RESUMO
OBJECTIVE: To assess the safety and effectiveness of the indocyanine green use in acute cholecystitis for identification of anatomical variants of the biliary tree; prevention and timely detection of intraoperative complications. MATERIAL AND METHODS: The medication of indocyanine green made by OOO «Ferment¼ domestic manufacturer was used. The drug dose from 2.5 mg to 10 mg was applied according to studied materials (8). Time of the surgery beginning was from 2 to 6 hours after intravenous injection of aqueous solution, respectively. In addition, it has been established that the optimal drug dose is 5 mg. The surgery should be performed not earlier than 3 hours after, but no later than 6 hours. This allows to achieve the most comfortable fluorescence of the extrahepatic biliary tract. The drug concentration in the liver cells decreases by this time and increases in the biliary tract. It is not always possible to perform the operation strictly within the specified time limit considering the urgency of the surgical intervention. In this connection, the surgery was carried out not earlier than 3 hours after the drug injection, but not later than 6 hours. Endoscopic equipment with the ability to display near-infrared fluorescence was used. A laser light source with a wavelength of 820 nm in the Arthrex imaging system with 4K resolution as well as the Olympus imaging system with HD resolution were used for fluorescence excitation. RESULTS: The implementation of intraoperative fluorescent navigation with indocyanine green contributes to the improvement of safety and effectiveness of surgical treatment through visualization of topography and identification of anatomical variants of the biliary tree; possibilities of prevention and timely detection of intraoperative complications. The use of indocyanine green allows to intraoperatively reveal atypical location and different variations of the extrahepatic biliary tract.
Assuntos
Colecistite Aguda , Verde de Indocianina , Verde de Indocianina/administração & dosagem , Humanos , Colecistite Aguda/cirurgia , Colecistite Aguda/diagnóstico , Masculino , Feminino , Pessoa de Meia-Idade , Corantes/administração & dosagem , Complicações Intraoperatórias/prevenção & controle , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Resultado do Tratamento , Colecistectomia Laparoscópica/métodos , IdosoRESUMO
OBJECTIVE: To create a system for choosing surgical approach and completing laparotomy in advanced secondary peritonitis via combination of clinical, visual intra-abdominal criteria and systems for predicting the outcomes of peritonitis. MATERIAL AND METHODS: The study included 686 patients with peritonitis between May 2015 and December 2022. Age of patients ranged from 16 to 95 years (mean 53.4±8.7). Male-to-female ratio was 1.2:11 (377:309). Destructive appendicitis was the cause of peritonitis in 274 (39.9%) patients, gastroduodenal ulcer perforation - 160 (23.3%) patients, colonic perforation - 188 (27.4%) patients, other causes - 64 (9.4%) patients. At baseline, 481 (70.1%) patients underwent diagnostic laparoscopy, and laparoscopic surgery was possible in 302 (62.8%) cases. Primary median laparotomy was performed in 205 (29.9%) patients. The closed method of completing laparotomy was used in 345 patients (77 - 22.3% died), staged elective surgeries - 28 (18 - 64.3% died), open abdomen technique was used in 11 patients (5 - 45.5% died). Redo laparotomy on demand was performed in 44 patients. Of these, 21 (47.7%) ones died. Overall mortality was 15.0% (n=103). The main causes of mortality were sepsis/septic shock (67 cases, 65.0%), acute cardiovascular and respiratory failure (15 patients, 14.6%). RESULTS: The developed index of approach and completion of surgery in secondary peritonitis is valuable to make a decision on access and completion of surgery in patients with widespread peritonitis. CONCLUSION: Integral systems for assessment of clinical status and choice of treatment strategy are effective in systematizing the results, evaluating treatment outcomes and conducting researches.
