Non-parasitic liver cysts

　　Most liver cysts are congenital, caused by developmental disorders of intrahepatic bile ducts or lymphatic vessels. During the period of embryonic development, the extra bile ducts regress spontaneously without connecting with the distal bile ducts; if the extra bile ducts in the liver do not regress and absorb, and gradually expand into segmented and cystic shapes, cysts may form. Polycystic liver often accompanies polycystic kidney, pancreatic cysts, lung or spleen cysts, and other malformations, and can also serve as evidence of congenital developmental abnormalities. Polycystic liver can occur in different members of the same family, so the occurrence of polycystic liver may be related to chromosome recessive inheritance, and solitary liver cysts are attributed to ectopic bile ducts. It is believed that such cysts originate from the atypical bile ducts in the liver or congenital intrahepatic bile ductal epithelial hyperplasia obstruction, leading to stasis and retention of the contents of the lumen.

　　1. Intracystic hemorrhage:The most common complication is intracystic hemorrhage, which is manifested by sudden severe abdominal pain and enlargement of the cyst. This complication is almost seen in women over 50 years old, but in a very small number of patients, the pain is relatively mild, or even not present. During ultrasound observation, the cyst contents appear to be mobile when bleeding occurs.

　　2. Cyst rupture or infection:When the cyst ruptures and complications such as infection occur inside, chills and high fever may occur; pressure on the duodenum may form internal fistula; portal hypertension, etc.,

　　3. Cyst pedicle torsion:It can cause severe abdominal pain.

　　4. Malignancy:In 1977, Kasai et al. reported 3 cases of cancer occurring on the wall of liver cysts, pointing out that if the contents of the cyst are turbid and there are irregular nodules on the cyst wall, it should be vigilant about the issue of malignant transformation.

　　5. Other:In addition, multiple cysts can also be accompanied by bile duct stenosis and cholangitis.

　　For patients with non-parasitic liver cysts, if the cysts are small, there are often no obvious symptoms, and it is difficult to make a diagnosis, which is often found during physical examination or abdominal surgery; when the cysts are large, they can cause discomfort or pain in the upper right abdomen, a feeling of fullness after meals, liver enlargement and a mass in the upper right abdomen, which is palpable as a cystic feeling, without obvious tenderness, and multiple liver cysts can feel scattered cystic nodules on the liver surface. When there is bleeding inside the cyst, combined infection, or pedunculated cyst torsion, acute abdominal symptoms may occur.

　　To prevent non-parasitic liver cysts, regular examinations of the liver, kidney, pancreas, ovary, lung, and other organs should be carried out, and attention should be paid to the following items.

　　1. Pay attention to rest:Liver cyst patients should pay attention to rest, avoid overwork or fatigue, and aggravate liver injury.

　　2. Abstain from drinking alcohol:Eat less spicy, fried foods, and foods that are too sweet; avoid blind supplementation, or do not easily believe in the advertisements of health products, in order to avoid damage to the liver or increase the burden on the liver.

　　3. Eat more red vegetables:Recommend red vegetables and fruits such as carrots, tomatoes, jujube, and pitaya. Drink plenty of water. Drinking plenty of water can enhance blood circulation, promote metabolism, and also promote the secretion of glands, especially digestive glands and pancreatic juice, bile.

　　4. Eat more food rich in high-quality protein:Pay attention to the supplementation of high-fiber and high-dietary fiber foods, and low-fat, appropriate sugar diet; do not have a one-sided diet, and all kinds of cereals, fresh vegetables and fruits, lean meat of cattle, sheep, and pigs, poultry eggs, milk, fish and shrimp can be eaten.

　　Non-parasitic liver cysts should undergo B-ultrasound, X-ray examination, and CT scan, as specified below:

　　1. Karnovsky test is positive.

　　2. B-ultrasound examination can determine the size, location, and number of cysts.

　　3. Liver radionuclide scanning can show occupying lesions (cysts with a diameter greater than 2-3 cm).

　　4. X-ray examination often shows signs of liver shadow enlargement, diaphragmatic elevation, and compression and displacement of the gastrointestinal tract.

　　5, CT examination is helpful for diagnosis and differential diagnosis.

　　In addition to general treatment, non-parasitic liver cysts can also be treated by diet therapy to alleviate symptoms. The diet therapy recipes are as follows.

　　1, Duck Congee:Take 100 grams of duck blood, 100 grams of crucian carp, 100 grams of white rice, cook into congee for consumption.

　　2, Chicken Liver Congee:Take 3 fresh chicken livers, 100 grams of rice, cook together into congee for consumption.

　　3, Silver Ear and Duck Egg Pudding:Duck egg 1, silver ear 10 grams, appropriate amount of rock sugar. Soak the silver ear in warm water, remove impurities, wash, cook in a pot with water, cook for a period of time, beat the duck egg into a bowl, mix well, pour into the congee, boil, add rock sugar and cook slightly, serve in a bowl.

　　4, Hougu Cough Drink:Hougu 60 grams, raw egg 150 grams, sugarcane juice 50 milliliters, pomegranate juice 20 milliliters. Peel the hougu, cut into thin slices, add water to a pot, boil for 30 minutes, cool slightly, filter and take the juice. Add sugarcane juice, pomegranate juice, and egg yolk to the hougu juice, boil, and it is ready.

