Anterior liver abscess incision and drainage

Anterior hepatic abscess incision and drainage for surgical treatment of liver abscess. General anesthesia plus continuous epidural anesthesia is generally used. The left liver abscess is generally taken in the supine position, and the right liver abscess is placed on the right shoulder and buttocks with a sand bag, so that the body is tilted 30° to the left. Treatment of diseases: liver abscess Indication The anterior hepatic abscess incision drainage method is applicable to: 1. Other therapies are ineffective, and the symptoms of poisoning are more serious. 2. There are cases of primary infection (appendicitis, biliary infection) in the abdominal cavity, which need to be treated together. 3. The abscess is large, and the pus is thick, the septum is separated, and the abscess is unable to puncture the tube drainage. Contraindications Old and frail, with severe heart disease, can not tolerate liver abscess incision and drainage. Preoperative preparation Whether it is bacterial liver abscess or amoebic liver abscess, due to the absorption of inflammatory toxins, patients with long-term fever, consumption, and more malnutrition, anemia, hypoproteinemia, etc., the general situation is poor. Actively improve the general condition before surgery, strengthen nutrition, appropriate transfusion, correct anemia and water and electrolyte imbalance, and should apply large doses of effective antibiotics or anti-amebic drugs for different types of liver abscess; in addition, should pass the physique Check B-ultrasound or CT examination, try to identify the location of the abscess in order to choose the surgical approach and surgical methods. Surgical procedure 1. The oblique incision of the right costal margin, after entering the abdominal cavity through each layer of the abdominal wall, the liver is examined, the abscess is clearly defined, and the saline gauze pad is used to protect the surrounding area of the surgical field. After pus extraction with a puncture needle, blunt insertion into the abscess with a hemostatic forceps in the direction of the needle (eg, the abscess is superficial, or an abscess can be cut with an electric knife), the pus is drained, and the pus is sent to the bacterial culture and the Gram stain. Then use your fingers to reach into the abscess, gently separate the interstitial tissue in the abscess, and absorb the pus. Remove the necrotic tissue in the abscess, repeatedly flush the abscess with saline or antibiotic flushing solution, place a porous soft rubber tube or double cannula drainage in the abscess, and cover the drainage tube with a large omentum. The drainage tube is taken out from the hole below the incision and properly fixed. The abdominal wall incision was sutured layer by layer. It is also advocated that the top of the abscess should be removed in a large block, and all the intervals must be opened. The resected wall of the abscess should be sent for pathological examination. If the wall of the abscess is thick after the topping, the cutting edge should be "8" and twisted. Or continuous seam stitching to prevent bleeding from the cutting edge. A porous drainage tube is placed in the cavity and a part of the omentum is filled. 2. If the abscess is located on the anterior side of the right lobe of the liver and is intimately attached to the anterior peritoneum, the anterior extraperitoneal approach can also be used to drain the pus. The method is as follows: the oblique incision of the right costal margin is performed, and the peritoneum is directly transmitted through the layers of the abdominal wall, but the peritoneum is not cut. Use your fingers to push the muscle layer upside down the peritoneum and go straight to the abscess. At this point, you can see the peritoneum of the edema, that is, puncture the pus into the abscess. After the pus was drawn, the hemostatic forceps were forcibly inserted into the abscess at the puncture site to discharge the pus. After using the finger into the abscess, the septal tissue was separated from the abscess and the pus was absorbed. Place a drainage tube inside the abscess. The incision was sutured layer by layer.