ALGORITHM OF SURGICAL TREATMENT LIVER ABSCESSES

Abstract

Abstract. Algorithm of surgical treatment of liver abscesses. V.G. Yareshko, V.V. Novak.at. For the period 2014-2023 analyzed the results of treatment of 80 patients with liver abscesses. Among the possible causes were hypothermia, pneumonia of the basal departments. However, in most cases the etiological factors were not established. Bacterial liver abscesses of various localization were the inclusion criteria for the study, and cholangiogenic and specific abscesses were excluded. In the examination of patients, generally accepted laboratory analyzes were used, which were supplemented with markers of the systemic inflammatory response (procalcitonin, C-reactive protein, alkaline phosphatase). Microbiological studies of the species composition of pathogens and their sensitivity to antibiotics were carried out in all patients during the period of the disease. Ultrasound examination (USD), computed tomography (CT), radiological methods were used to varying degrees in the medical and diagnostic process. On the basis of the developed ultrasound criteria for the stages of the formation of liver abscesses, an algorithm for the diagnosis and treatment of abscesses is proposed using the advantages and disadvantages of one or another surgical technique. As a result of the conducted studies, the IS was determined to be the leading one, which was used in 50 (68.7%) patients of both groups. Computed tomography was performed exclusively for differential diagnosis in the preoperative period in 27 (13.8%) patients. The main factors in choosing the method of surgery were the localization of the purulent center and its size, the stage of destruction, the general assessment of the severity of the patient’s condition. In 90% of patients, the general condition was assessed as moderate and severe. Abscesses were, as a rule, single and localized in almost all parts of the liver with possible damage from one to three segments. The proposed algorithm of surgical treatment is based on ultrasound characteristics of abscesses and the stage of their formation. Morphological changes in the abscess zone in the initial stages of the disease are insignificant and require the experience of the researcher with a mandatory assessment of the general condition of the patient and the characteristics of the symptoms of the purulent process. Sonograms of stage 1 liver abscesses (11,25% of patients) are characterized by an area of increased echogenicity without clear borders and the absence of destructive changes. The second stage (6,25% of patients) is manifested by an area of heterogeneous structure, when liquid inclusions appear against the background of a hypoechoic formation, sometimes of a confluent nature with unclear boundaries of capsule areas up to 2.0 mm. Ultrasound manifestations of the first two stages are difficult for differential diagnosis and may require a CT scan. The third stage (12.5% of patients) is characterized by ultrasound manifestations of a liquid formation and, most importantly, an unexpressed capsule of increased echogenicity in the size of 3-5 mm. The abscess of the fourth stage (18.8% of patients) is characterized, first of all, by a clear capsule of 5.0 mm or more with a liquid component of heterogeneous composition, sometimes with hyperechoic inclusions. The developed ultrasound criteria for the stages of the formation of a purulent center formed the basis of the algorithm for choosing the method of surgery for liver abscesses.