　　5, Five-juice Drink:Horsehoof, pear each 150 grams, lotus root, reed stem each 100 grams, miltiorrhiza 20 grams. Peel the horsehoof, squeeze the juice, wash the pear and lotus root, squeeze the juice for standby; wash the reed and miltiorrhiza, decoct separately and take 100 milliliters of juice for standby. Finally, mix the five kinds of juice to make it.

　　The treatment of non-parasitic liver cysts includes general treatment and surgical treatment, as follows:

　　First, general treatment

　　(1) Cyst diameter

　　(2) Solitary cysts with a diameter of 5-10 cm or multiple liver cysts with two cysts larger than 5 cm can consider surgical treatment. When there are abdominal masses, pain, or significant compression symptoms, or when complications occur, surgical treatment should be considered.

　　(3) For the elderly with poor physical condition or明显 abnormal function of important organs, it should be cautious when deciding on surgical treatment. Patients with polycystic kidney disease and severe renal impairment are generally not suitable for surgery.

　　Second, surgical treatment

　　For solitary liver cysts, unless complications such as cyst rupture, pedicle torsion, or intracystic hemorrhage require emergency surgical treatment, elective surgery should be determined according to the size and location of the cyst, and the patient's overall condition and subjective symptoms. Solitary liver cysts with no symptoms found occasionally during physical examination can be temporarily treated conservatively, using ultrasound examination to observe regularly and be vigilant for the occurrence of malignant transformation. Large liver cysts with symptoms should be treated with surgery, as conservative therapies such as puncture and aspiration are generally prone to recurrence and can lead to bacterial contamination. Polycystic liver disease usually should be treated conservatively. Since the lesions involve the entire liver, liver transplantation is usually required to根治 this disease, however, if polycystic liver disease causes liver enlargement that compresses the thoracic and abdominal cavity, affecting respiration and circulation, surgery should be considered to relieve pressure. The specific surgical method can be determined according to specific conditions:

　　(1) Cyst puncture and aspiration: Under the guidance of B-ultrasound, puncture the cyst percutaneously and aspirate the cyst fluid. This method is simple to operate and can be repeatedly punctured or catheterized after puncture. It is necessary to exclude liver hydatid cysts before puncture. Strict aseptic technique should be followed to avoid intracystic hemorrhage and abscess formation.

　　(2) Cyst resection: This type of surgery can be used for solitary cysts that are easy to peel off, and the treatment is relatively thorough.

　　(3) Cyst 'fenestration' operation: Used for cysts located in the superficial layer of the liver and without infection or when there is no communication between the bile duct and the cyst. Cut a part of the top wall of the cyst (i.e., 'fenestration'), aspirate the cyst fluid, and open the cyst cavity to the peritoneal cavity. If the cyst is complicated by infection or there is old blood in the cyst, clean the cyst cavity after fenestration, and fill the cyst cavity with part of the pedunculated omentum, and perform peritoneal 'cigarette' drainage. If the cyst fluid is contaminated with bile, clean the cyst cavity, confirm that there is no continued leakage of bile, and then block the cyst cavity with omentum as described above.

　　(4) Internal drainage of cysts: Used for cysts with leakage of bile juice inside, it is difficult to find the bile duct opening or the cyst wall is thick and the infection is severe.

　　(5) Atypical partial resection of liver and cyst 'fenestration' operation: For diffuse liver cysts, if a lobe has dense cysts and is compressed, causing significant atrophy of the liver parenchyma in that lobe, an atypical partial resection can be performed, and the remaining liver cysts can be treated with 'fenestration' surgery.

　　(6) External drainage of cysts: When cyst infection occurs and it is difficult to tolerate other more complex surgeries, temporary external drainage of cysts can be performed, but it is easy to form a long-term unhealed external fistula, which often requires a second operation.

　　(7) Surgical treatment for polycystic liver: Unless the lesion is localized to one lobe of the liver and accompanied by symptoms, or there is a suspicion of malignancy, it is generally not recommended to perform surgical treatment. When a cyst in the polycystic liver expands rapidly and compresses adjacent organs, severely affecting the patient's daily life, or when the respiratory and cardiovascular functions are affected, repeated puncture and aspiration of the larger cysts can be performed. If the patient's overall condition is good and the liver function is normal, a fenestration operation can also be performed to reduce pressure, relieve symptoms, and promote the regeneration of liver cells. Those who have the conditions can undergo liver transplantation for a thorough cure of the disease.

　　(8) Treatment for polycystic liver combined with polycystic kidney: The treatment of polycystic liver refers to the above plan for polycystic kidney. When there are no symptoms, it can be observed and regularly reviewed. If the kidney function shows symptoms (such as back pain, hematuria, hypertension, kidney failure, etc.), surgical treatment is required, including puncture or incision of the cyst, reduction of cyst pressure, which can sometimes delay the progression of the disease. Dialysis therapy is necessary for kidney failure. The radical method requires kidney transplantation.