Lugovy O. Features of surgical tactics for the patients with a bleeding peptic ulcer of duodenum and combined patologies

The status of structural local immunity and morphological homeostasis of area around of an active ulcer of a duodenal intestine for 159 patients complicated by a bleeding is investigated. The analysis of local changes of a contents of immunoglobulins around of a ulcer with risk of origin of a relapse of a bleeding in different periods after a stopping of the first bleeding is carried out. Being founded on dynamic learning of a contents of a secretory immunoglobulin And in sites of a mucosa duodenal is offered and the algorithm of definition of period of the operation in view of risk of origin of a repeated bleeding. The analysis of the nearest outcomes of surgical treatment 234 combined pathologies patients with a bleeding ulcer of a duodenum and a complications after surgery is carried out. Usage of the comprehensive approach to definition of time and size of the operation has lowered operating activity in 2 times (with 64,5 to 31,7 %), amount of complications from 21,5 % up to 5,8 % (in 3,7 times), lethality after operations from 2,4 % up to 0,0 %, amount of morses at conservative treatment - from 8,9 % up to 1,4 %, and common mortality from 4,7 % up to 0,9 % (in 5 times).