Sykal M. Peculiarities of Surgical Approach in Case of Gastric Ulcers Complicated by Sharp Gastroenteric Bleeding

In this thesis the author presents the complex comparative analysis of the results of surgical treatment of 180 patients with a gastric ulcer complicated by the sharp gastroenteric bleeding. The basic indexes of oxidizing homoeostasis have been studied. The paper demonstrates that the patients with sharp gastroenteric bleeding of middle and heavy blood loss severity have the considerable intensification of free radical processes, the significant increase of processes related to nitric oxide metabolism, the activation of albumens synthesis of sharp phase, the accumulation of oxidants and degradation of biopolymers and this influence on the course of a disease and postoperative period. Individual approach which was developed to selectionof operaive method allows applying the most rational strategy in every patient with stomach ulcer, complicated with bleeding. The prevalence of meta- and dysplastic changes of periulcerous area of stomach is studied. The findings testified for the considerable frequency of meta- and dysplastic changes in a periulcerous area on the background of chronic gastritis. The method of selection of surgical approach is developed in case of bleeding gastric ulcers depending on the dysplastic changes of periulcerous area, which was successfully applied with the operated patients. The operative treatment of patients with gastric ulcers complicated by the sharp gastroenteric bleeding was carried out with application of the traditional and newly developed advanced organ preserving methods. Implementation of the developed surgical approach and advanced methods of surgical treatment taking into account the changes of oxidizing homoeostasis allowed decreasing substantially the frequency of postoperative complications, and postoperative lethality for 3,7 %, and improving a medical and social rehabilitation