the ulcer; 415 patients underwent urgent operations when there occurred a danger of bleeding relapse in patients with gigantic ulcers, presence of large thrombosed vessels in the ulcer, severe blood loss. 382 patients underwent stomach resection, 33 - excision of ulcer with vagotomy. One or two weeks after admission to the hospital, 1011 patients with long ulcerous anamnesis and earlier experienced complications were operated; 620 patients underwent stomach resection, 391 - selective proximal vagotomy (SPV). The technique of duodenal stump suturing in complicated situations and the method of gastric stump formation are presented in the paper. Results. Out of 455 urgently operated patients 91 (20 %) died, including 19 of 43 after vascular suturing in the ulcer. After urgent surgeries, 17 (4,1 %) patients died. Out of 1011 patients operated according to the plan, 8 (0,8 %) patients died. The total postoperative lethality was 6,1 %. Among 2700 patients who were not operated 35 died. The total hospital lethality was 3,3 %. Conclusions. Treatment of patients with ulcerous gastroduodenal hemorrhages remains a complicated problem. These patients should be treated at specialized centers. Esophagogastroduodenoscopy, endoscopic hemostasis, stabilization of hemodynamics, blood replacement and continuous follow-up observation of a patient with objective assessment of health status are the most important measures when patients are admitted to the hospital. Indications for operation should be strictly grounded. It is necessary to limit urgent operations at the expense of repeated gastroscopies and endoscopic methods of hemostasis so as to operate only in urgent cases. Resecting surgeries are justified in case of emergency and urgent interventions. In case of delayed operations, the most effective for patients with duodenal ulcer is selective proximal vagotomy.

Stomach and duodenal ulcer, hemorrhage, surgical tactics