Tratamentul hemoragiei digestive superioare la pacienţii operaţi

Abstract

Hemoragia digestiva superioara este o complicatie severa in cazul pacientilor operati, crescand mult morbiditatea si mortalitatea acestora. Hemoragiile digestive superioare se clasifica in timpurii si tardive, in functie de momentul postoperator in care survin. Tratamentul hemoragiilor digestive la acesti pacienti poate fi tratament conservator, endoscopic sau chirurgical. Avand in vedere faptul ca pacientul operat este un pacient fragil, la care riscul operator este ridicat, este de preferat ca in aceste situatii sa se incerce evitarea reinterventiei chirurgicale. Momentul efectuarii endoscopiei digestive superioare este de asemenea deosebit de important: pacientul trebuie stabilizat anterior procedurii, avand in vedere faptul ca si endoscopia este o procedura invaziva. Tratamentul endoscopic la pacientul operat prezinta anumite caracteristici, deoarece este importanta protejarea anastomozelor (in cazul in care este vorba despre o interventie chirurgicala efectuata la nivelul tubului digestiv superior), tehnica endoscopica trebuind sa fie adaptata in concordanta cu acest lucru. Ca urmare, este importanta utilizarea unui endoscop cat mai flexibil, insuflare minima si tehnici hemostatice care sa nu puna in pericol integritatea anastomozei. Tehnicile hemostatice sunt cele utilizate in general in cazul hemoragiilor digestive superioare, cu reamintirea faptului ca injectarea de adrenalina nu poate fi utilizata ca metoda unica. Exista tehnici mai noi, cum ar fi montarea de OVESCO sau aplicarea de Hemospray sau de Purastat, tehnici la care se poate face apel in cazul in care tehnicile clasice au esuat.

Upper digestive bleeding is a severe complication in surgical patients, that rises their morbidity and mortality rates. This complication can be classified as early or late, depending on the postoperative moment it occurs. The treatment of upper digestive bleeding in these patients can be conservative, endoscopic or surgical. Taking into account the fact that the surgical patient is a fragile patient, with high operative risk, it is preferable in these cases to avoid the reintervention. The choice of endoscopic timing is also very important: the patient has to be in a stable state, because endoscopy is also an invasive procedure. The endoscopic treatment of the surgical patient has some characteristics, because it is vital to protect the integrity of the anastomosis (if the surgery involved the superior digestive tract), and the endoscopic technique must be adapted consistently. Therefore, it is important to use a flexible endoscope, to insufflate minimally and to utilize hemostatic techniques that do not compromise the anastomotic integrity. The hemostatic techniques are the same used in general in case of upper digestive bleeding, and we want to remind that injecting adrenaline alone is not a sufficient hemostatic technique. There are also new methods that we want to discuss, like OVESCO, Hemospray or Purastat, methods that can be used when the classic techniques did not work.