A method of surgical treatment of hydatid liver
(57) Abstract:The invention relates to medicine, in particular to surgery, and can be used for the surgical treatment of hepatic echinococcosis. For 1-3 days prior to laparoscopic surgeries performed percutaneous perhepatic puncture if Echinococcus cyst with a needle-catheter. Under ultrasound control conducts a full aspiration gidridnoi fluid. Then in the cyst impose adequate volume mixture of water glycerol concentration more than 80% and 0.5-1% of the radiopaque means of the input. Conduct x-ray control on the lack of communication of the cavity with the bile ducts and the abdominal cavity. After 8-10 minutes of exposure check the fluid in the absence of live parasites. After complete destruction of the needle removed. The method reduces the risk of contamination of the abdominal cavity of the embryonic elements of Echinococcus. This increases the efficiency of treatment of patients. The invention relates to medicine, in particular to hepatobilary.There is a method of surgical treatment of hydatid liver, which is a wide incision of the anterior abdominal wall, often dvuhpolyarnyy ("Mercedes"). Is mobilization of the liver with a list of the cyst with the removal gidridnoi fluid, treatment of a cavity of the cyst formalin solution or sodium chloride, followed by removal of the chitinous shell of the parasite and the technical capabilities of the fibrous capsule of the cyst. With a deep location if Echinococcus cysts perform the dissection of the liver tissue with subsequent echinococcectomy, or deletes to the left or right lobe of the liver together with if Echinococcus cyst (M. S. Gilevich. Diagnosis and surgical treatment of echinococcosis. Diss.Doc.the honey.Sciences., M., 1987, S. 295).Rarely (no more than 7-12% of cases) possible ideal echinococcectomy, when it is possible without opening the cyst to remove it together with the fibrous capsule.The disadvantages of this method is the high invasiveness, i.e. the need for extensive dissection of the abdominal cavity with the crossroads of almost all groups of muscles of the anterior abdominal wall. At small sizes, more if Echinococcus cysts, located in the heart of the liver parenchyma, often the last available intraoperative palpation, which leads to non-radical treatment, and patients have to deal with again. In addition, operation at globalresortagency cysts of the liver require cuts of the liver parenchyma, which is fraught with the risk of bolchini leads to disability of patients. It is impossible not to take into account that it is extremely postoperative period and long enough subsequent rehabilitation of patients. A significant disadvantage of this method is also the danger of contamination of the abdominal cavity at the opening of the cyst during surgery, in 8-22% of the observations leads to recurrence of the disease.Also known percutaneous method of treatment if Echinococcus cysts by percutaneous drainage and extraction of chitin shell through a set of special tools (patent RU 2140213 WITH, IPC And 61 In 17/00, 1999). Is percutaneous puncture or drainage if Echinococcus cyst of the liver under the control of ultrasound. For antiparasitic treatment of cysts is used 30-86% glycerol solution with a 1% solution Dimedrol in the ratio of 150: 1 with the exposition of germicide 3-10 minutes. After this special bogami expand the puncture channel through which removes the chitinous shell of the cyst, leaving in the subsequent thin drainage for closing the cavity.This method involves longer periods of inpatient treatment due to a prolonged period closing residual cavities. A significant drawback of the methodology is developed. The use of glycerol in a concentration of less than 80% will not reliably cause the death of all germinal elements Echinococcus, which can lead to recurrence of the infestation. Add in germicide other drugs (diphenhydramine and so on) leads to an additional reduction of concentration and possible chemical relationship solutions, resulting in lower protivochesotocnaya properties of glycerin.In recent years, also proposed laparoscopic echinococcectomy that includes the following steps (Khamidov, M. A., Emelianov S. I. Endovideosurgery heatedly cysts and residual cavities of the liver when the liver echinococcosis. Endoscopic surgery, 1, 2000, S. 13-15). First, perform a review laparoscopy, in which the precise localization of cysts in the liver. Then spend the restriction zone operations wipes moistened with anti-parasitic drugs (solutions of sodium chloride or glycerol, etc). After that cysts the dotted line and evacuate their contents. Perform antiparasitic treatment of the walls of the cysts by introducing into the cavity germicidal solutions, after which the fibrous capsule open and evacuate the contents