TREATMENT AND DIAGNOSTICS STRATEGY FOR NON-PARASITIC LIVER CYSTS
R.T.MAJIDOV, Z.R.KHABIBULAYEVA, G.A.ABDURASHIDOV
Dagestan State Medical Academy; Makhachkala, RUSSIA
The aim of the study.To evaluate the possibilities of modern research techniques and minimally invasive technologies in the treatment of non-parasitic liver cysts.
Materials and methods. Results of treatment of 118 patients are presented. Localization of cysts: in the right lobe 65 (55.0%), in the left lobe - 35 (30.0%) in both lobes - 12 (10.0%); pararenal cysts - 6 (5.0%). Multiple cysts were observed in 16 (13.5%) cases, isolated - in 82 (69.0%). 20 (17.5%) patients had 2 solitary cysts. The main and most informative method of diagnosis was liver echotomoscopy.
14 patients were performed puncture of non-parasitic cysts of the liver under ultrasound-guidance with treatment of the cavity with 96 ethanolwithin 10 minutes. Videolaparoscopic operations for non-parasitic liver cysts were performed in 33 patients. In 12 cases, with the sizes of formations to 3-3.5 cm in diameter, surgical interventions were not performed. Laparotomies were performed in patients 59 with the purpose of: external drainage of residual cavity - 4; cyst fenestration - 43; marginal or atypical resection of the liver - 12.
Results and their discussion. The sensitivity of the echotomoscopy method un the diagnosis of liver cysts constituted 96.0%. The main signs of cysts included: clear and smooth contours, absence of internal reflections, intensification of echo-signals after the formation, spotted pattern in the presence of the luminal wall. In 33 cases the puncture and fenestration ofcystswere performed under videolaparoscopiccontrol. With three-year observations, no recurrences of the disease were observed.
Conclusion. The introduction into clinical practice image forming diagnostic methods allows highly accurate differentiation of simple cysts from parasitic, implementation of percutaneous puncture, decompression and sclerotherapyof non-parasitic cysts under ultrasound guidance. In case of complications, multiple cysts, difficulties in difdiagnostics, ineffectiveness of punctured treatment of cysts, surgical treatment in the videolaparoscopicversion shall be conducted. Laparotomy is indicated for during the localization of cysts near the large vessels suspected parasitic nature of the cyst and the presence of concomitant pathology of biliary tracts.
COMPARATIVE CLINICAL AND HEMOSTASIOLOGICAL CHARACTERISTICS OF PATIENTS WITH CHRONIC HEPATITISES OF DIFFERENT ETIOLOGY
Central Scientific and Research Institute of Epidemiology, Infectious Clinical Hospital No 2,
The aim of the work - to identify characteristics of the clinical picture and disturbances in the hemostatic system in patients with chronic hepatitis C (CHC), toxic (TH) and mixed hepatitises (MH).
Materials and methods: A total of 72 patients were examined, males prevailed - 69.8%, average age - 39,4 ± 5,7 years. Etiology: 27 patients with CHC, 12 patients - and TH 33 - CHC against the background of the TH - mixed-hepatitis (MH). Liver cirrhosis (LC) at the stage of decompensation was detected in 24 patients, in two of them (8.3%) in the result of CHC, 6 (25%) - against the background of TH and 16 (66.7%) - MH. Lethal outcome was in 2 patients: 1 male at the age of 52 – LC in the result of the TH-and 1 woman at the age of 42 years – LC in the result of MH. Platelet aggregation (PA) was determined in all the patients by Born method, and erythrocyte aggregation (EA) by the original method of Sheremetyev Y.A. (Patent number 2027188 dated 20.01.1995), Nitric oxide (NO) by Griess method with the use of cadmium reductor. 20 healthy individuals were examined for control.
Results. The clinical picture in all patients regardless of etiology was characterized by severe weakness, subfebrile T, the presence of secondary liver marks, decreased appetite, jaundice, hepatosplenomegaly. Ascites was detected in 15 of 24 patients with LC (73.3%), with the majority in the result of MH - 11 (45.8%). The longest hospital stay was observed in patients with MH - 31,0 ± 2,1, that significantly more than in TH - 16,8 ± 1,3 (p ≤ 0.01). It was found that PA in all patients was almost 2 times significantly lower than in healthy individuals. In patients with MH PA amplitude was determined even less – 3 times as compared with normal values. Levels of EA and NO were determined also significantly below normal in all the patients regardless of etiology. The lowest hemostatic profiles were observed in patients with LC in the result of MH at the decompensation stage.
Conclusion. MH patients prevailed - 46.5%, LC often formed in men in the result of MH - 66.7%, mortality among them constituted 8.3%. The most expresses disturbances in the hemostatic system were observed in patients with LC in the result of mixed hepatitises.