Subject of the study: Perforative ulcer gastric and duodenal. Purpose of the study: Study the reasons of paraulcerative infiltrates formation and their role in mechanisms of gastroduodenal ulcers perforation and on the basis of received data to improve the complex surgical treatment. Methods of research: clinical, laboratory, instrumental (fibrogastroduodenocopy, ultrasound investigation, rentgenography), morphohistological and static methods. Practical significance of the obtained results: The methods of excision of the perforative ulcer, not only in limits of macroscopically visible infiltrate, but taking into consideration the area of microscopic changes expansion, which were defined during histomorphologic investigation, were offered. Taking into account the violations, which appear, the methods of complex treatment was improved and clinical tested. These methods of comprise the performance of disintoxication and antiinflammatory therapy with the use of antibiotics of the wide spectrum of action, antacids, hepatoprotectors, disaggregants and early enteral nutrition, and assists in restoration of wound defect, helps to improve the functional state of the liver and considerably decrease the postoperative complications in patients with perforative ulcer during pre- and postoperative periods. Scientific novelty: TSpecified and the reasons, based in detail, which assist in paraulcerative infiltrates and perforation of stomach and duodenal ulcer. For the first time, the role neuroendocrynocites of APUD-system and cable nerve conductors in the development of the lack of microcirculation, hypoxia and tissue necrosis in the area of ulcer bottom and paraulcerative infiltrate with inflammatory changes in surround a lymphatic follicle that ultimately brings to ulcer perforation, was defined. For the first time, on the basis of morphohistologic investigations of paraulcerative infiltrate tissues, in different distance from perforative orifice, the amount of necessary tissue removal of paraulcerative area was defined. The violations of proteinsynthesized function of the liver, certain proteins and enzymes of hepatocytes cytolysis, peroxidation of lipids and systems of antioxidant defence and content of certain microelements, which appear on the phone of general peritonitis, as a result of ulcer perforation and perniciously influence the clinical course of the disease, were studied. Degree of introduction: ThThe main items of dissertation are introduced into the work of the surgical departments of the district clinical hospital, central municipal clinical hospital and municipal clinical hospital №1 in Ivano-Frankivsk; Tlumach and Bohorodchany central regional hospitals, and are used in educational process of surgical chairs of Ivano-Frankivsk state Medical University.
