I. Definition.
All vesicular lesions growing on the liver are collectively referred to as hepatic cysts. The liver is the largest substantial organ in the body, with most of it located in the quadrant (right liver) and only a small portion crossing the median line (left liver) and covering the upper part of the stomach. A normal liver is as tender in texture as the fresh pork liver we see when we buy groceries. Normally, the cysts we see the most over 90% of the time are congenital liver cysts (also called true cysts).
II. Nature of disease.
Congenital cyst of the liver is an embryonic developmental disorder, so it is said to be a benign, congenital disease. It is said to be benign because it is not a tumor, not a cancer, and rarely cancerous, but a “small water ball” in the liver, the wall of which is epithelial cells, and the inside of the ball is water, and the epithelial cells produce water, which makes the water ball expand and become bigger. When we say it is congenital, it means that its normal cells are not well developed during the embryonic period, not that it starts to grow cysts in the embryo or after birth, most of them start to grow up when the body is not growing or declining, i.e. adult or old age.
III. Classification and size.
Congenital liver cysts are classified as single, multiple and multicystic liver. The number of cysts can be more or less, as few as one, a few, a dozen or as many as thousands (multicystic liver). The size of the cysts can be large or small, some are very small, only a few millimeters; some are the size of a soybean, a grape, an egg; some can be as large as more than 20 cm. The fluid inside the cyst can be as little as 1 ml or as much as 10,000 ml. Polycystic liver is often combined with polycystic kidney.
IV. Disease symptoms.
When the diameter of the cyst reaches more than 10 cm, compression symptoms may appear, such as compression of the stomach and intestines appearing upper abdominal fullness; compression of the diaphragm affects breathing; cysts in the hilar region of the liver compressing the bile ducts may appear jaundice; polycystic liver compression makes normal liver tissue less and less, and liver function is affected. If the cysts are infected by bacterial invasion, abdominal pain and fever can occur.
V. Disease hazards.
Most of the congenital liver cysts have no effect on the human body because they are small and have no effect on the liver, so there are no symptoms, and the vast majority of them are found during physical examination. Symptoms will appear when the cyst grows larger and larger.
VI. Examination.
Ultrasound is preferred for liver cyst examination, which is cheap, simple and accurate and reliable. CT is of great significance for the diagnosis of liver cysts: the whole liver can be displayed on CT films, and then all the large and small cysts on the liver can be presented on the CT films. This image display is more comprehensive and clearer than the ultrasound images we usually see, and ourselves and clinicians can better understand the situation of liver cysts.
VII. Treatment.
The vast majority of congenital liver cysts do not require treatment and only need regular observation. A portion of those with faster growth, larger cysts, associated infections, and symptoms need to be treated.
The principle of treatment for congenital liver cysts is very simple, which is to draw out the water from the “water balloon” or to stop it from producing water.
This includes
(1) cyst puncture and aspiration.
(2) cyst windowing.
(3) cyst drainage.
(4) cystectomy.
(5) liver transplantation.
Smaller cysts are treated by puncture with anhydrous alcohol and destruction of the cyst epithelium so that it no longer produces water and the cyst will not grow. Larger cysts can be treated by minimally invasive surgery (laparoscopy) by making an opening in the cyst to allow water to drain into the abdominal cavity, and the water can be absorbed. Some cysts require removal of part of the liver. In case of polycystic liver it is more difficult to take the above treatment, and when it affects the liver function, the only way is liver transplantation. Liver cysts need surgery if there is abdominal distension, abdominal pain and other discomfort, cyst diameter is greater than 5cm or cyst rupture occurs, while polycystic liver, liver insufficiency and ascites are contraindicated for surgery. The main traditional treatment methods are open cyst opening and drainage, hepatic lobectomy or abdominal ultrasound location puncture and aspiration with anhydrous alcohol. However, the above methods are more traumatic, slower to recover and prone to recurrence. With the popularization and application of laparoscopic technology, trans-laparoscopic hepatic cyst opening and drainage is increasingly used in clinical practice. Transcatheter laparoscopic liver cyst opening and drainage overcomes the shortcomings of the original treatment methods and has the following characteristics: less trauma, better visual field, less bleeding, can deal with liver cysts in different locations at the same time, less interference with abdominal organs such as gastrointestinal cavity and reduces the chance of postoperative intestinal adhesion.
VIII. Prevention.
There is no prevention method for congenital liver cysts. Nor can it be treated and prevented by medication. The important thing is regular medical examination and review.