Еволюція лікувальної тактики при кровоточивих гастродуоденальних виразках

Abstract

Тhе aim of our work is to optimize emergency endoscopy strategies and care on bleeding gastroduodenal ulcers (BGU). From 1982 to 2001 yrs we treated 10770 patients (pts) with chronic BGU (9824), acute ulcers (676),Dieulafoy's ulcers (185), ulcers of internal ligatures (85). Тhе endoscopic findings were based оn Forrest's classification and for the endoscopic hemostasis (ЕН) were used different miniinvasive endoscopic methods (МЕМ) of electrocoagulation, injection therapy, using tissue adhesives, hemoclips and their combinations. We studied the rate of recurrent bleeding (RB) without and after ЕН, proposed system of endoscopic monitoring (ЕМ). Our investigation was divided into 3 stages. І period (1982-1993) - in 7694 pts we used methods ЕН on FIA, В and studied the rate of RB. 11 period (1994-1998) - in 1869 pts we used methods ЕН not only on FIA,B but also on FIIA,B for profilactics of RB and studied the rate of RB, worked out programe of prognosis RB and endoscopic strategies with monitoring. ІІІ period (1999-2001) - in аІІ 1207 pts we used improved and our new МЕМ with ЕМ. So we reduced: а) RB from19,5% (П) to 5,5% (ІІІ) and in 80% RB was recognized during ЕМ before clinical sings, Ь) surgery of BGU from 46,4% (І) and 34,7% (П) tol7, 6% (ІІІ), с) operations on active or RB from 15,0% (І) to 1,0% (ІІІ), d) overall mortality from 4,4% and 4,4% to 1,8%, е) postoperative mortality from 3,6% and 4,9% to 1,6%.