Assuntos
Apendicite , Laparoscopia , Peritonite , Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Laparotomia/efeitos adversos , Laparotomia/métodos , Peritonite/diagnóstico , Peritonite/etiologia , Peritonite/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Resultado do Tratamento , Apendicite/diagnóstico , Apendicite/cirurgia , Apendicite/complicações , Estudos RetrospectivosRESUMO
To date, mortality in widespread peritonitis is still high (15-20%) and increased up to 70-80% in case of septic shock. Surgeons actively discuss wound closure technique in these patients considering intraoperative findings and severity of illness. The authors present scientific data and opinions of national and foreign surgeons regarding the methods of laparotomy closure. There are still no generally accepted criteria for choosing the method of laparotomy closure in secondary widespread peritonitis. Indications and clinical efficacy of each procedure require additional research.
Assuntos
Técnicas de Fechamento de Ferimentos Abdominais , Tratamento de Ferimentos com Pressão Negativa , Peritonite , Choque Séptico , Ferida Cirúrgica , Humanos , Peritonite/diagnóstico , Peritonite/etiologia , Peritonite/cirurgia , Técnicas de Fechamento de Ferimentos , Resultado do Tratamento , Laparotomia/efeitos adversos , Laparotomia/métodos , Técnicas de Fechamento de Ferimentos Abdominais/efeitos adversos , Tratamento de Ferimentos com Pressão Negativa/métodosRESUMO
The review is devoted to the most common general clinical and specific grading systems for peritonitis outcome prediction. Particular attention is paid to methodological approaches, prediction reliability, simplicity of use in clinical practice and their importance in decision-making. It is shown that none of the modern grading systems is universal and absolutely reliable. Combining several systems is quite difficult and will take additional time that is impossible for intraoperative environment. Despite various systems for peritonitis outcome prediction, none of them can completely satisfy surgeons, primarily in choice of surgical access, intervention type and option for its completion.
Assuntos
Peritonite , Cirurgiões , Humanos , Peritonite/diagnóstico , Peritonite/etiologia , Prognóstico , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: To compare the most common prognostic systems in patients with peritonitis. MATERIAL AND METHODS: The study included 352 patients with secondary peritonitis. At admission, sepsis was diagnosed in 15 (4.3%) patients, septic shock - in 4 (1.1%) cases. Mortality was associated with the following main causes: purulent intoxication and/or sepsis - 51 cases (87.9%), cancer-induced intoxication - 4 (6.9%) cases, acute cardiovascular failure - 3 cases (5.2%). We analyzed the efficacy of Manheim Peritoneal Index (MPI), WSES prognostic score, APACHE-II scale, gSOFA score and Peritonitis Prediction System (PPS) developed by the authors. RESULTS: Age of a patient, malignant tumor, exudate nature, sepsis (septic shock) and organ failure not associated with peritonitis are the most important criteria in predicting fatal outcome. ROC analysis was used to assess prognostic value of various prediction systems. Standard error was less than 0.05 for all scales. Therefore, all prediction systems can be considered accurate for prediction of mortality in patients with peritonitis. CONCLUSION: PPS (AUC 0.942) has the greatest accuracy in predicting fatal outcome in patients with advanced secondary peritonitis, APACHE II (AUC 0.840) - minimum accuracy. MPI had predictive accuracy > 90% too.
