Liver Hydadit disease. Akad. B.Agaev

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Liver Hydadit disease. Akad. B.Agaev

  1. 1. LIVER HYDATIDLIVER HYDATIDDISEASE:ETHIOLOGY,DISEASE:ETHIOLOGY,DIAGNOSTIC & SURGICALDIAGNOSTIC & SURGICALTREATMENTTREATMENTprof.prof. Boyukkishi AgayevBoyukkishi AgayevAzerbaijan Medical UniversityAzerbaijan Medical UniversityInstitute of Clinical Medicine,Institute of Clinical Medicine,BakuBaku
  2. 2. Echinococcus granulosus adults in situ
  3. 3. Hydatid cysts in bovine liver.
  4. 4. Ways of Contamination:Ways of Contamination:• Through Gastrointestinal tractThrough Gastrointestinal tract• Through Respiratory tractThrough Respiratory tract• Through Wound SurfaceThrough Wound Surface
  5. 5. Distribution of patients by age andDistribution of patients by age andsexsexYearsSex< 20 21-3031-4041-5051-6061-70>75 Total:№ %Male: 18 14 29 22 11 9 2 105 35,2Female: 16 40 61 30 25 21 __ 193 64,8Total(number):34 54 90 52 36 30 2 298 100,0Total (%) 11,4 18,1 30,2 17,4 12,1 10,1 0,7 100,0
  6. 6. Localization of cysts in liverLocalization of cysts in liverlobeslobes240(80,5%)18 (6,1%)Both lobes –40 (13,4%)Bothlobes40 (13,4%)
  7. 7. STAGES OF DISEASESTAGES OF DISEASECOURSE:COURSE:• II Asymptomatic stage (period fromAsymptomatic stage (period fromworm invasion prior to the beginningworm invasion prior to the beginningof clinical manifestations)of clinical manifestations)• IIII Stage of clinical manifestationsStage of clinical manifestations• IIIIII Stage of complicationsStage of complications
  8. 8. COMPLICATIONS OF LIVERECHINOCOCCOSISCalcination ofcysts 8,1%Suppuration ofcysts21,5%Affection ofbile ducts(20,5%)Perforation intoabdominal cavity(0,3%)
  9. 9. CLASSIFICATION OF BILIARYAFFECTIONS IN LIVER HYDATID DISEASE(by A.A.Movchun,R.M.Agayev, 2003)Segmental lesionsLesions of hepaticductsInternalCystobiliaryfistulasBilio-bron-chialfistulasRuptureintofrank bileductsComp-ressionof hepa-ticductsCicatricialstricturesof bileducts
  10. 10. CLINICAL MANIFESTATIONS &CLINICAL MANIFESTATIONS &SIGNS OF LIVER HYDATIDSIGNS OF LIVER HYDATIDDISEASEDISEASE• Pain (92,5%)Pain (92,5%)• Weight feeling in right subcostalWeight feeling in right subcostalregion(38,4%)region(38,4%)• Dyspepsia (23,5%)Dyspepsia (23,5%)• Fever (17,8%)Fever (17,8%)• Jaundice and chill (3,5%)Jaundice and chill (3,5%)• Allergic reaction (6,4 %)Allergic reaction (6,4 %)• Hepatomegaly (62,8%)Hepatomegaly (62,8%)• Disssimetry of stomach (4,7%)Disssimetry of stomach (4,7%)
  11. 11. Disssimetry of stomach in patient withDisssimetry of stomach in patient withliver hydatid diseaseliver hydatid disease
  12. 12. A- Calcination of hepatic cyst B- High standing of theright right dome of adiaphragmX-ray Examination
  13. 13. X-ray ExaminationA- High standing of the right B- Calcinated cyst with aleveldome of a diaphragm of gas - an attribute of thewith exudate in pleura cysto-biliary fistulas
  14. 14. UltrasonographyUltrasonographyEchogram of the liver: multicameratenon-complicated hydatid cyst
  15. 15. ULTRASONOGRAPHYULTRASONOGRAPHYA – Suppuration of B- Separationof
  16. 16. ULTRASONOGRAPHYULTRASONOGRAPHYA- Calcination of B – rupture of hydatidcyst hydatid cyst withobstruc-Bileducts
  17. 17. CT-scanCT-scanHydatid cyst in right lobe of liver
  18. 18. CT-scanCT-scanSuppuration of liver hydatid cyst
  19. 19. CT-scanCT-scanCalcination of liver hydatid cystsCalcination of liver hydatid cysts12
  20. 20. CT-scanCT-scan1 & 2 – Hydatid cysts of the liver1 & 2 – Hydatid cysts of the liver3 – dilated bile ducts3 – dilated bile ducts
  21. 21. Nuclear-magnetic resonantNuclear-magnetic resonanttomographytomography
  22. 22. ERCPERCP• Dilated bile ductsDilated bile ducts& contrasted& contrastedcyst’s cavitycyst’s cavity
  23. 23. ERCPERCPHydatid cystHydatid cystrupture intorupture intobile ductsbile ducts
  24. 24. FistulocholangiographyFistulocholangiography• Two residual cavitiesTwo residual cavitieswith parasite elements,with parasite elements,which required surgicalwhich required surgicaltreatmenttreatment
  25. 25. Puncture of cyst (a) & injection intoPuncture of cyst (a) & injection intocyst cavity antiscolicidal solution (b)cyst cavity antiscolicidal solution (b)a b
