RU2485907C1 - Method of treating non-parasitic cysts of liver - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine and can be applied for treatment of non-parasitic cysts of liver. Cyst cavity is processed by means of radio-frequency destruction with application of generator of high-frequency currents in minimal mode with heating epithelial lining of cysts cavity to 45°-55°C. Electrode is removed step-by-step, step being equal 1.5 cm.

EFFECT: method makes it possible to reduce risk of hemorrhagic complications, reduce risk of recurrence.

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Description

The invention relates to medicine, namely surgery, and can be used to treat patients with non-parasitic liver cysts in a surgical hospital.

There is a method of puncture treatment of a non-parasitic liver cyst with aspiration of its contents and carrying out sclerotherapy (MN Novikova Percutaneous targeted diagnostic and therapeutic puncture of focal liver formations under the control of ultrasound imaging: Author. Diss. Candidate of Medical Sciences - Kiev, 1986, 21 sec. .), which consists in performing a puncture of the cyst cavity under the control of ultrasound, removing its contents, introducing 96% ethanol into the residual cavity of the sclerosing solution, in a volume of up to 1/3 of the evacuated volume. The exposure time of the sclerosant is 5-10 minutes, then the sclerosing solution is aspirated. The mechanism of sclerotherapy is based on the chemical effect of the sclerosant solution on the epithelial lining of the cyst cavity, causing cicatricial changes and obliteration of its cavity.

The disadvantages of the method: for large-sized non-parasitic liver cysts with a diameter of more than seven centimeters, puncture methods of treatment are ineffective, since there is no complete treatment of all the walls of the cavity with a sclerosant solution, and, as a result, the residual cavity remains in the liver parenchyma, which causes cyst relapse. In addition, bleeding into the abdominal cavity or cystic cavity is possible from the puncture channel.

A known method of laparoscopic treatment of non-parasitic liver cysts (US Pat. RU 2402982 11/10/2010). The method consists in puncture of the cyst, aspiration of its contents, de-epithelialization of the cyst walls, excision of the protruding walls. De-epithelialization of the cyst walls is carried out by plasma flow at a current strength of 15-30 A, argon working gas flow rate from 0.8 to 1.5 l / min, from a distance of 5-10 mm from the cyst wall for 1-3 minutes, until a whitish color appears the inner wall of the cyst. Excision of the protruding wall of the cyst is carried out with a plasma scalpel with a current strength of 20-40 A, with an argon working gas flow of 1-2.5 l / min, from a distance of 2-3 mm. The disadvantages of the method: the method requires intracavitary intervention, the use of endotracheal anesthesia, allows you to treat only subcapsular cysts.

The purpose of the invention is the development of a method for the treatment of non-parasitic liver cysts, which helps prevent hemorrhagic complications and relapses of the cyst after puncture treatment.

The goal is achieved by radiofrequency exposure of the epithelial lining of the cyst cavity and coagulation of the puncture channel.

For radiofrequency treatment of the cyst cavity, a needle electrode and a Cool Tip high-frequency current generator manufactured by Radionix (USA) are used. In clinical practice, the generator is designed for radiofrequency ablation of primary and metastatic liver tumors.

The method is as follows. In the operating room after processing the surgical field, local infiltration anesthesia with a solution of novocaine 0.5% - 40 ml is performed; a skin incision is performed at the site of the most optimal acoustic access: epigastrium - with localization of the cyst in 2-3 segments of the liver, right hypochondrium - with localization of the cyst in 4-5-partially in 6 segments of the liver, or 7-8-9 intercostal space - with localization of the cyst in 6-7 segments of the liver. Under the control of ultrasound, a needle electrode is inserted to conduct radio frequency destruction with a maximum working surface of up to 4 cm. The electrode is positioned in the cavity of the cyst. Then the cyst is punctured with a puncture needle with an inner diameter of 18G. On the needle, the contents of the cyst are completely aspirated, sent for rapid cytological and biochemical studies. The puncture needle is removed. A radiofrequency destruction of the cyst cavity is performed - the high-frequency current generator is turned on in the minimum mode - the epithelial lining of the cyst cavity is heated to 45 ° -55 ° C. Subsequently, the electrode is removed step by step with a step length of up to 1.5 cm; coagulation of the puncture channel occurs as it is extracted, which helps prevent intraperitoneal bleeding and bleeding into the cyst cavity. An aseptic sticker is applied to the incision site.

Clinical example. Patient L., 57 years old, medical history N 9859, was admitted on August 19, 2009 in a planned manner with a diagnosis of liver cyst. According to ultrasound data dated 08/20/2009, an anechogenic mass, a non-parasitic cyst 88 × 70 mm in size, is located in the posterior-diaphragmatic sections of the right lobe of the liver. The patient is prepared for minimally invasive treatment of non-parasitic liver cysts. On August 20, 2009, under local anesthesia, under the control of ultrasound, a needle electrode with a working surface of 3 cm was installed in the cyst cavity. A cyst cavity was punctured from a 5 mm incision with a 18 G needle, and up to 60 ml of clear fluid was removed from the needle. The fluid is aimed at cytological examination. The needle is removed. Under neuroleptanalgesia, a radiofrequency treatment session was performed on the cyst cavity. After the intervention, the patient's condition is stable, there is no pain. During the control ultrasound scan dated August 25, 2009: in the posterior-diaphragmatic parts of the right lobe of the liver at the site of the cyst, a zone of reduced echogenicity is 54 × 36 mm. In blood tests, there is no pathology. Discharged in satisfactory condition on August 26, 2009. With a control ultrasound 12 months after a puncture in 7-8 segments of the right lobe of the liver, a hyperechoic formation of a spindle-shaped 38 × 14 mm is located in the projection of the cyst. Along the edges of the formation, an unchanged parenchyma.

According to the described method, 27 patients with non-parasitic cysts were treated with good immediate and long-term results. The method is easy to perform, less traumatic. In patients for whom surgical intervention is contraindicated, the described method is the only possible.

Thus, our proposed method, in contrast to the known ones, is performed by percutaneous access using local anesthesia and sedatives, which is more favorable for the patient. Using our proposed method, it is possible to treat not only subcapsular, but also intrahepatic nonparasitic cysts. The method does not require excision of the walls of the cyst, de-epithelization and "bonding" of the cavity of the cyst causes a high-temperature effect created by the electrode.

Claims (1)

A method of treating non-parasitic liver cysts by puncture of the cavity, aspiration of the contents of the cyst, treatment of the cyst cavity, characterized in that the treatment of the cyst cavity is carried out using radio frequency destruction using a high-frequency current generator in a minimum mode with heating the epithelial lining of the cyst cavity to 45 ° -55 ° FROM; the electrode is removed step by step, with a step length of up to 1.5 cm.