FACTORS OF PROGNOSTICATION OF THE RE-PEATED BLEEDING IN A REMOTE PERIOD AF-TER THE CARRIED ACUTE DUODENAL ULCER BLEEDING

The aim of work is an invention of method that would allow forecasting the risk of the repeated ulcer bleeding in a remote period after stationary treatment. Matherials and methods. 690 patients with acute du-odenal ulcer bleeding in the remote period were analysed from that 470 in the main group (2004-2008) and 220 - in the control group (1994, 1996). In the main group 21(4,5%) patients were operated and 449 patients (95,5%) were treated conservatively. In the control group 94 patients (42.7%) were operated and 126 (57.3%) of patients were conservatively treated. In the long term period 311 patients were examined with the help of endoscopy, pH-metry and rapid urease test (СLO-test). Results and conclusions. The index of frequency of relapses of ulcer after conservative treatment has decreased in 2,2 times (from 19,05% tо 8,68%, р=0,0010, р<0,05), as well as percent of the repeated bleeding in a remote period - in 1,93 times (from 15,08% tо 7,8%, р=0,0136, р<0,05). Among patients with Н.р.(+) ulcers (at a receipt) the repeated ulcer bleeding in a remote period was educed at 1,5% cases, or in 2,89 rarer than among patients with Н.р.(-) ulcers (4,34%, р=0,0668, р>0,05). Among the patients of basic group after operative treatment in a remote period, 21 patients were examined. 14,29% had excellent results , in 80,95% - good results, and satisfactory - in 4,76%. In a control group after operative treatment in a remote period excellent results got 12,77% patients, good - in 76,6%, satisfactory - in 8,51%, unsat-isfactory (relapse of ulcer) - in 2,13% of patients. The repeated ADUB bleeding in a remote period in a basic group arose up at 7,8% cases after conservative treatment with a minimum index after triple therapy (5,57%), thus in 3,6 times less than, than after monotherapy (20%, р=0,00001, р<0,05). The best effect was shown by the chart of Kontrolok+Klacid+Amoksil (absence of the repeated bleeding is in a remote period). In a remote period after application of triple therapy the amount of relapses of ulcer in a basic group appeared for certain in 6,27 times less, than in control (6,13% and 38,46%, р=0,00001, р<0,05). In a remote period after operative treatment in a basic group (N=53) 45 of them got antiulcerous treatment, data of inspections and questionnaire questioning in 15 patients testified the absence of relapses of ulcer and repeated AUGIB in this group. The factors of the risk of repeated ulcer bleeding in the long term were established on the basis of correlation analysis with calculation of Spearman's rank correlation coefficient: 1) direct correlation between the size of the ulcers of 1 cm and above and the incidence of repeated ADUB in the long term period (r = 1, p<0.00001); 2) direct correlation between age 60 and older and the frequency of repeated ADUB in the long term period (r = 1, p<0.00001); 3) the reverse correlation between the class of drugs for eradication therapy and the incidence of repeated ulcer bleeding in the long term period (r = 0.9, p=0.037); 4) the type of treatment (conservative or operative, reducing the risk of repeated ulcer bleeding in the long-term period by 11.36 times (χ2=9,889711, df=1, p=0,00166).