Assuntos
Peritonite , Sepse , Índice de Gravidade de Doença , APACHE , Humanos , Peritonite/diagnóstico , Peritonite/etiologia , Peritonite/mortalidade , Prognóstico , Curva ROC , Medição de Risco , Sepse/diagnóstico , Sepse/etiologia , Sepse/mortalidade , Choque Séptico/diagnóstico , Choque Séptico/etiologia , Choque Séptico/mortalidadeRESUMO
The purpose of the study was to comparatively assess efficacy of using agents belonging to the group of prostaglandin E1 in comprehensive conservative treatment of patients with unreconstructable critical limb ischaemia and trophic changes by the frequency of major amputation, amputation-free survival, and total mortality by combinations of the WIfI classification during a 6-month follow up period. Our retrospective multicentre study enrolled a total of 109 patients, including 60 men and 49 women, with a mean age of 70±7.3 years. The patients were subdivided into 2 groups. Group 1 patients (n=58) received standard conservative therapy without prostaglandin E1 and group 2 patients (n=51) received similar treatment with the use of prostaglandin E1. The statistical analysis (chi-squared test, Fisher criterion, log-rank test) was carried out with regard to stratification of the patients in the groups by the WIfI component combinations. No statistically significant differences between the groups in the frequency of amputation and total mortality were revealed (p=0.094 and p=0.925, respectively). The use of the WIfI classification system made it possible to single out a cohort of patients (with a WIfI combination of 130) for whom the results of administering prostaglandin E1 statistically significantly differed by the frequency of amputation (p=0.042) and by amputation-free survival (p=0.017). No significant differences by these outcomes were obtained for other combinations analysed. A conclusion was drawn that using prostaglandin E1 in comprehensive conservative treatment decreased the frequency of amputation and increased amputation-free survival in patients presenting with unreconstructable critical limb ischaemia and referred to the category with a combination of 130 according to the WIfI classification.
Assuntos
Tratamento Conservador , Isquemia , Salvamento de Membro , Infecção dos Ferimentos , Idoso , Amputação Cirúrgica , Técnicas de Apoio para a Decisão , Feminino , Humanos , Isquemia/terapia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , CicatrizaçãoRESUMO
In the present article, the authors substantiate the necessity of subdividing a heterogeneous cohort of patients presenting with Fontaine-Pokrovsky grade IV critical limb ischaemia into subgroups with the aim of making an appropriate therapeutic decision and predicting the outcome. We also translated into the Russian language the WIfI classification system developed by the Society for Vascular Surgery (2014) in order to predict limb loss and feasibility of performing revascularization. This is followed by comments on the classification, accompanied by examples of own clinical case studies. In order to check-up the ability of the SVS WIfI classification system to predict the one-year risk of major amputation in patients with decompensated ischaemia, we carried out a retrospective multicenter study, enrolling a total of 109 patients with unreconstructable stage IV chronic ischaemia. Our primary endpoint was the frequency of major amputation during the first year of follow up. The patients were divided into 4 subgroups based on a combination of the three WIfI domains, i. e., wound, ischaemia, and foot infection, respectively, as follows: 130 - 27% (n=29), 131 - 23% (n=25), 230 - 20% (n=22), and 231 - 30% (n=33). The frequency of amputation during the first year of follow-up with the natural course of the disease on the background of conventional therapy averagely amounted to 36%. By the WIfI component combinations, we revealed statistically significant differences between the subgroups (p=0.035): 130 - 21% (n=6), 131 - 28% (n=7), 230 - 36% (n=8), 231 - 55% (n=18). The WIfI classification makes it possible to predict the risk of major amputation in patients with limb-threatening ischaemia. The frequency of amputation during the first year of follow up in the natural course of the disease is associated not only with the WIfI clinical stage but also with the WIfI component combinations.
Assuntos
Salvamento de Membro , Infecção dos Ferimentos , Amputação Cirúrgica , Técnicas de Apoio para a Decisão , Humanos , Isquemia , Estimativa de Kaplan-Meier , Extremidade Inferior , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , CicatrizaçãoRESUMO
For today, it is necessary to recognize, that treatment of patients with abdominal sepsis remains the basic problem in urgent surgery due to the invariably high mortality. Early diagnostics and targeted therapy are the key points for improving of sepsis outcome. At present, researchers around the world have proposed a large number of biological markers for diagnosing sepsis and predicting mortality. Ideally, doctors can use biomarkers for risk stratification, diagnosing, monitoring of treatment effectiveness and outcome prediction. The biomarker is a laboratory parameter that can be objectively measured and characterized as an indicator of normal and pathological biological processes. The article presents the modern concept of the sepsis pathogenesis for understanding the role of various biomarkers and inflammatory indicators in its development. We have analyzed literature data and summarized information on the possible use of biological markers and their combinations in the early detection of sepsis, for monitoring sepsis and predicting its outcome.
