Wilson J. Radiological diagnosis and echocontrolled percutaneous drainage of liver abscesses

The dissertation research was aimed at increasing the effectiveness of diagnosis and treatment of liver abscesses (LA) by optimizing the use of ultrasound (US) visualization techniques in all stages of diagnostic and treatment processes. Results of US examination and treatment with the help of echo-controlled percutaneous puncture and drainage using miniinvasive interventions (MII) on 248 patients with the highlighted pathology were carried out. O the basis of US data, predominance are pylephlebitic LA (64.1%) was established, which developed primarily in patients with inflammatory diseases of the intestines (87.4%) and established the role of long-term use of proton pump inhibitors in their emergence. Based on data of ultrasound examination and updated information about the distribution of abscesses in liver segments was highlighted, for the first time it was established that segment VII was mostly affected by pylephlebitic abscesses (in 45.3% of patients in the aetiological subgroup) and there were no statistically significant differences for liver abscesses of other aetiologies. For the first time ultrasound signs of liver abscesses of various aetiological subgroups at different stages of formation, on the basis of which in 92.3% cases, aetiology of abscesses were determined. Highlighted were scientific data regarding the differential diagnosis for a number of liver abscesses, describing methods of their differential diagnosis with other focal liver pathology, among which the foremost (in 73.9% cases) wаs the diagnostic biopsy under ultrasound control. For the first time the possibility of using Doppler mode and Doppler artifacts to optimize visualization of the biopsy instruments was established which led to the absolute risk reduction of incorrect conclusions about the location and configuration of the distal part of drain to 70.0%. We have further developed provisions on the possibility of using ultrasound characteristics of liver abscesses in selecting optimal method of their treatment, making it possible to achieve therapeutic effect in 98.8% of patients with LA regardless of their aetiologies. The use of our developed set of measures increased the effectiveness and safety of minimally invasive treatment of liver abscesses from 84.3% to 97.7%, significantly reduced the duration of inpatient treatment from 18.2±9.9 to 8.3±4.4 days (p <0,001), significantly reduced the number of cases of inadequate drainage: from 45.8±4.2% to 18.9±4.6% (p <0.001), avoided significant complications (leakage of blood and bile, formation of subcapsular haematoma) and mortality.