Оптимизация методики лечения абсцессов печени.

В статье представлены результаты лечения пациентов с абсцессами печени. Целью работы является улучшение результатов лечения пациентов с абсцессами печени путем оптимизации методики чрескожного пункционного дренирования полости внутрипеченочного гнойника. В ходе исследования нами разработана и оформлена в виде алгоритма методика оптимизированной тактики лечения абсцессов печени.  Так при наличии у пациента перитонита, при необходимости выполнения симультанных операций, при отсутствии безопасной УЗ-траектории выполняли лапаротомию или лапароскопию. При этом во всех случаях отдавали предпочтение лапароскопическим операциям. При множественных или одиночных мелких абсцессах печени проводили консервативное лечение антибактериальными препаратами, при абсцессах более 2 см выполняли дренирование. При одиночных гнойных полостях диаметром более 2 см проводили чрескожное чреспеченочное дренирование. При множественных гнойных полостях диаметром более 2 см дренирование каждой полости мы производили отдельно. Использовали различные типы дренажей в зависимости от диаметра гнойной полости. Проведен сравнительный анализ различных подходов других авторов к вопросу лечения абсцессов печени. Сделаны выводы об эффективности представленной методики.

Annotation: The article presents the results of treatment of patients with liver abscesses. The aim of the work is to improve the results of treatment of patients with liver abscess by optimizing the technique of percutaneous puncture drainage of the intrahepatic abscess cavity. In the course of the study, we have developed and formulated in the form of an algorithm a method of optimized tactics for the treatment of liver abscesses.  Thus, in the presence of peritonitis in the patient, if necessary, simultaneous operations were performed, in the absence of a safe ultrasound trajectory, laparotomy or laparoscopy was performed. At the same time, laparoscopic operations were preferred in all cases. Conservative treatment with antibacterial drugs was performed for multiple or single small liver abscesses, and drainage was performed for abscesses of more than 2 cm. Percutaneous transhepatic drainage was performed in single purulent cavities with a diameter of more than 2 cm. In case of multiple purulent cavities with a diameter of more than 2 cm, we performed drainage of each cavity separately. Different types of drains were used depending on the diameter of the purulent cavity. A comparative analysis of the various approaches of other authors to the treatment of liver disorders has been carried out. Conclusions are drawn about the effectiveness of the presented methodology.

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