Assuntos
Gastroenteropatias , Sepse , Biomarcadores , Diagnóstico Precoce , Humanos , Prognóstico , Sepse/diagnósticoRESUMO
AIM: To create a reliable system for assessing of severity and prediction of the outcome of peritonitis. MATERIAL AND METHODS: Critical analysis of the systems for peritonitis severity assessment is presented. The study included outcomes of 347 patients who admitted at the Department of Faculty Surgery of Peoples' Friendship University of Russia in 2015-2016. The cause of peritonitis were destructive forms of acute appendicitis, cholecystitis, perforated gastroduodenal ulcer, various perforation of small and large intestines (including tumor). RESULTS: Combined forecasting system for peritonitis severity assessment is created. The system includes clinical, laboratory data, assessment of systemic inflammatory response (SIRS) and severity of organ failure (qSOFA). The authors focused on easily identifiable parameters which are available in virtually any surgical hospital. Threshold value (lethal outcome probability over 50%) is 8 scores in this system. Sensitivity, specificity and accuracy were 93.3, 99.7 and 98.9%, respectively according to ROC-curve that exceeds those parameters of MPI and APACHE II.
Assuntos
Escores de Disfunção Orgânica , Peritonite , Síndrome de Resposta Inflamatória Sistêmica , APACHE , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peritonite/complicações , Peritonite/diagnóstico , Peritonite/mortalidade , Peritonite/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Reprodutibilidade dos Testes , Federação Russa , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/etiologiaRESUMO
AIM: To evaluate an efficacy of endovascular hemostasis in patients with gastric ulcerative bleeding and high risk of recurrent bleeding and death. MATERIAL AND METHODS: The work is based on a study of the results in 30 patients with gastric ulcerative bleeding, high risk of recurrent bleeding (rebleeding forecast system (RFS) score over 17) and high risk of death (SAPS II score over 30). We attempted transcatheter embolization of left gastric artery to prevent rebleeding. The control group consisted of 60 patients with gastric ulcerative bleeding and the same RFS and SAPS II values in whom angiography and endovascular hemostasis were not performed. RESULTS: Technical success of endovascular hemostasis was achieved in 25 (83.3%) cases. In 5 cases embolization was not performed. Complications after transcatheter angiography and embolization were absent. Recurrent bleeding after technically successful embolization was observed in 3 (12.0%) patients. In all cases PVA microemboli were used. Mortality was 11.1% (3 patients). CONCLUSION: Endovascular hemostasis in patients with severe comorbidities (SAPS II score over 30) and high risk of rebleeding (RFS score over 17) reduced incidence of recurrent bleeding from 36.7% to 11.1%.
Assuntos
Embolização Terapêutica , Hemorragia Gastrointestinal , Hemostase Endoscópica , Úlcera Gástrica , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Estudos Retrospectivos , Úlcera Gástrica/complicações , Resultado do TratamentoRESUMO
AIM: To define the role of endoscopic hemostasis in treatment of gastroduodenal ulcers complicated by bleeding. MATERIAL AND METHODS: The results of endoscopic hemostasis in 770 patients with peptic ulcers were analyzed. RESULTS: Injection hemostasis had the highest efficacy in case of recurrent bleeding. No other method showed significant advantage in its efficiency. The efficacy of injection method was 52%, argon-plasma coagulation - 83.3%, radiowave technique - 78%, combined endoscopic method - 96%. In case of recurrent bleeding endoscopic hemostasis is effective alternative to surgery especially in high-risk patients. Repeated endoscopic hemostasis significantly decreases mortality from 45% to 23% in case of recurrent bleeding.
