Амбулаторная хирургия (Jun 2020)
Results of surgical treatment of uclear bleed in patients with ischemic heart disease
Abstract
Introduction. This article is devoted to one of the urgent problems of modern emergency abdominal surgery – the result of surgical treatment of ulcer bleed in patients with ischemic heart disease.Undoubtedly intensive hemostatic conservative therapy and endoscopic hemostasis methods are the main treatment methods for this group of patients. However, in a certain number of patients with NGDK with various variants of IHD, such treatment is ineffective and there is a need to perform surgical hemostasis in an emergency and urgently.Surgical methods of hemostasis of NGDK patients with different variants of IHD are shown only in cases of inefficiency of conservative and endoscopic treatment methods. Among surgical interventions, radical surgeries are more preferable, which, if performed against the background of intensive resuscitation support, allow to achieve reliable hemostasis and thus avoid postoperative recurrent bleeding. Palliative surgery should be used when radical surgery is not possible due to the severity of the patient’s condition or lack of technical skill of surgeons. Finally, it is clear that in order to improve treatment results in patients in this category, correction of changes caused by the accompanying IHD is necessary.Materials and methods: In our research material, 89 out of 997 patients had such a need, which was 8.9%. It mainly corresponds to the modern literature data.Results: An analysis of the results of these patients’ palliative and radical surgical interventions clearly showed that the last ones were more preferable.The basis for this judgment was the high percentage of mortality after palliative care compared to radical care with approximately the same number of postoperative complications.In addition, it is noteworthy that postoperative complications typical of palliative care in the form of recurrent ulcerative bleeding are often fatal, because half of these patients in our observations have not experienced repeated radical interventions.Conclusion: At the same time, the necessary condition for performing radical operations is, firstly, appropriate technical skill of the surgeon, and secondly, providing the latter with intensive resuscitation support. In case of impossibility of performance of these conditions the method of a choice should serve palliative care.
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