RU2675778C1 - Method of combined treatment of large multichamber pyogenic abscesses of the liver - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine and may be applicable for the combined treatment of large multichamber pyogenic abscesses of the liver. Percutaneous transhepatic puncture and drainage of liver abscess under ultrasound and X-ray television navigation through the shortest drainage path is performed using a stylet catheter with a diameter of 7 to 14 Fr, followed by evacuation of the exudate, then using a needle electrode with a length of 10 to 25 cm with a working part length of 2 to 4 cm, liver abscess puncture is performed followed by radiofrequency thermoablation for 15 minutes, reaching temperature in the focus after exposure in the range from 70 to 100 degrees Celsius.EFFECT: method allows to minimize the operating trauma, to create optimal conditions for the rehabilitation of the source of infection.1 cl, 1 ex, 6 dwg

Description

The invention relates to medicine, namely to surgery, can be used to provide a pronounced bactericidal effect and the formation of a single cavity in patients with large multi-chamber pyogenic liver abscesses in order to create optimal conditions for adequate rehabilitation of the focus of surgical infection.

Liver abscess is a rare and dangerous disease, accompanied without adequate treatment by a large number of complications. According to the summary data, the incidence of liver abscesses varies from 8 to 15 cases per 100 thousand people per year, mortality ranges from 5 to 26%, and with the development of complications it doubles. Diagnosis and treatment of this pathology remains one of the urgent and complex issues of modern surgical hepatology (Liu Y., Wang JY, Jiang W., 2013; Lubbert C., Wiegand J., Karlas T., 2014; Ferraioli G., Garlaschelli A. , Zanaboni D. et al., 2008).

For a long time, the main method of treating liver abscesses was the opening and drainage of the abscess cavity through a traumatic laparotomic approach. According to some authors, the use of percutaneous drainage in the treatment of multiple liver abscesses is less effective compared to the open surgical method. In research Pitt N.A. mortality is shown, which when using minimally invasive methods of surgical debridement of multiple liver abscesses was 26%, and with open methods of treatment - 14% (Huang C.-J., Pitt N.A., Lipsett R.A., 1996)

A number of researchers believe that open, including resection methods for treating liver abscesses are more effective in comparison with minimally invasive interventions. The authors consider the indications for surgery complicated forms of liver abscesses (arrosive bleeding into the abscess cavity, an abscess break into the abdominal cavity), a long-term multi-chamber abscess with a rigid capsule and the presence of large sequesters, the absence of the effect of puncture-draining techniques, and a high risk of damage to internal organs or vessels entering the percutaneous surgical intervention (Yareshko V.G., 2014; Tan L., 2013) Other authors believe that open surgical drainage is indicated for patients diagnosed with concomitant intra-abdominal pathology requiring surgical treatment (Hsieh H.F., Chen T.W., Yu C.Y., 2008; Rahimian J., 2004 ;, Siu L.K., Yeh K.M., Lin J.C., 2012; Yu S.C., Ho S.S., Lau W.Y., 2004).

According to some authors, the advantages of an open surgical method for treating intrahepatic abscesses are adequate sanitation and drainage of the abscess cavity, the possibility of revising the abdominal organs to identify and eliminate the primary source of surgical infection, as well as the possibility of performing intraoperative biopsy in patients with decay and suppuration of a liver tumor or tumor damage to the hepatopancreatobiliary zone. Despite the above advantages, mortality reaches 20-30%, (Gostishchev V.K., Khrupky V.I., Afanasyev A.N., 2008; Tsereteli I.Yu., Akhaladze G.G., Halperin E.I., 2004).

Of particular difficulty for treatment are multiple large multi-chamber pyogenic liver abscesses. Despite its large size, the multi-chamber structure often makes transdermal puncture-draining technologies ineffective (Halperin E.I., Vetshev P.S., 2009; Meyers W.C., Kim R.D., 2001).

The purpose of introducing the new technique is to minimize operational trauma due to the first performed percutaneous radiofrequency ablation (RFA) of large multi-chamber pyogenic liver abscesses, which leads to a pronounced bactericidal effect and the formation of a single cavity in order to create optimal conditions for adequate rehabilitation of the site of surgical infection.

