Modern approaches to diagnosis and minimally invasive treatment of hepatic echinococcosis

Background. Hepatic echinococcosis remains a relevant surgical problem in endemic regions, including Uzbekistan. Improvement of the diagnostic algorithm and introduction of minimally invasive technologies enhance treatment efficacy and reduce complication rates. The purpose was to improve the efficacy of surgical treatment for hepatic echinococcosis and its complicated forms through the introduction and optimization of minimally invasive endovideosurgical and navigation-puncture technologies. Materials and methods. Treatment outcomes were analyzed in 448 patients with hepatic echinococcosis. The study group (n = 236) received minimally invasive endo­videosurgical and navigation-puncture methods; the control group (n = 212) underwent traditional open surgery. Comprehensive diagnosis included ultrasound, CT, MRI, ERCP, portal circulation Doppler ultrasonography, and biochemical and serological investigations. Statistical analysis: χ2 test, Mann-Whitney U test; p < 0.05. Results. Diagnosis was verified in 99.1 % of cases. Minimally invasive methods were employed in 65.3 % of the study group. Postoperative complications in the study group were 8.1 versus 24.1 % in the control group (p < 0.05). Recurrence rates: 6.7 % in minimally invasive interventions versus 12.3 % in open surgery (p = 0.01). Conclusions. Sequential application of ultrasound, CT, MRI and ERCP ensures accurate verification of cyst type and location. Differentiated surgical tactics employing minimally invasive methods combined with anthelmintic therapy and hepatoprotectors significantly reduces postoperative complication rates, recurrence and mortality.

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