Smyrnov M. The surgical tactic in patients with acute bleeding tumors of digestive tract. .

Object of the study: Acute hemorrhages from malignant and benign tumors of the digestive tract of various localization. Purpose of the study: To improve the results of treatment of patients with acute hemorrhages from the tumors of the gastrointestinal tract by means of working out a differentiated approach to the choice of the method of endoscopic hemostasis and prevention of hemorrhage relapses, protocols of drug prevention of recurrent bleeding, indications to urgent surgery, its methods and volume. Methods of the investigation:. Clinical, endoscopic, x-ray, ultrasonography and laboratory methods to diagnose aceta hemorrhage to the lumen of the digestive tract, localization of its origin, to determine the degree of post-hemorrhage disorders and efficacy of the treatment; pathomorphological investigation of the biopsy material to verify the diagnosis; multifactor statistical analysis to reveal the factors influencing the relapse development. Practical significance of the obtained results A scheme ofendoscopic arrest and prevention of hemorrhage relapse allows to reduce the number of relapsing hemorrhages and to avoid urgent surgery was suggested. This allows reducing the death rate in patients with acutely bleeding tumors. Prognosis of the risk of relapse development allows to reduce the number of urgent operations which are performed during bleeding and to operate the patients in better conditions, i.e. in the condition of hemostasis, which is reflected in reduction of post-operative complications and death rate. The worked out therapeutic tactics allowed to individualize indications to surgery as well as the choice of the method and volume of surgical interventions. Novelty: For the first time, risk factors of hemorrhage relapse were determined. The criteria of prognosis of the probability of relapsing hemorrhages were worked out. A system for prognosis of the probability and terms of hemorrhage relapse was worked out. A differentiated approach to the choice of the method of endoscopic hemostasis at acutely bleeding tumors depending on location, microscopic characteristics of the tumor and the state of local hemostasis was developed. A complex of therapeutic measures aimed at prevention of hemorrhage relapses was developed and introduced into practice. A tactical approach to determining the indications and volume of urgent and early planned operations in acute hemorrhages from the tumors of the gastrointestinal tract was worked out and substantiated. For the first time, a therapeutic tactics based on the tumor location, efficacy of endoscopic hemostasis and degree of risk of hemorrhage development was developed. Degree of introduction: The findings of the research are used in the work and teaching process of hospital for surgery and endos-copy of Donetsk State Medical University named after M. Gorky, central city hospital No. 16 (Donetsk), city clinical hospital No. 1 (Makeyevka), city hospital No. 2 (Mariupol). Sphere of application: medicine, surgery.