肝囊肿

　　肝囊肿有先天的，也有后天的。先天性肝囊肿是由于胚胎时期肝内胆管或淋巴管发育异常造成的；后天性肝囊肿可能是肝脏管道发生退行性改变的结果。
　　由于形成的原因不同，可以分成①先天性肝囊肿，②创伤性肝囊肿，③炎症性肝囊肿，④肿瘤性肝囊肿，⑤寄生虫性肝囊肿。平常我们见得最多的90％以上的囊肿就是先天性肝囊肿（也叫真性囊肿）。
　　先天性肝囊肿：由于肝内胆管和淋巴管胚胎时发育障碍，或胎儿期患胆管炎，肝内小胆管闭塞，近端呈囊性扩大及肝内胆管变性，局部增生阻塞而成，多为多发。
　　创伤性肝囊肿是肝脏外伤后的血肿或组织坏死液化形成的一个囊腔，因为它不是一个真正的囊肿，所以也把它叫做假性囊肿。
　　炎症性肝囊肿是由胆管发炎或结石梗阻引起的胆管囊状扩张，内容物是胆汁，也叫胆汁潴留性囊肿。
　　肿瘤性囊肿包括畸胎瘤、囊状淋巴管瘤、囊腺瘤等。
　　寄生虫性囊肿主要是肝包虫性囊肿，病人在牧区接触犬、羊或直接食入棘球蚴绦虫卵后，虫卵在肠道孵化成幼虫进入血液停留肝脏生长发育成包虫成虫，并在肝脏内形成包虫生活的一个“窝”，这个“窝”就叫肝脏包虫囊肿。

　　肝囊肿常见的并发症是破裂出血、细菌感染、瘘及穿透，罕见癌变。
　　囊肿感染
　　囊肿感染是多囊肝的少见并发症，近期有过腹部手术史肾移植和慢性炎症为其危险因素。表现为发热右上腹痛、血沉加快、血白细胞增多、血清碱性磷酸酶升高，较少有胆红素及谷草转氨酶的升高，绝大多数以大肠杆菌感染为主。CT检查发现囊肿内有气泡形成提示感染。如果近期有囊肿穿刺史或含气的胆管相通但CT上亦显示看到气体囊肿穿刺抽液有利于诊断治疗以囊液引流加抗生素治疗为主
　　Other complications
　　Polycystic liver can be complicated by obstruction of the liver venous outflow tract, causing obstructive jaundice. Some patients have congenital fibrosis, with onset age ranging from birth to 24 years old, often accompanied by splenomegaly and portal hypertension.

　　Liver cysts grow slowly, so they may remain asymptomatic for a long time or even throughout life. Their clinical manifestations vary with the location, size, number of cysts, and whether they compress adjacent organs or have complications.
　　Congenital small liver cysts often have no symptoms, and symptoms usually appear when they grow to a relatively large size, including upper abdominal distension, pain, abdominal mass, and liver enlargement. If there is concurrent infection, there may be fever and pain, and inflammatory manifestations.
　　Liver cysts can cause pain in the liver area, abdominal distension, and sometimes sudden enlargement of the cyst or secondary infection, which can lead to sudden exacerbation of abdominal pain or fever. Sometimes, a mass can be felt in the upper abdomen, and some patients may experience abdominal pain, vomiting, and jaundice. When the liver cyst compresses the stomach, patients may be unable to eat normally or have a full meal; when it compresses the heart, symptoms of heart failure may occur, such as chest tightness, difficulty breathing, coughing, and expectoration.
　　When liver cysts undergo malignant transformation and trigger liver tumors, symptoms such as weight loss, fatigue, anemia, abdominal pain, and liver enlargement may occur. Once detected, active treatment is needed.

　　There is currently no effective preventive measure for congenital liver cysts; acquired liver cysts are often caused by trauma, inflammation, or even tumors, so it is important to actively treat the primary disease. To prevent the occurrence of liver cysts, attention should be paid to:
　　1. Change daily dietary habits, reduce the fat content and total calories in food. Whether you are a carrier of hepatitis B virus or a patient with hepatitis B, a reasonable and balanced diet is always an important link in daily life. If you can pay attention to dietary adjustment, it will help improve your immunity and improve liver function, and you can still live a long and healthy life.
　　2. Alcoholic beverages: Alcoholic beverages, especially white wine, are advisable for polycystic liver patients to quit. The刺激性 of alcohol to the liver is particularly important, as it can accelerate the growth of cysts, and also requires the liver to be decomposed, which increases the burden on the liver and damages liver cells.
　　3. Avoid eating greasy and spicy foods in large quantities to prevent additional damage to the liver. On the basis of ensuring necessary nutrition, the diet should be as light as possible, and it is better not to eat grilled or fried foods.
　　4. Pay attention to rest: Liver cyst patients should pay more attention to rest and avoid overwork or exhaustion, which may worsen liver damage.

　　Ultrasound examination
　　Liver cyst examination is the preferred method of ultrasound examination, with ultrasound imaging having the most diagnostic value. It is not only cheap, simple, and accurate, but also reliable, as it can clearly show typical fluid-occupied lesions.
　　Liver CT
　　CT is of great significance in the diagnosis of liver cysts, as it can display the entire liver on the CT film, showing all the cysts of various sizes on the liver. This image display is more comprehensive and clear than the B-ultrasound images we usually see, allowing a better understanding of the condition of liver cysts.
　　Casoni intradermal test
　　Cystic echinococcosis of the liver can be tested with the Casoni intradermal test for hydatid fluid, but diagnostic puncture is prohibited to avoid causing anaphylactic shock and the spread of hydatid disease in the peritoneum.

