Liver cysts are divided into two categories: parasitic and non-parasitic, while non-parasitic cystic disease of the liver, congenital liver cysts are the most common and can be divided into solitary and multiple liver cysts (polycystic liver).
For liver cysts less than 5 cm in diameter without symptoms, no treatment is required, while surgical treatment is recommended for diameters over 5 cm (the reason is that liver cysts will not shrink on their own but will continue to increase in size, thus compressing the surrounding liver tissues and causing liver atrophy, and are prone to rupture, bleeding and infection), and those with clinical symptoms should be operated as soon as possible.
What are the methods of treating liver cysts?
There are three modern methods of surgical treatment for liver cysts.
1.Cesarean section for opening and drainage of liver cyst or resection of liver cyst
That is, the traditional open surgery with good drainage is one of the main surgical methods for treating liver cysts in the past, but because of the long incision, trauma, slow recovery and also other common complications of open surgery, it has been applied less alone and only in some cases when other lesions need to be treated at the same time.
2.B ultrasound-guided hepatic cyst puncture and fluid aspiration and anhydrous alcohol injection
This method is less invasive but incomplete, requires repeated puncture and fluid extraction, is prone to recurrence and co-infection, and is only suitable for elderly patients with weak constitution and patients with other important organ diseases.
3.Laparoscopic liver cyst opening and drainage
This surgery is the best method for treating liver cysts at home and abroad, which is done through a tiny incision in the abdominal wall, using minimally invasive instruments, using abdominal endoscopy, intra-abdominal lighting and electronic camera system to complete window drainage of liver cysts in vivo.
It is characterized by the purpose of complete window drainage and avoiding the complications caused by caesarean operation and repeated puncture, with less trauma, less bleeding, faster recovery and shorter hospitalization time.
II. Morphology and function of liver
Morphology of liver: the liver is located in the right upper abdomen, hidden under the right diaphragm and deep surface of the rib cage, most of the liver is covered by the rib arch, if the liver is touched under the rib arch, it is mostly pathological hepatomegaly. The normal liver is reddish-brown in color and soft in texture. The weight of the liver in adults is equivalent to 2% of body weight. The right lobe of the liver is adjacent to the right pleura and right fundus of the lung above, the left lobe of the liver is attached to the heart above, a small portion is adjacent to the anterior abdominal wall, the right lobe of the liver is adjacent to the colon in front, the posterior lobe is adjacent to the right adrenal gland and right kidney, and the left lobe of the liver is adjacent to the stomach below.
Functions of the liver.
1, detoxification function: the liver has a “detoxification function” for many non-nutritive substances from the body and outside the body, such as various drugs, toxins and certain metabolites in the body. In severe liver disease, such as advanced cirrhosis, heavy hepatitis, the detoxification function is reduced, and toxic substances will accumulate in the body.
2, metabolic function: the daily intake of protein, fat, carbohydrates, vitamins and minerals and other nutrients in digestion and absorption to the liver, in the liver is broken down and synthesized into a variety of substances needed by the body.
3, secretion of bile: bile is produced by hepatocytes and then excreted and stored in the gallbladder through the bile ducts inside and outside the liver.
4, the functions of hematopoiesis, blood storage and regulation of circulating blood volume.
5. immune defense function.
6, regenerative function.
III. Preparation before surgery
1, outpatient blood tests, including routine blood, biochemistry, electrolytes, coagulation, urine, stool, hepatitis B, hepatitis C, HIV, syphilis antibodies, etc.
2, chest X-ray, electrocardiogram, abdominal ultrasound.
3, enema or oral laxative to cleanse the intestines one day before surgery.
4, a light diet the day before surgery and water fasting from early morning on the day of surgery.
5, appropriate fluids and intravenous antibiotics given before surgery to prevent infection.
6.Gastric tube and urinary catheter may be left in place before surgery.
If the inflammation is too severe and the surrounding stomach, duodenum, large intestine or large omentum is severely adherent, it may be transferred to traditional open surgery.
IV. Surgical method
Traditional open surgery is traumatic, slow to heal, with a high rate of incisional infection and large, unattractive scarring after healing, which can easily cause intestinal adhesions and is not conducive to the patient’s postoperative recovery.
Compared with traditional open surgery, laparoscopic hepatic cyst opening and drainage has the advantages of less trauma, smaller incision, less wound pain, the ability to eat and get out of bed on the first day after surgery, short postoperative medication time, short hospital stay, and significantly reduced incision infection and postoperative intestinal adhesions and other complications.
The 3-4 tiny wounds scattered in the abdomen can hardly be seen after healing.
V. Postoperative period
1.After the surgery, patients can generally return to the ward after waking up in the operating room.
2.An abdominal drainage tube will occasionally be left in the abdomen to facilitate the flow of fluid in the abdominal cavity. Please record the flow and color of the drainage every day, which is normally a small amount of light red or light yellow fluid and can be removed after 1-2 days.
3. it is recommended that you get down to the floor as early as possible, on the first postoperative day.
4. the laparoscopic incision is small and therefore the pain is usually not very severe; if the pain is unbearable use appropriate pain medication or seek medical help.
5, the wound usually requires only one or two dressing changes, please inform the health care provider if there is any abnormal bleeding and oozing.
6. early postoperative period still requires supplemental fluid and antibiotic therapy via IV.
7.For elderly patients or those with abnormal bladder function, a catheter will be left in place after surgery and can be removed after 1-3 days.
8.Individual patients may have slight shoulder pain after surgery, which is a normal reaction and will disappear on its own within a short period of time.
9, usually the first day after surgery can begin to eat through the mouth, initially from drinking water, and then gradually changed to liquid food, semi-liquid food, until the ordinary diet.
10.If there is obvious abdominal distension and nausea and vomiting, it is necessary to postpone eating.
11. A few patients have a mild fever (temperature between 37-38 degrees Celsius), which usually resolves within 1-2 days.
12. When there is no significant discomfort after resumption of diet, discharge from the hospital can be considered, usually on the third day after surgery.
Contact the doctor or nurse promptly if the following conditions occur.
(1) Chills or temperature over 38.5℃.
(2) Redness or swelling of the incision or leakage of fluid.
(3) If there is a change in the color of the drainage fluid or a large increase in drainage volume.
(4) Increased abdominal pain or new symptoms of pain.
(5) Nausea and vomiting.
(6) Other new or unexplained symptoms of discomfort.
VI. Post-discharge habits
1.After laparoscopic surgery, in addition to continuing medication and regular checkups according to medical advice, the following matters need to be noted in life and diet.
2, should abstain from smoking, alcohol, coffee, strong tea, carbonated beverages, spicy and sour and other stimulating foods.
3, should chew slowly, eat light and easy to digest food, avoid full and hard food.
4, fat and cholesterol intake should be limited, especially not too much animal offal at a time.
5, avoid too cold food, it is recommended to eat less and more meals, should not be too much exercise after meals.
6, avoid chocolate, coffee and other high-calorie food, so as not to promote the growth of cysts.
7. Have a regular life, ensure sufficient rest and sleep, and exercise regularly.
VII. Outpatient review
We recommend that you have your first follow-up examination 2 weeks to 1 month after surgery, and your doctor will recommend blood tests and abdominal ultrasound according to your actual situation.