The developed technique has led to an improvement in the treatment of patients with large multi-chamber pyogenic liver abscesses, their early activation, a decrease in the length of hospital stay and treatment costs.

The solution to this problem is provided by the fact that the method of combined treatment of large multi-chamber pyogenic liver abscesses is performed as follows. Under intravenous anesthesia, percutaneous transhepatic puncture and drainage of the liver abscess are performed under ultrasonic and X-ray television navigation along the shortest drainage path with a stylet-catheter with a diameter of 7 to 14 Fr followed by evacuation of the exudate, then using a needle electrode from 10 to 25 cm long with a length of the working part from 2 to 4 cm, a liver abscess is punctured, followed by its radiofrequency thermoablation for 15 minutes with reaching the temperature in the focus after exposure in the range of t 70 to 100 degrees Celsius.

The invention is illustrated in FIG. 1-6. In FIG. 1 shows a system for radiofrequency ablation of Cool-tip Valleylab (USA). In FIG. 2 shows a needle tip of a Cool-tip Covidien (USA). In FIG. Figure 3 shows the stage of percutaneous transhepatic radiofrequency ablation of a liver abscess after its puncture and drainage. In FIG. 4 shows an ultrasonogram of radiofrequency ablation of a liver abscess. In FIG. Figure 5 shows computed tomograms of a large multi-chamber liver abscess before radiofrequency ablation (indicated by an arrow). In FIG. Figure 6 shows the magnetic resonance imaging of a liver abscess after radiofrequency ablation and the creation of a single cavity (indicated by an arrow).

The method is as follows. Under intravenous anesthesia in the operating room with the observance of aseptic and antiseptic rules, percutaneous transhepatic puncture and drainage of the liver abscess under ultrasound and X-ray television navigation along the shortest drainage path with a stylet-catheter of various diameters followed by evacuation of the exudate are performed (Figs. 3, 4). The second step, using the Cool-tip Valleyiab Covidien system for radiofrequency ablation (USA) (Fig. 1), using a needle electrode (Fig. 2) 10 to 25 cm long with a working part length of 2 to 4 cm, liver abscess is punctured with its subsequent radiofrequency thermal ablation for 15 minutes with reaching the temperature in the outbreak after exposure in the range from 70 to 100 degrees Celsius.

The main indications for percutaneous transhepatic radiofrequency ablation were considered to be the presence of a large multi-chamber pyogenic liver abscess, a recurring course of the disease and the ineffectiveness of repeated minimally invasive surgical puncture-draining interventions. A contraindication to this surgical intervention was the subcapsular location of the liver abscess and the presence of an artificial pacemaker in the patient.

Clinical example.

Patient B., 46 years old, was hospitalized with complaints of severe general weakness, fever up to 38.5 degrees Celsius in the evening, constant moderate pain in the right hypochondrium. When multiphase computed tomography (MSCT) revealed a large multi-chamber abscess of the right lobe of the liver with dimensions of 85.2 × 76.2 mm (Fig. 5). The patient underwent percutaneous transhepatic drainage of the liver abscess under ultrasound and X-ray television navigation (Fig. 3, 4), as well as radiofrequency thermal ablation of the abscess of the right lobe of the liver. When MRI performed on the 2nd day after surgery (Fig. 6), a single cavity of the liver abscess (indicated by an arrow) is formed, in the lumen of which a stylet-catheter is installed. After surgery, a permanent laboratory and microbiological control was carried out. Syndrome of the systemic inflammatory response was stopped on the 2nd day, drainage was removed on the 7th day. In the control MSCT, the liver abscess was sanitized. The patient was discharged in satisfactory condition on the 9th day.

Claims (1)

A method for the combined treatment of large multi-chamber pyogenic liver abscesses, characterized in that, under intravenous anesthesia, percutaneous transhepatic puncture and drainage of the liver abscess are performed under ultrasound and X-ray television along the shortest drainage path with a stylet catheter with a diameter of 7 to 14 Fr followed by evacuation of exudate, followed by using a needle electrode with a length of 10 to 25 cm with a working part length of 2 to 4 cm, a liver abscess is punctured, followed by its radio -frequency thermoablation for 15 minutes with the temperature reaching the hearth after exposure in the range from 70 to 100 degrees Celsius.

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