Ways to improve the results of surgical treatment of patients with acute complications of malignant processes of the stomach
DOI:
https://doi.org/10.15574/PS.2025.1(86).2732Keywords:
malignant stomach, bleeding, surgical tactics, hemostasis, surgery, complicationsAbstract
Aim - to study and analyze the structure of acute surgical complications of malignant stomach (MS); to develop an optimal algorithm of surgical tactics in patients with acute complications of MS in emergency care; criteria for choosing emergency and early-delayed surgical procedures.
Materials and methods. The materials of the study were the results of a comprehensive examination and treatment of 452 patients with acute complications of MS who were inpatients at the Kyiv City Clinical Hospital No.12, for the period from 2014 to 2023. In the first period of the study, a retrospective analysis of the medical history and treatment results of 245 patients with acute complications of malignant gastric syndrome who were treated in clinics from 2014 to 2018 was conducted - the control group. Based on the analysis, an optimized surgical tactic was developed for the appointment with acute complications of malignant gastric diseases, which in the second period of the study was implemented in clinical practice for the treatment of 207 patients with acute complications of STDs who were in the clinic from 2019 to 2023. - the main group.
Results. An optimized algorithm of surgical tactics was developed in patients with MS complicated by bleeding, the key point of which is the performance of emergency endoscopy, where endoscopic hemostasis is effective or not effective, and in this regard, we get the opportunity to divide all patients into 2 groups regarding the choice of the timing of surgical intervention. The starting point for perforations of the gastrointestinal tract is the performance of emergency radiography and endoscopy with the determination of the localization and morphological characteristics of the perforation substrate and the conduct of preoperative preparation in the intensive care unit or on the operating table. Due to compliance with the tactics of clinical and endoscopic monitoring, in the second period, the overall mortality rate is reduced by almost half - by 5.2%, and postoperative mortality - by 3.5%.
Conclusions. An algorithm of surgical tactics in patients with complicated gastrointestinal tract has been developed, which involves compliance with active-extraction tactics with the use of clinical and endoscopic monitoring for bleeding and stenosis and active preoperative preparation with minimizing the volume of emergency surgical intervention for perforations of the disease.
The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patients was obtained for the study.
The authors declare no conflict of interest.
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