OVERVIEW
The vast majority of nonparasitic liver cysts are benign diseases of the liver, with congenital cysts being the most common. The disease may be solitary or multiple. Multiple hepatic cysts are often accompanied by multicystic lesions in the kidneys, pancreas, ovaries, lungs, etc. Non-parasitic hepatic cysts can be classified according to their etiology as: congenital cysts (isolated or solitary, diffuse or multiple); traumatic cysts; inflammatory cysts; retention cysts; and neoplastic cysts (dermatophytic cysts, cystic adenomas, and cysts formed by degenerative changes of malignant tumors).
Etiology
Most hepatic cysts are congenital and result from a developmental disorder of the intrahepatic bile ducts or lymphatic vessels. Studies have found that the cystic fluid is similar in composition to bile, so it is believed that these cysts originate from intrahepatic vagal aberrations of the bile ducts or congenital intrahepatic bile duct-like epithelial hyperplasia and occlusion, which results in stagnation and retention of the luminal content of the ducts.
Symptoms
Hepatic cysts grow slowly and can be asymptomatic for a long time or for life. Their clinical manifestations are related to the location, size and number of cysts, as well as the presence or absence of compression of neighboring organs and the presence or absence of complications. Generally, small cysts are usually asymptomatic and difficult to diagnose, and are often found during physical examination or abdominal surgery. When the cysts are large, there may be discomfort in the right upper abdomen, vague pain, feeling of fullness after meal, liver enlargement and right upper abdomen mass, which is cystic to touch without obvious pressure pain, and scattered cystic nodules can be touched on the liver surface of multiple liver cysts, such as intracapsular hemorrhage, combined with infections, or torsion of tibial cysts, there may be acute abdominal manifestations.
Examination
1. Laboratory examination
Total bilirubin is mildly elevated, alanine aminotransferase is elevated, menthyl aminotransferase is elevated, glutathione transcriptase is elevated, alkaline phosphatase is elevated, hypoproteinemia, urea nitrogen and creatinine are normal.
2.Ultrasound
Dense fine light spots, light bands floating or deposited in liver cysts.
3.CT
It suggests that the wall of the cyst is thickened and gas can be seen inside the cyst.
Diagnosis
There is no specific diagnosis for liver cysts, and the diagnosis depends on various imaging techniques, among which ultrasonography has an important diagnostic value. Ultrasonography has the advantages of high sensitivity, non-invasive, simple and easy to carry out, lesions over 1cm can be detected, and its diagnostic accuracy reaches 98%, and through ultrasonography can observe the nature of the cysts, the location of the cysts and the neighboring relationship of the surrounding organs, so it is the first choice of diagnostic methods.CT examination is also very sensitive, but due to the price of the relatively high, it is not preferred, and it is mainly used to exclude some tumor CT examination is also highly sensitive, but due to the relatively high price, it is not preferred and mainly used to exclude some tumor lesions.
Treatment
The treatment of hepatic cysts depends on their nature, size and the presence or absence of complications as well as the patient’s wishes. For cysts less than 3cm, if there are no obvious compression symptoms, treatment is generally not considered. For cysts between 3 and 5 cm, treatment can be considered according to the patient’s wishes. Cysts over 5 cm generally produce obvious compressive changes in the liver parenchyma and treatment is recommended. For cysts <5cm in diameter, surgery is generally not feasible, and B-mode ultrasound should be performed regularly to review and observe the changes.
1. Cyst aspiration by puncture
The cyst is punctured percutaneously under B-mode ultrasound monitoring and guidance, and the cyst fluid is extracted. This method is simple and can be repeated puncture or post-puncture placement. The cyst must be excluded before puncture. Strict aseptic technique should be used to avoid intracystic hemorrhage and abscess formation. The disadvantage is that cysts can recur a short time after aspiration and require repeated aspiration, so this method is only indicated for older (over 70 years old), poorer general condition, and only to relieve compression.
2. Cyst aspiration and sclerotherapy technique
This method is to inject anhydrous ethanol or other sclerosing agents into the cystic fluid after puncture and fluid extraction. While extracting the cystic fluid, this method also destroys the epithelium of the cystic wall by drugs, so that the cystic fluid secretion of the cystic wall will be gradually reduced, thus achieving the goal of effective treatment.
3.Surgery
Surgery includes cyst removal, cyst opening, cyst drainage, etc. Because of the large trauma, unless there are special circumstances, generally can be solved by puncture is not the first choice of treatment. The single cyst that can be easily peeled off can be treated by cystectomy, which is a more thorough treatment.