Assuntos
Endoscopia Gastrointestinal , Hemostasia Cirúrgica , Úlcera Péptica Hemorrágica , Hemorragia Pós-Operatória , Úlcera Gástrica/complicações , Adulto , Coagulação com Plasma de Argônio/métodos , Pesquisa Comparativa da Efetividade , Eletrocoagulação/métodos , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/métodos , Feminino , Hemostasia Cirúrgica/efeitos adversos , Hemostasia Cirúrgica/métodos , Hemostasia Cirúrgica/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Moscou , Avaliação de Resultados em Cuidados de Saúde , Úlcera Péptica Hemorrágica/diagnóstico , Úlcera Péptica Hemorrágica/etiologia , Úlcera Péptica Hemorrágica/cirurgia , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/cirurgia , Recidiva , Reoperação/métodos , Reoperação/estatística & dados numéricos , Risco Ajustado , Análise de SobrevidaRESUMO
AIM: Retrospective analysis of the results of stenting versus surgical palliation in patients with malignant gastrointestinal stenosis. MATERIAL AND METHODS: 85 patients underwent endoscopic stenting (41) or surgical intervention (44). Level of stenosis: gastric outlet (23/38), multi-level gastric obstruction (2/3), duodenum or jejunum (12/3), gastrojejunoanastomosis (3/0) and gastroduodenoanastomosis (1/0). 49 self-expanding metal stents were implanted in 41 patients. 41 gastroenteroanastomoses and 3 jejunostomas were performed in surgical group. RESULTS: Stents were successfully inserted in all patients. Early complications were observed in 3 (7.3%) patients after stenting and in 9 (20.5%) after surgical palliation, p = 0.0755. Postoperative lethality was 2,4% (1 patient) after stenting and 31.8% (14 patients) after surgery, p = 0.0003. Mean hospital stay was 15 days in stenting group and 23 days in surgical group, p < 0.001. There was no statistically significant difference in long-term results, neither in late complications (p = 0.3691), nor in survival (p =0.3697). CONCLUSION: Endoscopic placement of self-expanding stents is an effective method of restoration of oral intake in patients with malignant gastrointestinal obstruction. Stenting is associated with equal rates of early and late complications, lower mortality and decreased in-hospital stay as compared with surgery, and therefore may be recommended as a final palliation in inoperable patients.
Assuntos
Neoplasias do Sistema Digestório/cirurgia , Endoscopia do Sistema Digestório/métodos , Obstrução da Saída Gástrica/cirurgia , Obstrução Intestinal/cirurgia , Cuidados Paliativos/métodos , Stents , Idoso , Neoplasias do Sistema Digestório/complicações , Neoplasias do Sistema Digestório/mortalidade , Endoscopia do Sistema Digestório/mortalidade , Feminino , Obstrução da Saída Gástrica/etiologia , Obstrução da Saída Gástrica/mortalidade , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/mortalidade , Intestino Delgado/cirurgia , Masculino , Estudos Retrospectivos , Resultado do TratamentoRESUMO
It was analyzed the treatment results of 1341 patients with diagnosed ulcerative bleeding. The data shows that at present time mortality rate in case of ulcerative bleeding is determined by bleeding outcomes in patients with severe concomitant diseases including elderly patients. It was not observed significant advantages in any methods of endoscopic hemostasis for stop and prevention of recurrence ulcerative bleeding. All techniques are equivalent alternatives. None prognosis scale of recurrence ulcerative bleeding probability has high specificity and sensitivity.
