COMBINED SURGICAL TREATMENT LIVER ABCESSES IN EXPERIMENT

The results of surgical antibacterial rehabilitation and drainage of liver abscess largely depend on the effectiveness of local action of drugs. A promising direction in experimental liver abscess surgery is the local application of laser and nanotechnology. - The goal is to experimentally substantiate the effectiveness of the combined use of low-intensity laser radiation and copper nanoparticles in the surgical treatment of liver abscesses. Material and methods. In an experiment on 80 laboratory rabbits, a classic liver abscess was modeled. According to the variant of local two-week treatment, the animals were divided into 4 groups of 20 each. Animals of the first group were given daily standard sanitation of the cavity with an antiseptic solution; in the second group, low-intensity laser irradiation was locally administered; animals of the third group, the cavity of the abscess was washed with a suspension of copper nanoparticles; in the fourth group of animals, treatment with a suspension of copper nanoparticles in combination with low-intensity laser irradiation was applied. Clinical, planimetric, microbiological, morphological and instrumental research methods were used to evaluate the results of treatment. Results and discussion. The best clinical indicators of general condition by the 9th day were observed in the treatment of animals of the fourth group. Due to the active stimulation of reparative processes, by the 7th day of treatment of animals of this group, no aspirate cultures from the growth abscess cavity were given, which made it possible to speed up the closure of the purulent cavity, which by the 21st day according to ultrasound planimetry, the abscess cavity of the liver was completely obliterated. Conclusion. Used clinical and instrumental methods of research are effective ways to assess the results of treatment of simulated purulent cavity of the liver. The combined surgical treatment of simulated liver abscesses with topical application of uniformly scattered LLLT and copper nanoparticles provides accelerated cleansing of the abscess cavity causative agent and complete obliteration of the abscess cavity.

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Staged surgical treatment of cholangiogenic abscesses of the liver

Шпитальна хірургія Журнал імені Л Я Ковальчука ◽

10.11603/2414-4533.2020.1.10731 ◽

2020 ◽

pp. 20-23

Author(s):

V. V. Boyko ◽

V. M. Lykhman ◽

D. A. Miroshnichenko ◽

A. A. Merkulov ◽

S. V. Tkach ◽

...

Keyword(s):

Surgical Treatment ◽

Minimally Invasive ◽

Postoperative Mortality ◽

Treatment Method ◽

Stage Ii ◽

Abscess Cavity ◽

Controlled Drainage ◽

Results Of Treatment ◽

Liver Abscesses ◽

Single Lumen

The aim of the work: to improve the results of treatment of patients with cholangiogenic liver abscesses by means of staged treatment methods using minimally invasive interventions. Materials and Methods. 82 patients with cholangiogenic liver abscesses aged 21 to 80 years who underwent 130 operations were examined and treated. The main group consisted of 40 (48.4 %) patients who underwent ultrasound-controlled drainage of abscess cavities (stage I), followed by removal of the source of cholangiogenic abscesses (stage II). The comparison group consisted of 42 (51.6 %) patients who underwent rehabilitation and drainage only with laparotomy access. Results and Discussion. Minimally invasive methods of surgical treatment included ultrasound-controlled drainage with simultaneous rehabilitation of abscess cavities. The dimensions of the cavities averaged (150±23.3) cm³. One drainage was used to drain the liver abscess with a diameter of up to 10.0 cm. When the diameter of the abscess was more than 5.0 cm, drainage was carried out by two single-lumen tubes followed by suction-flow washing of the abscess cavity. Monitoring the standing of the drainage and reducing the cavity of abscesses was carried out on 3, 7, 14 days after setting. The drainage tube was removed after the disappearance of the cavity according to ultrasound and control fistulography, which coincided with the normalization of the general condition and body temperature, the disappearance of signs of purulent intoxication. Duration of drainage averaged from 7 to 30 days (an average of 15.2). The proposed treatment method is not very traumatic, the ability to control the effectiveness of the treatment, and most importantly – positive results in 87 % of patients. Second stage in 38 (95 %) was performed laparoscopic cholecystectomy of technical features. The optimal duration of stage II was considered (13±3) days after extraction of the drainage. In the diagnosis and treatment of cholangiogenic liver abscesses, it is necessary to use puncture ultrasound-controlled drainage methods. The stage-by-stage treatment of cholangiogenic liver abscesses with rehabilitation of the abscess cavity made it possible to reduce the incidence of sepsis from 9.5 to 2.5 %, reduce postoperative mortality in extremely severe patients to 2.4 %, and develop complications by 7.3 %.

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