　　Patients with liver cysts should pay attention to their diet:
　　Patients with liver cysts should eat more foods that can enhance immunity, such as yam, turtle, mushrooms, kiwi, fig, apple, sardine, honey, milk, and pork liver.
　　Patients with liver cysts should eat more anti-cancer, anti-tumor foods to enhance immunity and supplement adequate amounts of protein. Foods rich in selenium and iron, such as spinach, seafood, eggs, etc., can be eaten appropriately, with good anti-cancer and anti-tumor effects. It is essential to ensure sufficient protein intake daily, with abundant protein in soy products, milk, and lean meat. Foods like yam, mushrooms, honey, pork liver, and fresh fruits like kiwi, apple, grape, etc., can provide the body with the necessary vitamins and minerals, enhancing the body's immunity. Garlic, with its excellent anti-cancer, anti-tumor, and digestive aid properties, can be consumed appropriately.
　　Patients with liver cysts should eat more vitamin-rich foods, such as fresh fruits and vegetables. This not only provides the body with the necessary nutrition but also has an auxiliary anti-tumor, anti-cancer effect, preventing the transformation of liver cysts into cancer.
　　Patients with liver cysts should also pay attention to a light diet, avoiding spicy and stimulating foods, fried and smoked foods, and fermented foods. Smoking and drinking are strictly prohibited to avoid accelerating the growth of the cyst.

　　Liver cysts will not affect liver function or develop into liver cancer. Those without obvious symptoms or liver function impairment may not require treatment, and regular follow-up is sufficient.
　　If the liver cyst is large in size, with obvious clinical symptoms, and the patient cannot tolerate the symptoms, or it has affected liver function, surgical treatment may be considered. Partial cystectomy, also known as 'windowing surgery', is usually performed. For those with clear cyst fluid without bile, the superficial cyst wall can be removed while retaining the cyst wall within the liver parenchyma, allowing the cyst fluid to drain into the peritoneal cavity and be absorbed by the peritoneum; the same method can be applied to polycystic liver. For those communicating with the bile duct, efforts should be made to seal the cystic bile duct opening, and internal drainage surgery can be performed if necessary. Infection can be treated with drainage and catheter aspiration. It is also possible to treat by piercing the cyst percutaneously, aspirating the cyst fluid, and then injecting anhydrous alcohol to destroy the endothelial lining of the cyst wall. Under ultrasound guidance, a thin needle is inserted into the cyst, the fluid inside is aspirated with a fine needle, and then pure alcohol is injected to harden and occlude the liver cyst.
　　For solitary liver cysts, unless complications such as cyst rupture, pedicle torsion, or intracystic hemorrhage occur, emergency surgical treatment is required. Elective surgery needs to be determined according to the size, location of the cyst, and the patient's overall condition and自觉 symptoms. Surgical treatment involves removing the cyst along with the cyst membrane, which can alleviate the patient's pain.
　　Polycystic liver should generally be treated without surgery, as its lesions involve the entire liver, and the disease cannot be cured unless liver transplantation is performed. Once polycystic liver causes chest and abdominal compression due to liver enlargement, affecting respiration and circulation, surgical treatment should be considered to reduce pressure.
　　Large liver cysts with symptoms should be surgically treated because conservative therapies such as puncture and aspiration are generally prone to recurrence and may bring the risk of bacterial contamination. However, the following surgical methods can be used according to specific conditions:
　　1. Liver resection;
　　2. Cystectomy;
　　3. Fenestration of cysts or partial cystectomy;
　　4. Cyst internal drainage surgery;
　　5. Cyst puncture and aspiration, and sclerotherapy.
　　Surgical treatment for polycystic liver: Unless the lesion is limited to one lobe of the liver and is accompanied by symptoms; or there is suspicion of malignancy, surgical treatment is generally not recommended. When individual cysts in polycystic liver are found to grow rapidly, compress adjacent organs, and seriously affect the patient's daily life or cardiopulmonary function, repeated puncture aspiration of larger cysts can be performed. If the patient's overall condition is good, liver function is normal, a fenestration procedure can also be performed to reduce pressure, alleviate symptoms, and promote regeneration of liver cells. Liver transplantation can be performed under certain conditions to completely cure the disease.
　　Treatment for polycystic liver and polycystic kidney: The treatment for polycystic liver refers to the above plan. When there are no symptoms of polycystic kidney, renal function can be observed and re-examined regularly. If symptoms such as back pain, hematuria, hypertension, renal failure, etc., occur, surgical treatment is required, including puncture or incision of the cyst, reduction of cyst pressure, which can sometimes delay the progression of the disease and renal failure, and dialysis therapy may be necessary if necessary. The radical method requires kidney transplantation.
　　Traumatic liver cysts can be absorbed spontaneously if there is no infection or bile stasis. Otherwise, puncture drainage or surgical drainage may be required. Inflammatory liver cysts require surgical treatment of the primary disease, such as bile duct stones, bile duct stenosis, etc. Tumorous liver cysts often require surgery for resection. Hydatid liver cysts require surgical treatment. Most congenital liver cysts do not require treatment and only need regular observation. Some with faster growth, larger cysts, associated infection, and symptoms may require treatment.