RESUMO
The retrospective analysis (2006-2010 yy) of treatment of 895 patients with gastroduodenal ulcer bleeding was conducted. Lethal outcome was registered in 220 (24.6%) patients, of them directly of the ulcer bleeding died 45 (5%). The Rockall score was used as universal prognostic instrument. Of 164 lethal outcomes, did not directly connected to the ulcer bleeding, the etiological distribution was as follows: multiple organ failure - 36% (n=59), cardiovascular diseases - 24.4% (n=40), inveterate oncology - 15.9% (26). Of 45 deaths from bleeding, only 4 patients died of the uncontrolled bleeding, whereas 18 (45%) died after the emergency surgery. Signs of hemorrhagic shock were registered in 60% of died patients (in comparison with 18% among the survived). Bleeding reccurrence was registered in 28.6% of died patients (in comparison with 11% among the survived). The use of the Rockall score confirmed its prognostic value: the mean score was 4.3±2.12 points among the survived patients, whereas among the died patients it was 7.16±2.35 points (p=0.001). Authors conclude, that the leading reasons of death, considering the bleeding itself, were the hemorrhagic shock and recurrent bleeding. Though, about 80% of patients are dying of reasons, do not directly connected to the bleeding episode, but of concomitant diseases (multiple organ failure, cardiovascular and oncologic diseases). The least, nevertheless, leads to the wrong formulation of the final diagnosis and incorrect interpretation of the etiology of death.
Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Úlcera Péptica Hemorrágica , Úlcera Péptica/complicações , Complicações Pós-Operatórias/mortalidade , Adulto , Idoso , Comorbidade , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Moscou/epidemiologia , Úlcera Péptica Hemorrágica/etiologia , Úlcera Péptica Hemorrágica/mortalidade , Complicações Pós-Operatórias/classificação , Prognóstico , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Análise de Sobrevida , Resultado do TratamentoAssuntos
Icterícia Obstrutiva , Falência Hepática , Complicações Pós-Operatórias , Succinatos , Idoso , Colelitíase/complicações , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/métodos , Combinação de Medicamentos , Monitoramento de Medicamentos , Feminino , Humanos , Infusões Intravenosas , Icterícia Obstrutiva/etiologia , Icterícia Obstrutiva/metabolismo , Icterícia Obstrutiva/cirurgia , Falência Hepática/tratamento farmacológico , Falência Hepática/etiologia , Falência Hepática/metabolismo , Testes de Função Hepática/métodos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/metabolismo , Substâncias Protetoras/administração & dosagem , Substâncias Protetoras/farmacocinética , Succinatos/administração & dosagem , Succinatos/farmacocinética , Resultado do TratamentoRESUMO
The work analyses the results of emergency laparoscopy in 4,730 patients with acute surgical pathology of the abdominal organs. There were 26.3% of males and 73.7% of females; 26.5% of patients were of an elderly age. Laparoscopy was undertaken in all cases in which the diagnosis was questionable but the clinical picture was that of "acute abdomen" and in patients with an established diagnosis for conducting therapeutic manipulations: microcholecystostomy, drainage of the abdominal cavity. The authors show differential endoscopic signs of some acute surgical diseases of the abdominal organs. Laparoscopy confirmed the clinical diagnosis in 45.5% of cases and revealed indications for an emergency operation in 896 patients (33.8%). Laparoscopic microcholecystostomy was performed 137 times and drainage of the abdominal cavity 398 times. The diagnostic value of laparoscopy came to 97.1% on the average.