New approaches to the treatment of liver echinococcosis
Science Articles / / May 13, 2016
Chernyshov VN, Panfilov KL, Bogdanov, VE
Samara State Medical University
Regional Clinical Hospital.MIKalinin Samara
Echinococcosis of the liver is one of the urgent problems of surgery.This is due to the fact that the incidence of echinococcosis tends not to decrease.
Currently, surgical treatment of echinococcosis of the liver, in most cases, there is no alternative.However, surgery is a risk factor, which is determined by a number of reasons: the patient's condition, localization of foci of parasitic, number of previous operations.Mortality in the first, second and third surgery in recurrent throughout echinococcosis liver comes to 2.6%, 6.0% and 20%, respectively.Radical surgical treatment of traditional methods are not possible in all patients.There is a need for the development of optimal algorithms of early diagnosis of echinococcosis and improving ways to prevent recurrence of the disease, reducing the trauma of operations and the prevention of postoperative complications.
Despite the large number of proposed methods for the elimination of residual cavities after echinococcectomy, festering in the postoperative period is 20%.This indicates that all types used operations are still far from perfect.
One promising area is the treatment of liver echinococcosis minimally invasive technology.For one of these therapies include percutaneous puncture technique hydatid cysts.This method has long been considered dangerous because of the possibility of contamination of the abdominal cavity protoskoleksami parasite after a puncture.However, with the development of technologies was made possible maloiivazivnyh puncturing and drainage of hydatid cyst under ultrasound guidance.This technique is called PAIR (puncture, aspiration, injection, reaspiratsiya).
since 2002. We observed 30 patients undergoing treatment for puncture.In 17 patients had primary hydatid disease of the liver, 13 relapsing.The age of patients ranged from 17 to 70 years.Most often localized in cysts VII, VIII segments.
ehooperatsionnoy The conditions under ultrasound cyst was punctured by a special needle and drainages.After aspiration was performed puncture and administering the contents of 20-30% of a hypertonic sodium chloride solution or 96% ethanol.After a 10 minute exposure was conducted reaspiratsiya fluid and cyst contents.In 28 patients with drainage of the cyst was performed, only two patients puncturing.Manipulation is performed under intravenous anesthesia.
treatment is implemented via fistulography and ultrasound examination of the liver, held immediately after the procedure in order to identify tsistobiliarnyh fistula and 1.5 - 2 months after the puncture and drainage.The criterion of effectiveness of the treatment was the obliteration and hardening of the cysts.
Thus, the first experience of using PAIR-method allows to consider it a viable alternative to conventional surgical treatment of liver echinococcosis.Improving technology puncture and drainage of cysts, gives results comparable to conventional treatments.The technology meets all modern requirements: Minimally invasive, organ, easily tolerated by patients, reducing the time of rehabilitation, mortality is reduced to zero.