No abstract

This article presents the results of treatment of patients with ulcerative gastroduodenal bleeding who were treated in the 2nd clinic (surgery for the improvement of doctors) Military Medical Academy at the I.I. Dzhanelidze Research Institute of Emergency Medicine. A retrospective analysis was conducted of the frequency of rebleeding, surgical activity and mortality in groups with the use of transcatheter arterial embolization with and without it. The criteria for inclusion in the study were: the presence of ulcerative gastroduodenal bleeding, confirmed by laboratory and instrumental methods of examination, severe general somatic condition of patients. The comparison was carried out in the main and control groups. The main group consisted of 20 patients who underwent endovascular hemostasis. The control group included 46 patients without the use of X-ray surgical methods. The average age of patients in the main and control groups was 65.5 3.7 and 60.7 3.9 years. In both groups, most patients were admitted later than 24 hours after the onset of the disease and with severe blood loss. The severity of the somatic state of the intervention was assessed according to the APACHE II multiple organ failure assessment scale, according to which, patients in the main group were somatically more severe than in the control group. In the groups, bleeding from stomach ulcers prevailed (up to 75%). Most often, endovascular hemostasis is performed at a high risk of recurrent bleeding, and adhesive compositions and spirals were used as an embolizing agent. Angiography revealed direct or indirect signs of bleeding (extravasation, hypervascularization, aneurysmal dilatation) in 12 cases, and preventive embolization was performed in 8 cases. In 70% of cases, the source of bleeding was the left gastric artery. In the control group, recurrent bleeding and surgical activity accounted for 26%. In the main group, 20% and 15%, respectively. In the main group, recurrent bleeding occurred in 4 cases, 1 patient underwent repeated endoscopic hemostasis, 3 patients underwent open surgical interventions. All 4 patients had a fatal outcome, against the background of massive blood loss and aggravated somatic pathology. The overall mortality rate in the control group was 44%, in the main group 35%. Transcatheter arterial embolization did not significantly improve the results of treatment of ulcerative gastroduodenal bleeding due to the severity of the general somatic condition of the patients included in the study.

Nowadays the treatment of patients with malignant neoplasms of the abdominal organs against the background of decompensated liver cirrhosis is largely an unsolved problem. Complications of portal hypertension syndrome such as ascites, hypersplenism, recurrent bleeding from the veins of the esophagus prevent the implementation of radical surgical treatment. Low trauma of endovascular methods of treatment, low level of complications and mortality are the main advantages of interventional techniques that make it possible to prepare a patient with portal hypertension syndrome for further radical treatment of oncological disease. The presented clinical case describes the results of a combined approach to the treatment of a patient with complications of portal hypertension syndrome and a competing disease a giant tumor of the uterus. The patient was denied in surgical treatment for the neoplasm due to the presence of decompensated cirrhosis. Liver transplantation is not possible due to the presence of cancer. Transjugular intrahepatic portosystemic shunting led to relief of diuretic-resistant ascites, regression of the degree of esophageal varicose veins, which made it possible to remove the tumor with extirpation of the uterus with appendages. Up to now the observation period for the patient is more than 12 years (4 figs, bibliography: 7 refs).

At the present stage treatment of gastrointestinal bleeding, x-ray surgical methods play an important role. This review examines the features of the use of transcatheter arterial embolization in the most relevant nosological forms: ulcer bleeding, bleeding in chronic and acute pancreatitis, and in decaying tumors of the gastrointestinal tract.