UNSOLVED PROBLEMS OF IMPROVING THE RESULTS OF PATIENTS WITH PERFORATING GASTRODUODENAL ULCER TREATMENT. (HISTORY, EVOLUTION OF VIEWS, MODERN APPROACHES, UNSOLVED PROBLEMS)

Despite more than a century-long history of studying and introducing surgical methods for surgical treatment of perforated DGD and indications to them, many questions and conclusions related to the implementation of surgical interventions are controversial and unresolved, sometimes requiring little further clarification and study. Therefore, the aim of the study was to study natural observations in order to express their own directions for improving the results of treatment on their results. A retrospective analysis of the surgical treatment of 725 patients with complicated HGD in the clinic from 1990 to 2010, aged 16-85 years was conducted. In the first 6 hours from the moment of perforation, 79.3% of patients were delivered, up to 12 hours - 10.2%, up to 24 hours - 4.1% and after 24 hours - 5.5%. Suturing a perforating hole was performed in 121 patients; indications for its implementation were cases with pronounced phenomena of peritonitis and a young person with so-called "mute" ulcers. Primary gastrectomy performed by 40 patients. We performed the organ-preserving surgical inter-ventions in 564 patients. If at the initial stages of mastering the technique of surgery we preferred the stem and selective vagot-omy, then later, as the technique was mastered, the clinic began to perform selective proximal vagotomy. The study leads the author to the conclusion that at the present stage of surgical treatment of patients with perforated gastroduodenal ulcer, the choice of the method should be determined taking into account the patient's general condition, age, degree of prevalence and prevalence of peritonitis, ulcer localization, duration of ulcerous anamnesis, tera changes in the periulcerogenic zone, the presence of other concomitant compli-cations of peptic ulcer (penetration, stenosis, malignancy, etc.), taking into account the phases of gastric secretion. The organ-preserving operations with vagotomy cor-respond to all the pathophysiological requirements of ulceration and, individually, can be a method of choice in the treatment of perforated gastroduodenal ulcers. Improving the results of treatment of patients with complicated gastroduodenal ulcer with a steady increase in their number should be considered with the overall objective of sur-gical treatment of patients with peptic ulcer disease by relative indicators.