Ivanchov P. Surgical aspects of gastro-duodenal bleedings of the tumorous origin

The dissertation is devoted to the development of the surgical tactic at the patients with acute bleeding gastric malignant and benign tumors. On the grounds of the multifactor analysis of 1292 patients with malignant (1125) and benign (167) gastric tumors (1992-2009) there were studied the clinical course and the severity of bleeding depending to the localization, type, patomorphological features of the tumorous affection. The structure of endoscopic stigmata and their influence on the frequency of early relapses of bleeding were established. The influence of the tissue-stromal factors and features of the tumorous angioarchitecture on the clinical course was established by the patomorphological research. The worked-out surgery-tactic approach allowed for malignant tumors: to enlarge the surgical activity from 44,3 % to 52,6 %, radical operations from 66,0 % to 75,9 %, to decrease urgent operations from 10,5 % to 6,2 %, general mortality from 10,0 % to 5,8 %, postoperative - in 2,7 times (from 11,6 % to 4,3 %), complications after radical operations in 2,4 and non-radical - in 1,2 times; for benign non-epithelial tumours: to enlarge the surgical activity from 80,0 % to 87,5 % without lethal consequences, to decrease urgent operations in 2,5 times (from 17,9 % to 7,1 %), postoperative complications in 3 times; for polypus: to lead the surgical activity to 100 %, to enlarge the primary-urgent endoscopic polypectomy from 62,0 % to 87,8 %.