Non-parasitic Hepatic Cysts: Diagnosis and Surgical Treatment

A.V. Kapshitar

Abstract


If previously non-parasitic hepatic cysts (NHC) were detected in 1 % of the population, then now due to the widespread use of ultrasound, CT, MRI, and their detection rate increased significantly, reaching 5–6 %. In most cases cysts are asymptomatic and only in 10–18.3 % of cases, while increasing them than 5 cm in diameter, they manifest with discomfort moderate pain in the right subcostal area and other complications occur in patients 5–5.9 %. Despite significant advances in surgical hepatology, problem of NHC diagnosis and treatment approaches are still not fully resolved and remain controversial.
Objective: to evaluate the state of diagnosis, indications and results of surgical treatment of non-parasitic hepatic cysts.
Material and Methods. We examined 18 patients with solitary NHC. In a matter of urgency, 9 patients (50 %) were operated and in the planning — 9 (50 %). Men were 4 (22.2 %), women — 14 (77.8 %). The age of patients ranged from 31 to 82 years, with a median of 57.6. All 18 patients had concomitant diseases of the abdominal cavity and retroperitoneal space. Intercurrent illnesses suffered 16 (88.9 %) patients. In the diagnosis of NHC, along with clinical and laboratory biochemical examination of patients, we determined tumor markers and anti-parasitic antibodies, performed a plan radiography of chest and abdominal cavity, fiberoptic esophagogastroduodenoscopy, ultrasound, CT, laparoscopy.
Results and Discussion. On admission to urgently and routinely club NHC identified in 9 (50 %) patients. In the process of ultrasound in 13 (86.7 %) patients diagnosed with hepatic cysts and its location has been defined. In 3 patients during CT we visualized round or oval hypodense lesions. Laparoscopic examination performed in 4 patients enabled to determine the combination of NHC with acute abdominal surgical pathology. NHC in 9 (50 %) patients were located in the left lobe of the liver, in 8 (44.4 %) — and in the right lobe and in two lobes — 1 (5.6 %). Morbidity recorded in 8 (44.4 %) patients, in 2 (25 %) of them — empyema of cyst with spontaneous rupture and diffuse purulent-fibrinous peritonitis, in 1 (12.5 %) — rupture of the cyst with bleeding into abdomen and hemoperitoneum, in 1 (12.5 %) — empyema of cyst. in 2 (25 %) — compression by the cyst of hepaticocholedochus and jaundice, and in 2 (25 %) — hepatic insufficiency.
Group I included 9 (50 %) patients who underwent emergency surgery. Of these atypical liver resection performed in 4 (44.4 %) patients (cholecystectomy — 3, dissect mesentery hematoma — 1), left-sided hemihepatectomy— in 2 (22.2 %), pericystectomy — in 2 (22.2 %) and open festering cyst of the liver — in 1 (11,1 %). Postoperative complications occurred in 2 (22.2 %) patients, of whom one was festering wounds, and 1 — developed pneumonia. Average bed/day 13.0 ± 1.2. All have recovered. II group consisted of 9 (50 %) patients operated in a planned manner. Of the 9 patients after an atypical liver resection 6 (66.7 %) patients underwent simultaneous operations of cholecystectomy, and 1 (11.1 %) — right hemicolectomy with ileotransversostomy. Complications or deaths weren’t observed. Average bed/day 11.0 ± 1.3.
Conclusions. Diagnosis of non-parasitic hepatic cysts should be comprehensive. The operation of choice is atypical liver resection, or hemihepatectomy pericystectomy, the frequency of postoperative complications — 11.1 %, and no deaths.


Keywords


non-parasitic hepatic cysts; diagnosis; surgical treatment

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DOI: https://doi.org/10.22141/1997-2938.2.25.2014.83091

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