  26. 26. GerminativelayerGauze withAntisepticsolutionHydatidcystgallbladder
  27. 27. Scheme of apparatus for removing of hydatidScheme of apparatus for removing of hydatidcystscysts• 1- accepting capacity; 2 – bent tube; 3-lateral aperture;1- accepting capacity; 2 – bent tube; 3-lateral aperture;4 – puncture needle; 5 – source of vacuum4 – puncture needle; 5 – source of vacuum
  28. 28. The circuit of application of the device forThe circuit of application of the device fordrainage of hydatid cystsdrainage of hydatid cysts
  29. 29. • a -a -Removal ofRemoval ofdaughter cystsdaughter cystsfrom cyst cavityfrom cyst cavitywith the help ofwith the help ofthe spoonthe spoon• B – specialB – special
  30. 30. Type of operationsType of operations: Total %Echinococcectomy with completeliquidation of residual cavity:84 28,2Echinococcectomy with sutureappliance and external drainage ofresidual cavity:154 51,7Echinococcectomy with externaldrainage of residual cavity:29 9,8Pericystectomy: 26 8,6Resection of liver: 5 1,7Total: 298 100
  31. 31. The circuit of echinococcectomy operationThe circuit of echinococcectomy operationwith liquidation & external drainage of residualwith liquidation & external drainage of residualcavitycavitya bc
  32. 32. OmentoplastyOmentoplastyof residualof residualcavitycavity
  33. 33. gallbladderFibrousecapsule
  34. 34. Echinococcectomy with completeEchinococcectomy with completeliquidation of residual cavityliquidation of residual cavity
  35. 35. PericystectomyPericystectomy
  36. 36. PericystectomyPericystectomy
  37. 37. Resection of left lobe of liverResection of left lobe of liver• a – CT-scan:a – CT-scan:hydatid cysthydatid cystoccupies all leftoccupies all leftlobe of a liverlobe of a liver• b - Resection of leftb - Resection of leftlobe of a liverlobe of a liver
  38. 38. Resection of right lobe ofResection of right lobe ofliverliver• A – CT-scan:A – CT-scan:large hydatidlarge hydatidcyst in rightcyst in rightlobe of liverlobe of liver• B – Circuit ofB – Circuit ofoperationoperation
  39. 39. Circuit of pathology & operation in case ofCircuit of pathology & operation in case ofrupture of hydatid cyst into bile ductsrupture of hydatid cyst into bile ducts
  40. 40. • A Choledocho-A Choledocho-duodenostomyduodenostomy• Choledocho-Choledocho-jejunostomyjejunostomyab
  41. 41. • A - hepatico-A - hepatico-duodenostomy withduodenostomy withtranshepatictranshepaticdrainagedrainage• B - hepatico-B - hepatico-jejunostomy withjejunostomy withtwo transhepatictwo transhepaticdrainagedrainage
  42. 42. Nature of postoperative complicationsNature of postoperative complications№ COMPLICATIONS number ofcases:numb. ofreoper.:lethaloutcomes:I SPECIFIC COMPLICATIONS: 41(13,8%) 8 (3,1%) 3(1,0%)a. Suppuration of sutured residualcavity:2 (0,7%) 2 (0,7%) ---b. Suppuration of drained residual cavitywith formation of external biliary andpurulent fistula:33 (11,0%) 2 (0,7%) ---c Hemorrhage in residual cavity: 2 (0,7%) 2 (0,7%) ---d. Cholangitis, acute hepato-renal failure: 2 (0,7%) 1 (0,3%) 2 (0,7%)e. Subdiaphragmal and subhepaticabscesses2 (0,7%) 2 (0,7%) 1 (0,3%)II NON-SPECIFIC COMPLICATIONS:38 (12,7%)---- 2 (0,7%)Total: 79 (26,5%) 8 (3,1%)8 (3,1%) 5 (1,7%)
  43. 43. Factors affecting morbidity &Factors affecting morbidity &mortality in postoperative periodmortality in postoperative period• Age of patients over 60 yearsAge of patients over 60 years• Duration of disease more than 5 yearsDuration of disease more than 5 years• Localization of cysts in central (I,IV)Localization of cysts in central (I,IV)segments of liversegments of liver• Size of cysts more than 10 cmSize of cysts more than 10 cm• Complications of echinococcosisComplications of echinococcosis(suppuration & calcination of cysts,(suppuration & calcination of cysts,lesions of bile ducts)lesions of bile ducts)• Type of operation (drainage of residualType of operation (drainage of residualcavity)cavity)
  44. 44. Thanks for your attention
  45. 45. Looking forwardto see you inBaku

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