MINIINVASIVE TECHNIQUES IN TREATMENT OF NONPARASITIC HEPATIC CYSTS

Aim. To improve the results of treatment of patients with nonparasitic hepatic cysts and to determine optimal treatment technique depending on concomitant pathology, terms of hospitalization, number of relapses and postoperative complications. Materials and methods. Experience of complex examination and treatment of 175 patients with nonparasitic hepatic cysts for the period of 1999-2012 was analyzed. Depending on treatment tactics, patients were divided into 3 groups. Group 1 consisted of 50 patients who underwent open operations, 54 patients of group 2 experienced laparascopic fenestration of cysts with diepithelization of internal lining using diathermic coagulation and 98% ethanol treatment, 71 patient of group 3 underwent transcutaneous puncture and 96% ethanol hepatic cyst sclerosing under ultrasound control. Results. Mininvasive techniques were used for treatment of 125 (71,4%) patients. Postoperative complications in group 1 were noted in 11 (22%) patients that increased the time of hospital treatment and was accompanied by essential economic losses. In patients of group 2, relapse of cysts requiring transcutaneous puncture and 96% ethanol sclerosing was detected in 5 (9,3%) observations 5-12 months after the surgery. In one case the postoperative toxic hepatitis was diagnosed that needed conservative hepatoprotective therapy. Full cyst obliteration in group 3 was reached in 32 (45,1%) patients and 8 patients (11,3%) had no complaints but preserved small-volume cysts that allows to draw a conclusion about the reached clinical effect. The terms of hospital stay in patients of group 1 were 14,7±5,5 days, group 2 – 7,1±3,8 days, group 3 – 4,6±2,7 days. Conclusion. Patients with nonparasitic hepatic cysts <50 mm in diameter without any signs of compression of adjoining organs and disturbance of basic liver functions should be dynamically observed (USI of liver) every 8–12 months. Active treatment tactics for prevention and elimination of complications is indicated to patients with cysts >50 mm in diameter. Taking into account benign character of nonparasitic hepatic cysts, low probability of their malignization and hepatic function disturbance, preference should be given to miniinvasive techniques (laparoscopic, puncture) which do not yield to open operations by their efficiency, but are accompanied by less number of complications and shorter time of hospitalization.

Liver, nonparasitic hepatic cysts, laparoscopic fenestration, puncture and aspiration