Yefremov V. The short-term and long-term results of surgical and complex conservative treatment of duodenal ulcer bleedings at modern level

2285 patients with duodenal ulcer bleeding were the subject of the research, from which two groups analyzed: I -main group (1st period) - 1630 (2004-2008), II - control group (2 period) - 655 (1994, 1996). Modified forecasting scale of relapse bleeding risk was developed on the basis of the research results analysis. The purpose of modified scale is definition of surgical treatment tactics for duodenal ulcer bleeding which provides integral prognostic index (IPI) calculation of relapse bleeding risk with revealing of patients with high risk relapse bleeding and performance of urgent (preventive) operations. Active-individualized tactics and algorithm were improved that given the chance for patients with duodenal ulcer bleedings conservatively treated to decrease mortality statistically significantly in 2.17 times, and the general mortality decrease in 1.51%. Offered the method to prevent the early bleeding relapse by administration of protone pump inhibitors intravenously in high-dose regime (240-320 mg/day) under the рH-level control. Developed algorithm of duodenal ulcer bleeding treatment at outpatient stage allowed to increase frequency of excellent results in 2.57 times (р=0.00001). Two new, more effective methods of operative interventions at duodenal ulcer bleeding were developed, 3 new combined methods of endoscopic hemostasis, a method of forecasting of early relapse duodenal ulcer bleeding, method of early duodenal ulcer bleeding relapse prevention and method of iterative ulcer bleeding forecasting in long-term period, covered by patents. Risk factors of repeated ulcer bleeding in the long-term period were specified.