THE CHOICE OF TREATMENT FOR LIVER ABSCESSES
Summary. Improving the results of treatment in patients with liver abscesses by treatment using minimally invasive interventions.
Materials and methods. We examined and treated 87 patients with liver abscesses aged 21 to 80 years. Of these, 82 patients underwent 102 surgeries. Abscess drainage was performed 95 times in 82 patients in four ways: under ultrasound guidance — to 45 (54.88 %) patients, laparoscopic - to 20 (24.4 %), under the control by angiography — 2 (2.44 %) and laparotomic access — 15 (18.28 %) to patients. 7 patients underwent resection operations.
Results. So, in our analysis of the clinical picture of liver abscesses, specific symptoms were not noted. Therefore, the combination of the results of ultrasound and CT (the sensitivity of which was 98 % and 100 %, respectively) was decisive in the diagnosis and differential diagnosis of liver formations. Most often strains were sown from the abscess cavity E. coli and Kl. Pneumoniae in 43.91 % of cases. A positive effect was noted after the first minimally invasive intervention occurred in 76 (92.68 %) patients. In operated patients with laparotomic access, the main indications were, first of all: the inefficiency of external drainage under ultrasound control or the inability to use the puncture drainage method itself due to the localization of the abscess; the presence of concomitant surgical pathology, which requires surgical treatment, choledocholithiasis with complications, peritonitis
Conclusions. The main task in the treatment of purulent diseases of the hepatobiliary system is the decompression and rehabilitation of the biliary tract, further antibiotic therapy, taking into account sensitivity with the active use of ultrasound-controlled drainage methods. Laparoscopic and open interventions are indicated for multiple and giant multi-chamber abscesses.
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