Assuntos
Hemostase Endoscópica , Úlcera Péptica Hemorrágica , Úlcera Péptica/complicações , Adulto , Idoso , Comorbidade , Feminino , Hemostase Endoscópica/efeitos adversos , Hemostase Endoscópica/métodos , Hemostase Endoscópica/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Péptica Hemorrágica/etiologia , Úlcera Péptica Hemorrágica/mortalidade , Úlcera Péptica Hemorrágica/fisiopatologia , Úlcera Péptica Hemorrágica/terapia , Prognóstico , Risco Ajustado/métodos , Medição de Risco , Federação Russa/epidemiologia , Prevenção Secundária , Índice de Gravidade de Doença , Análise de Sobrevida , Resultado do TratamentoRESUMO
500 patients with cancer of biliopancreaticoduodenal area who underwent treatment and survey in the hospital at the period from 1986 to December 2011 years were included in the study. There were 212 (42.4%) males and 288 (57.6%) females. It was analyzed the long-term results of palliative surgical interventions in 72 (40.2%) patients and endoscopic interventions in 107 (65.2%) patients. It was done a comparative analysis of palliative interventions results. It was concluded that both methods have high efficiency for resolution of obstructive jaundice. Average survival rate of patients depends on the biliary decompression method (8 months after surgical interventions and 7 months after endoscopic interventions). It was analyzed the long-term results of radical surgery in 55 (78.5%) patients. It was concluded that the best 5-years survival rate was in patients with major papilla cancer without invasion into mesenterical vessels (54.2%). 5-years survival rate was observed only in 2 patients in case of pancreatic head and terminal bile duct cancer. And lifetime of the majority did not exceed 3 years.
Assuntos
Neoplasias do Sistema Biliar , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Neoplasias Duodenais , Endoscopia do Sistema Digestório/métodos , Icterícia Obstrutiva/cirurgia , Neoplasias Pancreáticas , Neoplasias do Sistema Biliar/complicações , Neoplasias do Sistema Biliar/mortalidade , Neoplasias do Sistema Biliar/patologia , Neoplasias do Sistema Biliar/cirurgia , Pesquisa Comparativa da Efetividade , Descompressão Cirúrgica/métodos , Neoplasias Duodenais/complicações , Neoplasias Duodenais/mortalidade , Neoplasias Duodenais/patologia , Neoplasias Duodenais/cirurgia , Feminino , Humanos , Icterícia Obstrutiva/etiologia , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Cuidados Paliativos/métodos , Cuidados Paliativos/estatística & dados numéricos , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
The work is based on the analysis of the palliative treatment of 66 patients with malignant upper digestive tract obstruction who underwent implantation of 75 self-expanding metallic stents in the period of 2003-2012 yy. Early postoperative complications developed in 10 (15.2%) cases. Procedure-related complications were observed in 8 (12.1%) patients, non-specific complications occurred in 2 (3.0%) patients. In-hospital lethality was 4.5% (3 patients). 51 patients were followed until death. Symptomatic relapse of obstruction was observed in 4 cases. Median survival was 97 days. Stenting with self-expanding metal stents was concluded to be an effective and safe method of palliation of malignant upper digestive tract stenosis.
Assuntos
Constrição Patológica/cirurgia , Stents Farmacológicos , Endoscopia do Sistema Digestório , Neoplasias Gastrointestinais/complicações , Cuidados Paliativos , Trato Gastrointestinal Superior/cirurgia , Idoso , Constrição Patológica/diagnóstico , Constrição Patológica/etiologia , Constrição Patológica/fisiopatologia , Stents Farmacológicos/efeitos adversos , Stents Farmacológicos/normas , Stents Farmacológicos/estatística & dados numéricos , Endoscopia do Sistema Digestório/efeitos adversos , Endoscopia do Sistema Digestório/instrumentação , Endoscopia do Sistema Digestório/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Cuidados Paliativos/estatística & dados numéricos , Falha de Prótese/etiologia , Radiografia , Resultado do Tratamento , Trato Gastrointestinal Superior/diagnóstico por imagem , Trato Gastrointestinal Superior/fisiopatologiaRESUMO
229 patients with ulcerous gastroduodenal bleeding were included in the study. Prognostic scales of the bleeding recurrence by Rockall, Blatchford, Vinokurov and System of Prognosing of Bleeding Recurrence (SPBR) I and II were comparatively analyzed. The SPBR II proved to be statistically relevant and the most accurate in prognosing the bleeding recurrence, then other scales.
