SCIENCE AND INNOVATION IN THE
EDUCATION SYSTEM
International scientific-online conference
31
MODERN ASPECTS OF THE TREATMENT OF PATIENTS WITH
LIVER ABSCESSES
Yakhshiboev S.S.
Babadjanov A.R.
Urgench Branch of Tashkent Medical Academy, Urgench, Uzbekistan
https://doi.org/10.5281/zenodo.11169723
Abstract.
According to summary data, the incidence of liver abscesses varies from
8 to 15 cases per 100,000 inhabitants per year, and the mortality rate ranges
from 5 to 26%. To improve the effectiveness of treatment of patients with liver
abscesses by improving the technique of local intra-arterial antimicrobial
therapy. We analyzed the results of surgical treatment of 83 patients with liver
abscesses who were in the department of purulent surgery and surgical
complications of diabetes mellitus at the multidisciplinary clinic of the
Tashkent Medical Academy from 2016 to 2023. In the first group, 5
complications occurred (6.0%): in 3 patients, biliary bleeding. 1 has a right-
sided hydrothorax. 1 fatal outcome is the cause of the breakthrough of
abscesses into the abdominal cavity and the addition of hepatic - renal
insufficiency. The use of minimally invasive techniques in the treatment of liver
abscesses in combination with long-term intra-arterial catheter therapy is
highly effective and in the future requires a more detailed approach to this
method.
Keywords:
liver abscess, bacterial abscesses minimally invasive
techniques, antibacterial therapy.
Introduction.
According to summary data, the incidence of liver
abscesses varies from 8 to 15 cases per 100,000 inhabitants per year, and the
mortality rate ranges from 5 to 26%. The formation of purulent foci in the liver
is accompanied by severe complications such as liver failure and
cholangiogenic sepsis [1].
Bacterial abscesses remain one of the most difficult complications in
surgical hepatology [2]. Traditionally used in their surgical treatment, various
methods of intra- and extraperitoneal accesses are quite traumatic and, often,
insufficiently adequate. This is especially true in cases with multiple abscesses,
as well as with the development of sepsis [3, 4, 5, 6, 7]. The widespread
introduction of minimally invasive techniques in the form of interventions
under the control of ultrasound diagnostics (ultrasound), endoscopy and
laparoscopy has made it possible to qualitatively improve the results of
SCIENCE AND INNOVATION IN THE
EDUCATION SYSTEM
International scientific-online conference
32
treatment of this complex category of patients [8].
Currently, the most common method of treating liver abscesses is
percutaneous puncture and drainage of the abscess. In some studies, the
effectiveness has been shown at the level of 96 % when using only the puncture
method [9].
In addition to supporters of minimally invasive percutaneous methods,
there are also followers of open drainage of abscesses, mainly in multiple liver
lesions [10, 11, 12].
The advantages of minimally invasive methods of treating abscesses
under ultrasound control are due to their low traumatism, relative simplicity,
lack of risk of general anesthesia, reduced hospitalization time, and allow for
better results at lower cost [13, 14, 15, 16, 17].
The aim of the study:
To improve the effectiveness of treatment of
patients with liver abscesses by improving the technique of local intra-arterial
antimicrobial therapy.
Materials and methods of research.
We analyzed the results of surgical
treatment of 83 patients with liver abscesses who were in the department of
purulent surgery and surgical complications of diabetes mellitus at the
multidisciplinary clinic of the Tashkent Medical Academy from 2016 to 2023.
Patients are divided into two groups depending on the type of surgical
intervention performed. The first group (control) consisted of 45 patients who
were treated with standard percutaneous drainage of liver abscesses,
correction of water-electrolyte disorders, detoxification and intravenous
antibacterial therapy. The second group (the main one) consisted of 38 patients
with liver abscesses. In this group, standard treatment was combined with local
intra-arterial antimicrobial therapy: Seldinger catheterization of the hepatic
artery.
Men -53 (63.8%), women - 30 (36.1 %) aged 21 to 72 years (average age
43.6-3.7 years). The main cause of liver abscesses: infection of post-traumatic
hematoma in 13 (15.6%) patients, suppuration of a parasitic cyst in 20
(24.0%), cholangiogenic liver abscesses were present in 29 (34.9%) patients,
formation of a purulent process in the liver after primary surgery (residual
cavities), in 10 (12%) and metastatic liver abscess - in 11 (13.2%) individuals.
In 70 (84.3%) patients, these were single liver abscesses and only 13 (15.6%)
had multiple abscesses. The right lobe of the liver was mainly affected 73
(87.9%), abscesses were localized in the left lobe in 9 (10.8%) patients, in both
lobes in 1 (1.2%). The main number was localized in the SVII VIII segment - y
SCIENCE AND INNOVATION IN THE
EDUCATION SYSTEM
International scientific-online conference
33
(87.9%).
The results of the treatment.
In the first group, 5 complications
occurred (6.0%): in 3 patients, biliary bleeding. 1 has a right-sided
hydrothorax. 1 fatal outcome is the cause of the breakthrough of abscesses into
the abdominal cavity and the addition of hepatic - renal insufficiency.
In the second group, local intraarterial antimicrobial therapy was
performed by injecting Cefbac into the common hepatic artery at a daily dose
of 3.0 g and metronidazole - 1.0 g in saline solution, infusomat for 5-7 days.
There were no complications or deaths.
