Modern approaches to the diagnosis and treatment of liver abscesses

Abstract

The aim. To determine the optimal surgical approach for liver abscesses based on ultrasound semiotics and self-developed staging of purulent center formation.

Materials and methods. The study was conducted in 80 patients with liver abscesses, operated on with the help of interventional sonography (IS), laparoscopic operations (LO), laparotomy, as well as the combined use of IS and LO. According to his own research, ultrasound characteristics of the development and formation of liver abscesses were developed, with the allocation of four stages. The informativeness of ultrasound was monitored from the first signs of a local inflammatory process to the stage of pyogenic capsule formation. Therefore, the main group consisted of patients who were operated on according to their own developed ultrasound characteristics – 48 (60 %), and the comparison group consisted of 32 (40 %) who were operated on according to generally accepted diagnostic signs. Computed tomography (CT) was performed at the stage of diagnostic search and differential diagnosis in a small part of patients – 27 (33.7 %). And the method of ultrasound diagnostics and IS remained the leading one, i.e. “the method diagnoses – the method operates”. This is confirmed by the fact that in both groups, 50 (62.5 %) operations were performed using IS at various stages of abscess formation.

Results. The choice of the method of surgical treatment largely depended on the stage of destruction of the abscess center and its localization, the severity of the patient’s condition. It is important to note that almost all patients (100 %) had elevated body temperature, 85 % had fever and symptoms of purulent intoxication. In 90 % of patients, the general condition was assessed as moderate and severe. In the main group, a differentiated approach to the choice of the method of operation was used on the basis of the developed sonographic criteria for the stage of abscess formation, as well as the technological capabilities of each method. The morphological difference of the substrate, the heterogeneity of the liquid component, the degree of capsule formation, as well as the localization of the cell made it possible to choose between these methods. In the main group, there were significantly more IC operations – 37 (77.1 %), which significantly exceeded the frequency of operations in the comparison group (χ2 = 9.39; p = 0.002). The frequency of performing LO in the comparison group was 53.1%, which is probably higher than in the main group – 14.6 % of cases. We used the combined use of IS and LO in the treatment of 4 (8.3 %) patients of the main group. The operation consisted of a laparoscopy and its puncture under the control of a sonographer, followed by the operation of a laparoscopic instrument and an ultrasonic dissector (a wide access to the abscess cavity was performed with its external drainage). The methods eliminate the shortcomings of each of them separately, and generally guarantee a positive result. Laparotomy operations of the Clermont type and others in the main group of patients were not used in the treatment of abscesses. All patients at the stages of treatment underwent a microbiological study of the focus of inflammation with de-escalation and targeted antibacterial therapy. In the main group, the average postoperative bed-day was 21.3 ± 1.2 days, which is 16.5 % (р < 0.05) less than the similar indicator in the comparison group – 25.5 % ± 1.6 days. According to the results of the treatment, there were no deaths.

Conclusions. The proposed ultrasound-based classification of liver abscess formation enables a differentiated approach to surgical treatment, leading to a 9-fold reduction (p < 0.05) in the number of repeated fluid drainage procedures and a 16.5 % reduction in hospital stay duration. In the early stages of abscess formation, interventional sonography is recommended as a safer and less invasive technique, offering high diagnostic sensitivity (91.3 %), facilitating differential diagnosis, enabling microbiological analysis, and effectively preventing disease progression.