of the cysts in endcontainer. Inspect the cyst wall and perform (if technical is I great danger of contamination of the germinal elements of the parasite of the abdominal cavity in the intraoperative cyst puncture. The reasons lie in the pressure in the cavity of the cyst on the background of a busy pneumoperitoneum (12-14 mm RT.CT.) or not always possible puncture of the cyst through the liver tissue.The objective of the proposed invention is the increase in the radical treatment by eliminating contamination of the abdominal cavity of the embryonic elements of Echinococcus, a reduction in the morbidity intervention and disability of patients in connection with organoboranes the nature of the operation, reducing intra - and postoperative complications due to the possibility of inspection of the walls of the cyst with suturing revealed biliary fistula. All this ultimately increases the quality of life of patients.This task is solved in that conducts a full aspiration gidridnoi fluid, then into the cavity of the cyst impose adequate volume mixture of water glycerol concentration more than 80% and 0.5-1% of a radiopaque contrast agent from the volume injected glycerin, conduct x-ray control on the lack of communication of the cavity with the bile ducts and the abdominal cavity, after 8-10 minutes of exposure check the fluid in the absence of live parasites, if necessary, repeat procedure, the needle is removed and after 1-3 days spend laparoscopically.tramadol apparatus determines the optimal trajectory injection puncture instrument which passes through the maximum thickness of the parenchyma of the liver and eliminates the holding tool through the pleural sinus and vascular-secretory trunks liver. Access if Echinococcus cyst performed by percutaneous insertion of the needle under constant ultrasound monitoring. After entering the cyst removed the rod from the stiletto and through the needle to produce a full aspiration gidridnoi fluid. Adequately obtained volume in the cavity of the cyst inject a mixture of water-glycerine more than 80% and 0,5-1,0% radiopaque drug from the volume injected glycerin. Then, fully aspiritual entered germicide, and the resulting liquid is subjected to microscopy. Microscopy allows to verify the total loss of germinal elements of the parasite. Otherwise, repeat the treatment cavity germicidal. X-ray television control allows to detect the presence of oral communication of the cyst with biliary ducts. After the total loss of germinal elements of the parasite needle is removed. In a further 1-3 days conduct laparoscopic cyst removal. A longer period between percutaneous and laparoscopic stages not feasible due to possible changes in topical location of the cyst is filled laparoscopic echinococcectomy, in addition to the traditional tools used five retractor and vacuum aspirator with removable five - and desyatimillimetrovogo nozzles. Trocar for holding the laparoscope is introduced above the navel. After inspection and Refine the localization of the cysts determine the point of introduction, the number and diameter of the other trocars. Opening the cyst is carried out at a point of the greatest of her bulging above the surface of the liver. Aspiritual liquid contents. The chitinous shell of the cyst is removed through a 10 mm nozzle vacuum aspirator, which allows to avoid possible contact chitin shell with intact surrounding tissues when immersed her in endcontainer. Perform the maximum possible pericystectomy. At the same time preserve a small area (0.5-1.0 cm) cyst wall on the border with unmodified tissue of the liver, which serves for fixing the strands of the greater omentum with omentoplasty or capitonnage the residual cavity of the cyst. The remaining walls of the fibrous capsule is carefully examined with the help of a laparoscope. When detecting biliary fistula last sutured or perform their coagulation. Make the elimination of the residual cavity one of the known methods used in both traditional and at laparosc is dependent on their size.Specific clinical examples of the implementation of the proposed method.Sick of Idrisova M. A., 16 years old, medical history, 4257, was in PHC with 07.02.2000 on 07.03.2000, with a diagnosis of echinococcosis of the liver, a giant if Echinococcus cyst of the right lobe of the liver, solitary if Echinococcus cyst of the left lobe of the liver.Complaints received at a periodic drawing pain in the right hypochondrium, the increase in the size of the volume of the stomach.Sick since October 1999, when he noted the increase in size of the abdomen and dense tumor formation in the right hypochondrium. In December 1999 when the ultrasound revealed a cystic masses in both lobes of the liver. Serological test for echinococcosis positive. For further examination and treatment