[The treatment of gastoduodenal ulcer bleeding].

Treatment data of 1279 patients with gastroduodenal ulcer bleeding are analyzed. Outcomes are comparatively analyzed depending on the chosen treatment modality. Optimal treatment algorithm is worked out. The expediency of conservative ulcer bleeding treatment, including primary and repeated endoscopic hemostasis, is proved. It allows performing deferred planned reconstructive operations, thus decreasing the operative risk substantially. Indications for the operative treatment of ulcer bleeding are specified, as well as efficacy and safety of organ-saving methods is proved.

[Bleedings from ulcers after resection of stomach and vagotomy].

Overall 162 patients with recurrent ulcers after previous operations for ulcer disease were treated. Resection of stomach was performed in 69 (42.6%) of them, vagotomy--in 93 (57.4%). Episodes of bleeding were revealed in anamnesis at 56 (81.2%) patients with peptic ulcers after stomach resection, and at 15 (16.1%)--with ulcers after vagotomy. Bleeding was the cause of urgent hospitalization at 39 (28.1%) patients. One hundred and thirty-six from 162 patients have been operated (including 52 patients after primary resection and 81--after primary vagotomy). Vagotomy at the patients with ulcers after primary resections demonstrates good results. Repeated resection of gastric stump with vagotomy is indicated in great penetrating ulcers. Resection of stomach is the operation of choice in majority cases of recurrent ulcers after primary vagotomy. Stem re-vagotomy demonstrates good result an the patients with ulcers of gastro-intestinal anastomosis after primary selective proximal vagotomy.

[Plastic closure of large ulcers of duodenum posterior wall complicated with bleeding].

New method of organ-saving surgery for bleeding duodenal ulcer is described. Advantages of this method have been confirmed in experimental studies on 10 mongrel dogs and by successful clinical application at 3 patients with large bleeding ulcers of duodenum posterior wall.

[Diagnosis, treatment and prophylaxis of acute ulcero-erosive gastroduodenal bleedings at cardiosurgical patients].

Results of treatment of 495 patients who has undergone various cardiac operations with artificial circulation are analyzed. The complex program "Blood-free surgery" was used at 388 (78.4%) of them. Among the patients treated traditionally the acute gastroduodenal erosions and ulcers were diagnosed at 25.7% patients, the rate of gastroduodenal bleedings was 3.0%. Complex of prophylactic measures permits to reduce the rate of acute erosions and ulcers in 1.5 times (18.4%) and the rate of postoperative gastroduodenal bleedings--to 0.7%. Control of risk factors, timely diagnosis, complex prophylaxis and treatment of acute gastroduodenal erosions and ulcers are effective way to improvement of operations results at cardiosurgical patients. "Blood-free" program doesn't lead to increase of acute postoperative gastroduodenal erosions and ulcers rate. Endoscopic (including repeated) hemostasis at acute ulcero-erosive gastroduodenal bleedings is available method and permits to achieve the stable hemostasis.

[Esophagogastroduodenal bleedings at the patients with portal hypertension].

Overall 92 patients with esophagogastroduodenal bleedings, portal hypertension and esophageal varicose veins dilatation were treated, gastric erosions and ulcers were diagnosed at 21 (22,8%) of them. Urgent esophagogastroduodenoscopy was 100% diagnostic value. Endoscopic hemostasis is the method of choice for the treatment of these patients. Five patients underwent urgent operation. Three (14,3%) patients died, all of them -- after urgent operations. Mass health examination and well-timed elective surgery are the main ways for reduction of complication and lethal outcomes rate.