Puncture methods of treatment of patients with fluid formations of the pancreas and liver

Abstract

Summary. Diagnosis and treatment fluid formations of the liver and pancreas non-parasitic genesis remains a controversial issue, despite current advances in minimally invasive surgery. The aim of the study is to improve the results of surgical treatment of patients with fluid formations of the liver and pancreas non-parasitic genesis through the integrated use of mini-invasive methods of diagnosis and surgical treatment. Patients were carried out clinical, instrumental, laboratory methods of examination, in the course of which liquid formations were revealed. With the help of ultrasound of the apparatus the liquid structure was elucidated, then dopplerography determined the non-vascular zone for passing the puncture needle. For punctures we used special nozzles on the ultrasonic sensor. The puncture was performed under local anesthesia. Chiba-type needles were used for the puncture, and Pig tail catheters from 6 to 9 F were used for drainage. The timing of the puncture was determined individually, taking into account clinical and sonographic signs, with the average time of drainage of pancreatic cysts being 24 ± 4,3 days, and drainage of liver cysts – 32 ± 1,6 days. Indications for puncture under the control of sonography and laparoscopic treatment were determined. Puncture-draining interventions were performed in 53 patients with non-parasitic liver cysts, of which 30 patients were drained under ultrasound control, and 23 patients underwent video laparoscopic drainage. Also punctuation-drainage interventions were performed in 72 patients with pseudo-pancreatic cysts, of which ultrasonic drainage was performed in 48 patients, 24 patients had video laparoscopic drainage. In the case of puncture treatment of liver cysts and pancreas, narcotic analgesics were not used for pain relief. The postoperative period was more favorable in patients where percutaneous puncture interventions were used. Immediately after percutaneous interventions under ultrasound control and from the second day after videolaparoscopic operations, patients returned to their usual diet and volume of physical activity. Thus, comparing different methods of surgical treatment of non-parasitic fluid formations of the liver and pancreas it was established that application of puncture-draining methods allowed to improve significantly medical and social indices of this group of patients.