of the patient was received in FHC.When you receive a state closer to satisfactory. Skin and visible mucous regular color. Peripheral lymph nodes are not enlarged. The rib cage is somewhat skewed due to the right half, in the act of breathing both halves participate symmetrically. The heart rate of 78 beats per minute, rhythmic. AD= 100/70 mm RT.article Tongue moist, coated brownish tinge at the base. Abdomen rounded, enlarged excessively wybuchowego under p is boleznennyj in the right hypochondrium, there is defined granulomas, rounded, painful, sedentary education, photoelasticity consistency, more than 20 cm in diameter, reaching the borders mathimagery. Spleen not palpated. Chair regular, decorated, without pathological impurities.When examining changes in blood and urine tests within normal limits.In ultrasound, CT - in the right lobe of the liver cyst size 245187145 mm, occupying almost all subphrenic space, due to which the liver is displaced to the left and down, in the left lobe of the liver is determined by the second cyst mm.The first stage 26.02.2000 was performed percutaneous perhepatic drainage giant if Echinococcus cyst of the right lobe of the liver. Evacuated 4.0 liters gidridnoi fluid. The cyst treated 3980 g 87% aqueous solution of glycerol with addition of 20 g of Oxilan (radiopaque drug). When the x-ray television communication control cavity with the bile ducts of the liver, the free abdominal cavity is not received. After 10 minutes of exposure glycerin aspirated, the material is subjected to microscopy. All of the germinal elements of Echinococcus in the stage of death. The needle is removed. Analogically to puncture and processing the definition of echinococcectomy cysts with partial pericystectomy. Trocar for holding the laparoscope is introduced above the navel imposed pneumoperitoneum. After inspection and Refine the localization of the cysts introduced the other two 10 mm and one 5 mm trocars. A cyst of the right lobe of the liver revealed at the point of greatest bulging above the surface of the liver. Aspirated liquid contents. Chitin shell removed through a 10 mm nozzle vacuum aspirator. Performed pericystectomy 2/3. Performed a thorough inspection of the remaining walls of the cyst, biliary fistula was not detected. Similarly processed and removed a cyst of the left lobe of the liver. The residual cavity cysts Packed strands greater omentum. The trocars are removed. Layer-by-layer suturing wounds.The postoperative period was uneventful. When the control ultrasound in the projection 7-8 segments of the liver was preserved residual cavity dimensions 56 see On the 8th day after surgery in satisfactory condition the patient was transferred in 24 CCH for carrying out a course of antiparasitic therapy. During follow-up by the end of 6 months after the operation, the residual cavity in the liver was not detected. After 13 months after surgery serological test for echinococcosis negative, the patient was withdrawn from the account.Performed minimally invasive species is the liver, to avoid traumatic wide cut and remove part of the body.The method according to the invention was used in 28 patients, none of the observations was noted to have disease recurrence.Thus, the method according to the invention allows simultaneously with melodramatically operations and the ability of the patient's behavior in the first days after surgery to remove if Echinococcus cyst of the liver, to increase the efficacy of treatment and significantly improve the quality of life of patients. A method of surgical treatment of hepatic echinococcosis, including laparoscopic removal of cysts and pericystectomy, characterized in that for 1-3 days prior to laparoscopic surgeries performed percutaneous perhepatic puncture if Echinococcus cyst of the liver with a needle-catheter under ultrasound guidance, conducts a full aspiration gidridnoi fluid, then into the cavity of the cyst impose adequate volume mixture of water glycerol concentration more than 80% and 0.5-1% of the radiopaque means of the input, conduct x-ray control on the lack of communication of the cavity with the bile ducts and the abdominal cavity, after 8-10 minutes of exposure check the fluid in the absence of live parasites, after the
SUBSTANCE: method involves applying one or two parallel through draining tubes having lateral perforations. Flow lavage of the retroperitoneal space with antiseptic solutions is carried out via the perforations at room temperature and cooled solutions are administered concurrently with vacuum suction. Omental bursa is concurrently drained using the two parallel through draining tubes. Flow lavage of the omental bursa is carried out using these tubes.
EFFECT: enhanced effectiveness of treatment in healing pyo-inflammation foci.
5 cl, 1 dwg