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26COMPREHENSIVE DIAGNOSIS OF LIVER
ECHINOCOCCOSIS (LITERATURE REVIEW) 1 "2 "l Usarov Sh.N. , Umirov Kh.A. , Yusupalieva D.B. ,
Tilavova Yu.M.4
1 Usarov Sherali Nasritdinovich - Assistant; Umirov Khushvaqt Alisherovich - Master Student, DEPARTMENT OF SURGICAL DISEASES № 1, SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND;
Yusupalieva Dilnora Bakhodir qizi - Student, FACULTY OF MEDICINE, TASHKENT PEDIATRIC MEDICAL INSTITUTE, TASHKENT;
4Tilavova Yulduz Muhammadshukur qizi - Student, DEPARTMENT OF SURGICAL DISEASES № 1, SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: the article presents a modern view on the epidemiology and diagnosis of liver echinococcosis, according to domestic and foreign literature. When this disease requires a comprehensive examination of patients (ultrasound, computed or magnetic resonance imaging, laparoscopy, serological reactions). Magnetic resonance imaging allows you to effectively examine such patients, to conduct differential diagnosis of the disease. It provides an opportunity to identify the morphological characteristics of the development of echinococcosis, which is important when choosing a method of operation. In addition, MRI can be recommended as a second (after ultrasound or computed tomography), specifying the method of diagnosis in difficult cases when it is necessary to determine the relationship of cysts with the vessels of the liver and bile ducts.
Keywords: liver echinococcosis, diagnostics, ultrasound, computed or magnetic resonance imaging, laparoscopy, serological reactions.
Introduction. Hydatid echinococcosis of the liver is a severe chronic parasitic disease in humans and animals caused by the parasitization of the larval stage of single-chamber
echinococcosis. Echinococcosis is a serious medical and social problem in many countries of the world where large endemic foci persist and an increase in the number of cases is observed. This disease is characterized by long-term chronic, severe organ, and systemic pathology, extensive lesions leading to disability and often - in patient death [7, 11, 18, 25].
The increase in the number of stray dogs, their high prevalence of echinococcus, the stability of oncospheres in the external environment are the main factors in the spread of this disease. Echinococcosis is more often observed in regions with a low level of socio-economic development and sanitary culture of the population. The problem of cystic echinococcosis is very relevant for practical public health [9, 17, 26].
To date, the problem of increasing the efficiency of diagnosing echinococcal diseases remains topical, despite the use of modern methods of medical imaging. In many cases, radiation testing of such patients ends with an indefinite conclusion.
From 37% to 86% of patients are admitted to hospital in the stage of clinical complications of echinococcosis [7, 16, 20, 27].
The purpose of the work is to clarify the optimal methods of diagnosis of hydatid liver echinococcosis according to the data of domestic and foreign literature for choosing a rational method of surgical intervention. Diagnosis of liver echinococcosis is based on epidemiological, clinical, laboratory data and materials of special research methods. When liver echinococcosis, some laboratory parameters change (eosinophilia, accelerated ESR, leukocytosis with cyst suppuration).
The diagnostic algorithm for liver echinococcosis includes: a clinical study, an epidemiological history, a laboratory study, an ultrasound scan, computed tomography (or magnetic resonance imaging), laparoscopy, angiography as needed with an unclear diagnosis [2, 14]. In the diagnosis of liver echinococcosis, the main are clinical data, the results of immunological reactions, ultrasound data, CT scan (MRI) and laparoscopy. These special methods should be applied consistently. But in many cases, one ultrasound allows you to answer all diagnostic questions [1, 6].
Ultrasound is one of the most effective methods for diagnosing liver focal lesions; it is used as a screening in such patients. Uncomplicated hydatid cyst is a rounded education with smooth walls, a clear capsule (in 70 -85%), liquid contents. Child cysts can be detected in the form of rounded formations inside the cyst, compact echo-negative sites, with complicated echinococcosis, irregularity of echo signals with the presence of hyperechoic inclusions is observed. The extinction of some of them indicates necrotic changes in the contents of the cyst. With the detachment of the cuticular sheath from the fibrous and partial destruction of the cyst, the phenomenon of "wall crack" or "floating shell" is observed. After a cyst breaks into the bile duct or the abdominal cavity, a decrease in cyst size is detected. With thick-walled and calcified cysts, strong echoes are recorded from the anterior wall of the cyst, behind which an echo-negative ultrasound pathway is detected. Vascularization of cysts and the course of the main vessels of the liver are evaluated in the mode of color Doppler mapping and energy doppler [1, 8, 12, 27].
Ultrasound in combination with serological reactions to echinococcosis allow in most cases to establish the diagnosis of the disease. Ultrasound and CT often lead to late diagnosis. Difficulties of differential diagnosis arise with small sizes of cysts and their pseudo-tumoral forms [7, 13, 20]. In recent years, CT and MRI have been increasingly used to diagnose liver echinococcosis.