Assuntos
Hemostasia Cirúrgica , Úlcera Péptica Hemorrágica , Úlcera Péptica , Feminino , Hemostasia Cirúrgica/efeitos adversos , Hemostasia Cirúrgica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Péptica/diagnóstico , Úlcera Péptica/cirurgia , Úlcera Péptica Hemorrágica/diagnóstico , Úlcera Péptica Hemorrágica/cirurgia , Valor Preditivo dos Testes , Prognóstico , Medição de Risco/métodos , Fatores de Risco , Prevenção Secundária , Índice de Gravidade de DoençaAssuntos
Antiulcerosos/uso terapêutico , Hemorragia Gastrointestinal , Hemostase Endoscópica , Hemostasia Cirúrgica , Úlcera Péptica/complicações , Fatores Etários , Comorbidade , Gerenciamento Clínico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/fisiopatologia , Hemorragia Gastrointestinal/terapia , Hemodinâmica , Hemostase Endoscópica/efeitos adversos , Hemostase Endoscópica/métodos , Hemostasia Cirúrgica/efeitos adversos , Hemostasia Cirúrgica/métodos , Humanos , Seleção de Pacientes , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Prognóstico , Fatores de Risco , Prevenção Secundária , Índice de Gravidade de Doença , Tempo para o TratamentoRESUMO
900 patients with gastrointestinal bleedings were included in the study. Basing on the endoscopic findings, prognosis for recurrent bleeding and clinical evaluation of the patients, diagnostic algorithm and treatment protocol were worked out. Use of forecasting system concerning the bleeding risk and clinical evaluation of the patients applying SAPS II for medical tactics choice allowed decreasing lethality from acute hemorrhage from 6.1 to 0.9%, in case of conservative treatment--from 4.5 to 1.0%, postoperative lethality--from 14.5% to 0.
Assuntos
Úlcera Duodenal , Endoscopia Gastrointestinal/métodos , Hemostase Endoscópica/métodos , Úlcera Péptica Hemorrágica/cirurgia , Úlcera Gástrica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Péptica Hemorrágica/diagnóstico , Recidiva , Estudos Retrospectivos , Federação Russa/epidemiologia , Taxa de Sobrevida/tendências , Resultado do Tratamento , Adulto JovemRESUMO
The work deals with problems of prophylactics and treatment of patients with symptomatic gastroduodenal ulcers complicated by bleedings. In somatically critical patients the main disease in 14% of cases is complicated by the appearance of symptomatic gastroduodenal ulcer which in its turn results in bleedings or perforation in 50% of cases. H. pylori is of no leading significance in formation of acute gastroduodenal ulcers. The only indication to surgery in patients with bleedings from acute ulcers is persistent bleeding which can not be arrested by the method of endoscopic hemostasis or a recurrent bleeding in patients with the state of severity not less that 30 scores by the SAPS II scale.
Assuntos
Diatermia/métodos , Úlcera Duodenal/terapia , Hemostase Endoscópica/métodos , Fotocoagulação a Laser/métodos , Úlcera Péptica Hemorrágica/terapia , Úlcera Gástrica/terapia , Idoso , Idoso de 80 Anos ou mais , Úlcera Duodenal/patologia , Feminino , Humanos , Incidência , Masculino , Úlcera Péptica Hemorrágica/epidemiologia , Úlcera Péptica Hemorrágica/patologia , Estudos Retrospectivos , Federação Russa/epidemiologia , Taxa de SobrevidaRESUMO
Treatment results were studied in 542 patients with ulcerous gastroduodenal hemorrhage. Authors offer to use index of bleeding relapse and forecasting system of bleeding relapse for definition of ulcerous bleeding relapse probability. It provides quick and objective appraisal of relapse probability and allows making a proper choice of therapeutic approach reasoning from the patient's status.