Evidence-based Medical Analysis Of Treatment Strategies For Congenital Liver Cysts

Objective: The treatment of hepatic cysts has developed from traditional open fenestration,to ultrasound and CT image-guided puncture drainage and injection of different sclerosing agents,to the now widely respected endoscopic fenestration of hepatic cysts.At present,the treatment methods of liver cysts by various treatment teams are different.At present,the commonly used treatment methods are ultrasound /CT-guided puncture and sclerotherapy of liver cysts,laparoscopic or open fenestration of liver cysts.In order to further explore which of the above treatment methods has more advantages and is more in line with evidence-based medicine.This study retrospectively analyzed the comprehensive factors of liver cyst treatment in our hospital,combined with evidence-based medicine,summarized the different treatment methods as follows.Methods: A total of 177 patients with simple hepatic cysts admitted to Dalian Friendship Hospital from January 2011 to December 2021 were collected.Among them,143 patients were treated with ultrasound-guided puncture and catheterization of hepatic cysts under local anesthesia and anhydrous alcohol lavage and sclerotherapy as the experimental group(puncture group).34 patients were treated with open or laparoscopic fenestration of hepatic cysts as the control group(fenestration group),of which 16 patients were treated with laparoscopic fenestration of hepatic cysts and 18 patients were treated with open fenestration of hepatic cysts.The follow-up time was3-6 months.Through a retrospective study,the total effective rate(effect),operation time,bleeding volume,hospitalization time,postoperative complications(intracapsular hemorrhage,bile leakage,infection,hemopneumothorax)and cost of the two groups were compared.Statistical and evidence-based medical analysis was performed to evaluate different methods.Results: After treatment,the clinical symptoms of the patients were alleviated.The total effective rate of the ultrasound-guided hepatic cyst sclerosis treatment group(experime ntal group)was 97.9 %,and the total effective rate of the laparotomy or endoscopic fenestration group(control group)was 94.12 %.The difference between the two groups was statistically significant(p < 0.001).In the experimental group,the operation time was 30.27 ± 5.697 min,the hospitalization time was 5.87 ± 0.804 d,the bleeding volume was 4.10 ± 0.883 ml,the hospitalization cost was 6375.74 ± 1194.95 yuan,and the cyst recurrence rate was 3.50 %.Two patients had postoperative pulmonary infection without hemopneumothorax.In the fenestration group,the open operation time was 86.78 ± 29.126 min,the hospitalization time was 7.44 ± 5.11 d,the bleeding volume was 54.89 ± 4.10 ml,the hospitalization cost was 11118.50 ± 1174.84 yuan,and the cyst recurrence rate was 11.1 %.The endoscopic operation time was113.31 ± 24.165 min,the hospitalization time was 6.25 ± 0.775 d,the bleeding volume was 26.38 ± 3.775 ml,the hospitalization cost was 15071.13 ± 1086.22 yuan,and the cyst recurrence rate was 18.75 %.In the open group,2 cases had postoperative pulmonary infection and 1 case had incision infection.There were no serious complications such as intracapsular hemorrhage,bile leakage and hemopneumothorax.The p values of operation time,bleeding volume,complications,hospitalization expenses and cyst recurrence rate were less than 0.05,which were statistically significant.Hospitalization time p greater than 0.05 was not statistically significant.Conclusion: Liver cyst puncture catheter drainage of anhydrous alcohol sclerotherapy operation is simple and easy to promote,do not need general anesthesia,shorter operation time,more minimally invasive,less pain,fewer complications and good controllability,no special treatment,shorter hospitalization time,low cost(operation cost and consumables),wide application range,for older,poor cardiopulmonary function can not tolerate patients and cyst central type position deeper patients are applicable,and the total effective rate of treatment is better than fenestration,comprehensive evidence-based medical analysis is more in line with the preferred method for the treatment of liver cysts,which is consistent with the diagnosis and treatment of benign liver space-occupying lesions expert consensus.In the 2016 edition of the consensus on the treatment of liver cysts,the preferred treatment is laparoscopic partial resection and drainage of the cyst wall(recommended intensity I).But ultrasound-guided puncture catheter anhydrous alcohol sclerotherapy ineffective treatment of large cysts,accompanied by other abdominal cavity need surgical treatment of the disease,we recommend laparoscopic or open liver cyst fenestration.Laparoscopic surgery is the first choice for hepatic cysts with fenestration.Open surgery can be used for patients with a history of abdominal surgery to predict severe abdominal adhesion and are not suitable for laparoscopy.