Ultrasound sensitivity in the diagnosis of liver echinococcosis -87.2-96%, and diagnostic accuracy -83.7-92% [4, 10, 16, 24]. False-negative results are associated with the fact that in complicated liver cysts, the interpretation of ultrasound changes is difficult. In case of marginal, echographically atypical formations of the liver that are suspicious of the tumor nature, determination of the nature of intracystic inclusions (daughter cysts, partitions, etc.) facilitates differential diagnosis. Serological reactions, as well as data from cytological, bacteriological, biochemical studies and microscopy of the native material obtained by transcutaneous diagnostic puncture under ultrasound control, contribute to the diagnosis. Ultrasound examination is less informative with
multiple and common echinococcosis, with giant cysts. In these cases, it is advisable to combine ultrasound with CT or MRI [6, 10, 15, 25].
Computed tomography is used to clarify ultrasound data for the purpose of differential diagnosis between echinococcal and non-parasitic liver cysts in diagnostically unclear cases. Densitometric indices for these cysts are different: for an echinococcal cyst, 1025 units. H, with a non-parasitic cyst - 0-15 units. N. After the death of the parasite, the density of the cyst contents increases significantly - 20 units. H and more [6, 13, 16, 23]. With the help of CT, one can judge the thickness of the fibrous capsule (usually -2-3 mm) and the presence of calcification in it; to identify the areas of destruction of the capsule, and sometimes the exit of daughter cysts outside the capsule [11]. The maximum value of the total diagnostic accuracy of CT parameters in liver echinococcosis reaches 82.1-84.5% (a clear education circuit), and sensitivity - 95-100% (hyposensitive nature of education) -[2, 8, 17, 21].
To select the optimal treatment method, high accuracy of diagnosis is of particular importance. At the present stage, MRI is increasingly being used to study the organs of the abdominal cavity (primarily the liver). Tomograms are obtained in T1- and T2- modes, including - with the suppression of the signal from fat, in the axial, sagittal and coronary planes, as well as in the modes of hydrography, "thick" and "thin" sections. In order to assess liver vessels, a 3-dimensional MR is performed - arteriography and phlebography [5, 23].
With MRI, echinococcal cysts of the liver are usually multi-chamber, have liquid contents of varying intensity of the MR signal, which is especially clearly detected on T2-weighted tomograms. In the walls of the cysts, multiple calcifications are often identified, having bone density on CT and hypointense on MRI. The maximum value of MRI parameters in echinococcal cysts of the liver reaches 90.4 - 93.6%, and sensitivity - 96-100% [15, 22]. On T2-Vi, an echinococcal cyst is detected as a section with an increased intensity of the MR signal, an irregularly rounded shape, with clear, even contours. The hydatid fluid has a
uniform hyperintense signal with its moderate hypointensity in the basal regions in the presence of a large amount of "hydatid sand" in the cyst. Partitions in the lumen of the cyst, the walls of the secondary cysts have a hypointense signal. The difference in the hypointensity of the fibrous capsule and the chitinous membrane of the parasite creates on the tomograms a two-layer image of the wall of the cyst, which is characteristic only of a parasitic cyst and allows it to be differentiated from other cystic formations. Linear areas of reduced signal intensity in the lumen are characteristic of a dead cyst and are a detached chitinous membrane. The use of MR angiography (MRA) and MR cholangiopancreatography (MRCP) allows precise localization of the length and topographic relationship of the cyst with a large vessel, intrahepatic bile duct, which significantly reduces the risk of intraoperative complications [3, 17].
Typical Mr signs of echinococcus cysts were characteristic in all cases if the diameter of the cysts was more than 3 mm. With a smaller diameter of cysts, differential diagnosis with other cystic formations of the liver is extremely difficult. In such cases, immunological tests (latex agglutination, indirect hemagglutination, enzyme immunoassay) help in clarifying the diagnosis [12, 19].
With the help of MRI, it is possible to reveal the aggressive nature of the course of liver echinococcosis (the presence of endo-exogenous budding, which leads to a change in treatment tactics - the abandonment of minimally invasive surgical treatments [14, 15].
Percutaneous diagnostic punctures in echinococcal liver cysts are considered dangerous due to the danger of seeding the germinal elements of the parasite of the wound channel along the trajectory of the needle and the abdominal cavity. However, the emergence of special tools and the development of techniques for performing percutaneous punctures that prevent the development of complications, made it possible to widely introduce percutaneous interventions for diagnosing, and later for treating patients with echinococcosis [3, 5, 19].
Detection of echinococcal cyst of the liver is an indication for surgery, regardless of its size and location. Currently, in addition to traditional operations, minimally invasive interventions are becoming more widely used: laparoscopic, percutaneous with ultrasound navigation and mini-access operations [20, 24].
Conclusions. Thus, in the preoperative algorithm for examining patients with liver echinococcosis, it is advisable to use a set of diagnostic methods (at the first stage, an ultrasound scan, to clarify the diagnosis, CT, MRI, video laparoscopy, serological reactions). MRI can be used in diagnostically difficult cases, to determine the localization of cysts of the abdominal cavity, the relationship of cysts with the vessels of the liver and bile ducts, which is important for choosing the optimal method of operation.
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