Conclusion.
The use of minimally invasive techniques in the treatment of liver
abscesses in combination with long-term intra-arterial catheter therapy is highly
effective and in the future requires a more detailed approach to this method.
References:
1. Lubbert C., Wiegand J., Karlas T. Therapy of liver abscesses // Visceral
Medicine. 2014. Vol. 30, № 5. Р. 334-341.
2. Корымасов Е.А. Эффективность малоинва¬зивных пункционно-
дренажных вмешательств в лече¬нии панкреонекроза / Е.А. Корымасов,
А.М. Кричмар, Р.М. Джарар // Казан. Мед. Журнал. - 2013. - №1. - С.1-6.
3. Meyers W.C. Pyogenic and amebic liver abscess / W.C. Meyers, R.D. Kim //
Sabiston Textbook of Surgery. - 16th ed. - 2001. - P. 1043-1055.
4. Рузибаев Р.Ю., Курьязов Б.Н., Сапаев Д.Ш., Якубов Ф.Р., Рузматов П.Ю., &
Бабаджанов А.Р. (2019). Современная оценка проблем диагностики и
хирургического лечения эхинококкоза. Вестник Национального медико-
хирургического Центра им. Н. И. Пирогова, 14 (1), 134-139.
5. Babadzhanov, A. R., Babadzhanov, K. B., Matmuratov, K. J., Sh, Y. S., & Yokubov,
I. Y. (2023). Application of Combined Laser Irradiation in Postoperative Period
in Patients with Complicated Hepatic Echinococcosis. Экономика и социум, (7
(110)), 66-70.
6. Курьязов, Б. Н., Бабаджанов, А. Р., Рузматов, П. Ю., & Бабаджанов, К. Б.
(2024). Эффективность использования минилапаротомного доступа в
хирургическом лечении больных желчнокаменной болезни. Journal of
Universal Science Research, 2(2), 373-381.
7. Рузматов, П. Ю., Матмуротов, К. Ж., Бабаджанов, А. Р., Каримов, Р. Х., &
Рузметов, Б. А. (2024). Особенности выполнения реконструктивных
вмешательств у больных синдромом диабетической стопы. Journal of
Universal Science Research, 2(3), 96-112.
SCIENCE AND INNOVATION IN THE
EDUCATION SYSTEM
International scientific-online conference
34
8. Толстиков А.П. Выбор метода хирургического лечения больных с
бактериальными абсцессами пе¬чени / А.П. Толстиков // Казан. Мед.
Журнал. - 2012. - №2. - С. 265-269.
9. Cohen, J. L. Liver Abscess : The need for complete gastrointestinal evaluation /
J. L. Cohen, V. F. Martin, R. L. Rossi, D. J. Jr. Schoetz // Arch. Surg. - 1989. - Vol.
124, № 5. - P. 561-564.
10. Beregi, A. Ultrasonographic detection of abdominal abscess in two guinea
pigs / A. Beregi, S. Zorn, V. Molnar, F. Biro // Acta Vet. Hung. - 2000. - Vol. 48, №
3. - P. 271-276.
11. Рузибаев, Р. Ю., Курьязов, Б. Н., Сапаев, Д. Ш., & Якубов, Ф. Р. РузматовП.
Ю., & Бабаджанов АР (2019). Современная оценка проблем диагностики
и хирургического лечения эхинококкоза.Вестник Национального медико-
хирургического Центра им. НИ Пирогова,14(1), 134-139.
12. Sapaev DS, Yakubov FR, Yakhshiboev SS. Evaluation of the factors influencing
the choice of laparoscopic echinococcectomy in liver echinococcosis (LE) and its
impact on postoperative outcomes. Exp Parasitol. 2023 May;248:108495. doi:
10.1016/j.exppara.2023.108495. Epub 2023 Mar 5. PMID: 36871791.
13. Сапаев Д.Ш., Рузибаев Р.Ю., Курьязов Б.Н. Пятилетний опыт
современных операций в лечении эхинококкоза печени //
Профилактическая и клиническая медицина. –2017. –No4 (65). –С. 74–78.
14. Лебедев, М.С. Применение внутриполостной лазертерапии в хирургии
моделированных абсцессов / М. С. Лебедев, А. И. Урусова, Д. А. Андреев //
Бюллетень медицинских Интернет-конференций. - 2015. - Т. 5, №4. -С. 255-
256.
15. Sapaev D.S., Yakubov F.R., and Yakhshiboev S.S. 2023.
Comparative results of surgical treatment of primary echinococcosis of the
liver. European Journal of Medical Genetics and Clinical Biology 1 (2):36-45.
https://escience.net/index.php/JMGCB/article/view/223
16. Yakhshiboev, S. S., & Babadjanov, A. R. (2024). The use of minimally invasive
interventions in the treatment of cholangiogenic liver abscesses. В theoretical
aspects in the formation of pedagogical sciences (Т. 3, Выпуск 8, сс. 204–208).
Zenodo. https://doi.org/10.5281/zenodo.11107335
17. Акбаров М.М., Рузибаев Р.Ю., Сапаев Д.Ш., Рузматов П.Ю., Якубов Ф.Р.
Современные пути лечения и профилактики эхинококкоза печени.
Проблемы
биологии
и
медицины.
–2020;
120(4):12-18.
DOI:
http://doi.org/10.38096/2181-5674.2020.4.00181
