Comparative Study Of Different Method Of Anhydrous Ethanol Treatment Of Simple Hepatic Cysts By Ultrasound-guidance

ObjectiveTo investigate curative effect difference between repeated washing method,retention ethanol method and catheter drainage method in treatment of simplehepatic cysts by ultrasound-guidance and to investigate the influence of lastethanol retention time in anhydrous ethanol washing treatment of different sizeof simple hepatic cysts by ultrasound-guidance.Methods90cases of6~9cm diameter of SHC were chosen from March2011toAugust2012. They were randomly divided into Group A, Group B and Group C(each30cases). After puncture needle placement for patients of Group A byultrasound-guidance and pulling out the needle core, the cystic fluid wasexhausted. After washing3times by anhydrous ethanol of1/5the amount ofextract fluid, the4th ethanol was lien for10min. The needle was pulled out afterexhausting the fluid. This was repeated washing method. Anhydrous ethanol of1/5the amount extract fliud and1~2mL2%lidocaine were injected andreserved in the cyst chamber after exhausting the cyst liquid for patients ofGroup B. This was retention ethanol method. After6~8F drainage tube wasplaced in the cyst for patients of Group C by ultrasound-guidance, the cysticfluid was exhausted and anhydrous ethanol of1/5~1/3of the amount of cysticfluids was injected within the cyst and was retained for20min. the amount ofanhydrous ethanol was no more than100mL. After changing positions and each position lasting for5min, the ethanol was exhausted and drainage tubewas fixed. After anhydrous ethanol sclerotherapy again by ultrasound-guidancein the third day, drainage tube was pulled out. This was catheter drainagemethod. Cases of Group A, Group B were observed for2~3hours, and cases ofGroup C were need to be hospitalized to pull out the tube. They were allfollowed up for6months. The curative effect was judged by repeated ultrasoundexam after6months.180cases of SHC including90cases of cyst diameter3~5cm (Group D)and90cases of cyst diameter5~8cm (Group E) were chosen from March2011to March2012. Two groups were randomly divided into three subgroupsrespectively: Gorup D1, E1, D2, E2, D3and E3. After washing3times byanhydrous ethanol of1/5the amount of extract fluid, the4th washing ethanolwere retented for0min in Group D1, E1, for3min in Group D2,E2and for10min in Group D3, E3. They were all observed for2~3hours. They werere-examed by ultrasound and related adverse reactions were recorded after6months. The efficacy differences between subgroups were judged.ResultsAll cases of Group A, group B and group C were completed the follow-upwithout loss to follow-up. In Group A20cases cured,8cases were effective,2cases were ineffective. In Group B10cases cured,12cases were effective,8cases was ineffective. In Group C22cases cured,7cases were effective,1case were ineffective. The difference of curative effect among the three groupswas statistically significant (Hc=13.326, P <0.05). Between two groups, GroupA and Group C curative effect was obvious higher than Group B (P <0.01), andthe curative effect difference between Group A and Group C has no statisticalsignificance (P>0.05). The adverse reaction rate of three groups was23.33%(7/30),56.67%(17/30),56.67%(17/30) respectively. The rate of Group B andGroup C was higher than that of Group A (P <0.01). Face flushing, mild nauseaand dizziness of drunken reactions and local discomfort in right upper abdomen disappeared after1~2h. Right upper abdomen pain, elevating of ALT and AST,bleeding slightly and low fever disappeared after treatments for symptoms.Drainage tube of one case were shed which was invalid when reviewing. Theaverage medical cost of Group C was obviously higher than that of Group A andGroup B (P <0.01).Groups D, E completed follow-ups without loss to follow cases.24caseswere cured and6cases were effective in Group D1. All cases were cured inGroup D2and Group D3. There was not ineffectiveness in three subgroups. Thedifference of effectiveness among subgroups was significant(χ2=12.857, P＜0.05). thereinto Group D1was different from Group D2and Group D3in thecurative rate (χ2=4.630, P＜0.05).9cases were cured,13cases were effectiveand8cases were invalid in Group E1.10cases were cured,12cases wereeffective and8cases were invalid in Group E2.26cases were cured and4caeswere effective in Group E3. The difference of curative effect among threesubgroups was statistically significant (H=20.380, P<0.05).The differencebetween Group E1and Group E2, E3was statistically significant. Adversereactions of Group D and Group E mainly included face flushing, mild nauseaand dizziness of drunken reactions and local discomfort in right upper abdomen,which disappeared after1~2h.There were not pneumothorax, bleeding,infection, bile leakage, shock and other serious complications.ConclusionFor6~9cm diameter simple hepatic cysts, repeated irrigation method isbetter than retention ethanol method and catheter drainage method, which notonly have advatanges including good curative effect, less adverse reaction,convenient and low cost but also is more likely to be accepted by patients. Thelast retention time of3min is enough for gaining satisfactory effectiveness inanhydrous ethanol washing treatment simple hepatic cysts with diameter3~5 cm by ultrasound-guidance. The effect is better for SHC with diameter5~8cmwhen the last retention time keep10min.