Dotsenko Y. Surgical treatment of the biliodigestive bleeding

Dissertation work represents clinical research based on the study of diagnostics and surgical treatment of the biliodigestive bleeding (BDK) of a different etiology. Morphological researches of features of structure of vascular-bilious structures of liver are conducted: so-called "weak" points which are the most dangerous in regard to the BDK development were exposed; a possibility of roentgen-endovascular occlusion application for the BDK stop was grounded.The clinical section of work is based on the comparative study of results of treatment of 62 patients with the biliodigestive bleeding of a different etiology, being on treatment in the Institute of General and Urgent Surgery of AMN of Ukraine and Kharkov City Hospital for Urgent Medicare from 1982 to 2006. All patients were divided into two comparable groups: a primary group and a comparison group. The results of laboratory and instrumental diagnostic methods and traditional treatment methods were analyzed in the comparison group. On the basis of findings a diagnostic algorithm and a stepwise surgical tactic dependent on the BDK variant were developed; the working BDK classification was formulated. The offered diagnostic algorithm was used in the primary group what allowed to improve considerably quality and terms of diagnostics. Stepwise surgical tactic based on the division of hemostatic nature (I stage) from radical nature (II stage) was developed, at that on the first stage miniinvasive methods were used, the most widely - roentgen-endovascular. After achievement of hemostasis intensive correcting therapy was conducted, that allowed to stabilize the state of patients and execute the radical operations directed on the removal of primary pathology in favorable conditions. The use of the offered medical tactic in the primary group allowed reducing general lethality from 14.2 to 6.1%. Postoperative lethality in the primary group went down from 15.4% to 6.67%. Middle in-day made 23.4±5.2 in the comparison group and 14.3±4.4 in the primary group.