Treatment of liver echinococcosis
Helminthiases / / May 03, 2016
treatment echinococcosis of the liver, as, indeed, echinococcosis and other organs, surgery alone.In establishing this diagnosis should immediately resort to surgical treatment given the opportunity to develop at any time of life-threatening complications: festering cysts, break it into adjacent organs, capsule rupture and massive infestation Echinococcus into the abdominal cavity.In the case of such complications may be needed urgent surgery because of severe suppurative processes, the development of obstructive jaundice, suppurative cholangitis, peritonitis, intestinal obstruction.
Contraindications to surgery are the only serious cardiovascular insufficiency and deep functional disorders, often developing in the liver as a result of multiple echinococcosis off a large part of its fabric.
necessity of surgical treatment of echinococcosis of the liver caused by the absence of any effective methods of struggle against the conservative implement parasite.In addition, the death of the latter is not a cu
Preoperative preparation is of great importance, despite the fact that the liver has a high degree of compensation, as a result of which its function can be fully retained even after turning off half of parenchymal organ in any pathological process.Before the surgery, prescribe calorie diet (3,000 calories per day).For the normalization of metabolic processes it is expedient purpose of bed rest, daily administration of 40% glucose solution with insulin, ascorbic acid, vitamins B1 and B6.
When significant anemia, low levels of blood serum proteins, reducing albumin-globulin ratio and violation of antitoxic liver function is recommended high-grade and highly digestible proteins (milk, cheese, fresh meat, boiled fish), a sufficient amount of carbohydrates and vitamins.The total calorie diet adjusted to 4500-5000 cal.Strict bed rest.In addition to a 40% solution of glucose and vitamins B1 and B6 should be administered 1-1.5 L of 5% dextrose solution intravenously and vitamin B12, favorably influencing the carbohydrate and pigment of liver function.
drip isotonic solutions are particularly necessary sick with jaundice.Also shown are repeated transfusions of fresh blood and plasma inogruppoy that increase blood clotting.
is important to keep track of bowel function by assigning appropriate laxatives if necessary.
the presence of suppurative processes in the liver is advisable to antibiotic therapy after individual determination of sensitivity to them (pus for sowing take during surgery).
Complications during surgery
Among the most common complications during surgery for liver echinococcosis noteworthy bleeding.In most cases, it arises from a damaged liver parenchyma, but may be of larger vessels of the body.Especially dangerous are injured hepatic veins near their confluence with the inferior vena cava, the branches of the portal vein and the hepatic artery.
Postoperatively frequent and most dangerous complication is a bile leakage.Efflux occurs if the free bile, abdominal cavity, peritonitis develops ending in most cases lethal.At the expiration of bile out of the patient eventually develops exhaustion, which can also lead to a sad end.It should be emphasized that bile leakage often occurs after only 2-3 days after echinococcectomy, despite the fact that during surgery after removal of the cuticular membranes was not observed.This phenomenon is explained by an increase in pressure in the bile ducts located in the fibrous capsule, after the removal of cysts and rupture their consequence for the rest cavity.With the death of the parasite or festering cysts usually takes place a direct message with her bile ducts (bile impurity in the cyst contents), so the risk of bile leakage after the operation is further increased.
In cases of significant loss of bile (700 ml or more) should be given to the patient to drink, or to enter the bile through a tube directly into the stomach.
to postoperative complications are also subdiaphragmatic abscess fester and stitched tightly residual cavity.In the first case, against the background of a satisfactory state of sudden temperature rises to 38-39 ° C, there are chills, and pain in the right upper quadrant.X-ray examination in subdiaphragmatic space is usually found with the liquid level of the gas bubble above him.An abscess must be opened and drained by the generally accepted principles.
Suppuration in the residual cavity develops in those cases where there are conditions that prevent resorption of the accumulated fluid in the cavity and its walls spadenie (fibrosis, calcification, extensive adhesions).
- Echinococcosis kidney
- Echinococcosis bones
- Echinococcosis of liver
- Symptoms echinococcosis liver
- Echinococcosis light
- Multiple hydatid disease of the abdomen and pelvis
- clinical picture echinococcosis
- echinococcosis gallbladder
results of treatment
results of surgical treatment of echinococcosis of the liver depend on many factors and are largely determined by the nature of the disease and the intervention produced the stage.The mortality rate after surgery, according to domestic authors, ranges from 3.5 to 16.2% and is observed mainly in complicated echinococcosis.Operative intervention in the early stages of the disease is now almost not accompanied by deaths.However, in previous years after closed echinococcectomy mortality was observed in 4%, and liver resection - 10% of cases.