WAYS OF IMPROVING THE RESULTS OF SURGICAL TREATMENT OF GASTRIC MALIGNANT TUMORS, COMPLICATED BY GASTROINTESTINAL BLEEDING IN THE CONDITIONS OF EMERGENCY CARE

Abstract

The aim is to improve the results of surgical treatment of patients with gastric malignant tumors, complicated by gastrointestinal bleeding, by developing and implementing in clinical practice a new treatment tactic. Materials and methods. The study was conducted on the basis of the Kyiv City Center for Emergency Care of Patients with Gastrointestinal Bleedings and at the Kyiv City Clinical Ambulance Hospital (Ukraine) for the period from 2010 to 2020. A comprehensive examination and analysis of reatment’s results of 140 patients with malignant gastric tumors complicated by acute gastrointestinal bleeding, which amounted to 2.2 % of all reated patients with gastrointestinal bleeding during this period. Results. Radical operations were performed in 97 (69.3 %) patients, palliative and symptomatic – in 43 (30.7 %). Comparing the frequency of complications in the two periods of treatment of patients, a decrease in the second period, compared with the first period, the frequency of complications from 27.2 % to 11.4 % due to a decrease of 1.8 times (from 68.8 % to 37,5 %) complications after emergencies and related fatalities from 36.4 % to 0 and 2.2 times (from 20.8 % to 9.6 %) the incidence of complications after early delayed operations with a decrease in frequency fatalities from 20.9 % to 18.2 %. Conclusions. Operations at the height of acute bleeding in patients with gastric cancer are too dangerous due to the high postoperative mortality. The optimal standard is the use of a set of minimally invasive methods of endosurgical hemostasis to stop active bleeding and prevent its recurrence and operate on patients in the early delayed period. Adherence to such tactics is expedient from the point of view of reduction of risk for a life of the patient and possibility of carrying out radical operations.