Optimization of treatment of patients with acute bleeding syndrome in the lumen of the digestive duct
DOI:
https://doi.org/10.11603/2414-4533.2020.4.11783Keywords:
gastric ulcer, duodenal ulcer, gastroduodenal bleedingAbstract
the aim of the work: is to improve the results of treating patients with acute bleeding syndrome into the lumen of the upper gastrointestinal canal with ulcer genesis by improving the methods of local endoscopic hemostasis.
Materials and Methods. Patients with manifestations of acute bleeding syndrome into the lumen of the upper section of the digestive canal with ulcerative genesis were included in a randomized, prospective study which was carried out in the surgical clinic of Dnipropetrovsk Medical Academy on the basis of Surgical Department No. 2 where advanced therapeutic endoscopic manipulations and surgeries to improve local endoscopic hemostasis have been actively implemented. According to the obtained data, peptic duodenal ulcer was among the diseases that caused acute bleeding into the lumen of the upper part of the digestive canal. In case of acute bleeding syndrome into the lumen of the upper digestive canal with ulcerative genesis, the structure of the nosological units can be represented as follows: peptic duodenal ulcer – 67.8 %, gastric ulcer – 32.2 %.
Results and Discussion. As a result of the carried out analysis of the distribution of local hemostasis states according to Forrest, it was found that the first class of danger (Forrest I) was determined in 39.5 % of cases and the second class of danger (Forrest II) in 60.5 % of cases. Based on the analysis of the clinical and experimental study we have created an integrated scale to determine the risk of recurrent bleeding. High risk of bleeding was evaluated by an integral score of 20 to 30 points, medium risk – from 13 to 20 points, low risk – up to 12 points respectively. In the period 2016–2017 with the active use of local endoscopic hemostasis and endoscopic monitoring in the complex of conservative therapy in patients with acute bleeding syndrome into the lumen of the upper gastrointestinal canal with ulcer genesis, we managed to significantly reduce the number specific of surgeries from 13.1 % to 8.2 % cases. For the purpose of early detection of stigmas of recurrent bleeding and measures to prevent its occurrence, endoscopic monitoring is indicated to all patients with acute bleeding syndrome into the lumen of the upper gastrointestinal canal of the ulcerative genesis. In order to temporarily stop bleeding and prepare the patient for the delayed surgery in case of extremely high risk of surgical intervention in patients with acute bleeding syndrome, it is reasonable to apply once again local endoscopic hemostasis methods. In the complex of conservative therapy of patients with acute bleeding syndrome into the lumen of the upper division of the digestive canal with ulcer genesis we managed to reduce significantly the number of surgical interventions by 2.5 times due to the widespread introduction of methods of local endoscopic hemostasis, endoscopic prophylactic prophylaxis.
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