Possibilities of Modern Methods for Diagnosis and Surgical Treatment of Benign Focal Liver Lesions

Ya.G. Коlkin, V.V. Khatsko, O.D. Shаtаlоv, O.Ye. Кuzmenko, V.M. Vоytyuk

Abstract


In the last few years a frequency of benign focal liver formations increased considerably. Each of these formations has many problems of both diagnostic and tactical character. The role of minimally invasive and laparoscopic operations is not specified at treatment of such patients.
Material and methods. Treatment outcomes for 340 patients with benign focal liver lesions for the last 20 years had been analyzed. Among them there were 215 (63.2 %) women and 125 (36.8 %) men, middle age — 47.5 ± 2.2 years. 164 (48.2 %) patients had nonparasitic hepatic cysts, with abscesses — 71 (20.9 %), with hydatidosis — 41 (12.1 %), with hemangiomas — 48 (14.1 %), with an adenomas — 12 (3.5 %), with local nodular hyperplasia — 4 (1.2 %).
The next methods of investigation are applied (in different combinations): clinical and laboratory, ultrasonic, computer or magnetic resonance tomography, laparoscopy, cytological and bacteriological examination of liquid from a liver’s abscess or cyst. At suspicion at Echinococcus a latex-agglutination reaction and immune-enzyme methods were used. In a hospital minimally invasive surgical interventions were carried out for 230 patients of І group and 110 — to the patients of II group.
Results and discussion. The most frequent minimally invasive operations in patients of І group: punction external drainage — 68; laparoscopic excision of front wall of cyst, deepitelization of residual cavity, drainage, introduction to the cavity of thrombocyte concentrate — 38; resection of liver — 31.
The most frequent opened operations for the patients of II of group were: regional or atypical resection of liver — 27; excision of cyst and external drainage — 24; drainage of cyst or liver abscess — 20.
In a clinic there had been worked out and applied for the patients of І group 6 new methods of diagnostics and mini invasive treatment of benign focal liver formations: «Method of differential diagnostics of benign focal liver lesions by a spiral computer tomography», «Method of surgical treatment of cyst of parenchymal organ», «Laparoscopic punction’s needle», «Device for laparoscopic treatment and drainage of liquid formations of organs of abdominal region», «Method of liquidation of remaining cavities of liver», «Device for removal of gall-bladder or cyst of parenchymal organ».
The rate of postoperative complications in a І group was 6 %, in II group — 24.5 %. 3 (1.3 %) patients of І group died after an operation and 5 (4.5 %) — II of group caused by multiple organ failure.
Conclusions. Minimally invasive methods of diagnostics and treatment, with the use of 6 worked out inventions, under ultrasonic and laparoscopic control expediently wider to use for of benign focal liver formations in the specialized surgical hepatological centers. Such methods assist the decline of frequency of complications and lethality.


Keywords


benign focal liver lesions; diagnosis; surgical treatment

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DOI: https://doi.org/10.22141/1997-2938.1.20.2013.87562

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