Strategia chirurgicală în tratamentul abceselor hepatice

Abstract

Material și metode. Lucrarea prezintă experienţa clinicii pe o perioada de 20 ani (1995-2015), asupra unui lot de 112 pacienți. Vârsta pacienților: 19-72 ani, cu prevalarea sexului feminin (68,75%). Diagnosticul s-a bazat pe datele investigațiilor de laborator si imagistice. Abcesele solitare, in majoritatea cazurilor (82,14%) au afectat lobul drept al ficatului. Cauzele de apariție a abceselor hepatice: colangiogene (26), postraumatice (18), parazitare (34), metastatice portale (7), metastatice arteriale (4), neidentificate (23). Cele mai frecvente manifestări clinice au fost febra, durerea abdominală si hepatomegalia. Germenii microbieni decelați ca responsabili de producerea abceselor: E.coli,St.Aureus, Bac Piocianic, Proteus. Rezultate. Tratamentul chirurgical practicat a constat in asanarea focarului septic realizat preponderant in ultimii ani prin puncția ecoghidata transcutanata si laparotomii. Tratamentul general si local practicat prin schimbarea de drenaje (fistulografie) a determinat dinamica schimbărilor focarului septic si a contribuit la obținerea rezultatelor satisfăcătoare in cazuri clinice concrete. Mortalitatea postoperatorie - 6(5,3%) pacienți. Concluzii. Tabloul clinic a abceselor hepatice este polimorf si necesită metode contemporane de diagnostic: tomografia computerizată si rezonanta magnetică nucleară ne permit de a concretiza diagnosticul topic si diferențial; drenarea transcutanată ecoghidata computerizata sunt metode contemporane de perspectivă; antibioticoterapia selectivă prin recanalizarea venei ombilicale şi trunchiului celiac prin puncţia aortică în cazuri concrete sunt o componentă importantă.

Material and methods. Study presents the clinic’s experience of a period of 20 years (1995-2015) by the group of 112 patients. Patient’s age varied from 19 to 72 years with the prevalence of female (68.75%). The diagnosis was based on laboratory indexes and image methods of investigation. Solitary abscesses in majority cases (82.14%) affected the right lobe of the liver. Causes of abscess developing were: cholangiogenic (26), posttraumatic (18), parasitic (34), portal metastasizes (7), arterial metastasizes (4), non- identified (23). The most common clinical manifestations were fever, abdominal pain and hepatomegaly. Microbial germs identifiable as responsible for the abscesses developing were: E.coli, St.Aureus , Bac.Piocianic, Proteus. Results. Surgical treatment consisted in drainage of septic focus practiced predominantly by echo-guided percutaneous puncture especially in recent years and by laparotomy. Practiced general and local management via changing of drains (fistulography) determined the dynamic changes and contributed to obtaining of satisfactory results in concrete clinical cases. Postoperative mortality was 6 patients (5.3%). Conclusions. The clinical picture of hepatic abscesses is polymorphic and requires contemporary methods of diagnosis such as computed tomography and magnetic resonance which allowed us to concretize the topical and to perform the differential diagnosis. Echo- guided or computerized percutaneous drainage is contemporary methods of abscesses management. Selective antibiotic therapy through recanalyzed umbilical vein and via celiac trunk by aortic puncture in concrete cases is an important component.