Percutaneous Radio-Guided Chemical Ablation with Absolute Ethanol of Cystic and Solid Lesions in Kinshasa Hospital Environments
Introduction: the main objective of the present study is to evaluate the therapeutic effectiveness and safety of percutaneous radio-guided chemical ablation with absolute ethanol (96%) in the therapeutic management of cystic and solid lesions. benign localization: thyroid classified EU-TIRADS 2, parathyroid, hepatic, renal, inguino-scrotal, ovarian as well as osteoarticular. Materials and Methods: Eighty patients were included in the present study. Ages ranged from six to seventy-five. After ultrasound reassessment, psychological preparation, premedication and local anesthesia; we perform a puncture-drainage of the lesion under strict ultrasound guidance with good visualization of the bevel, followed by rinsing for certain lesions and injection of 96% ethanol. The volume of ethanol injected was obtained by calculating 10 to 20% of the overall volume of the lesion. We performed one to three sessions of Sclerotherapy on our patients, particularly on D1-D4 and D7. We studied the effectiveness of sclerotherapy through the complete drying of the lesion, the reduction of the lesion volume to more than 50% of the initial volume as well as the disappearance of the pain. As for recidivism; it was evaluated by the persistence of pain, the persistence or reappearance of the cystic lesion with a residual volume estimated at more than 50%. Results: Out of eighty patients listed; We recorded 46.2% men and 53.8% women, with a sex ratio of 0.83%. The age of the patients was between 6 -75 years with an average age of 43.5±17.5 years. The youngest patient was 6 years old and the oldest 75 years old. The 37-47 age groups were the most represented with 26.3%. The majority of women were aged between 26-36 and 37-47 years, respectively 27.5% of the entire workforce. In addition, 17.5% of men were aged between 48-58 years. Nearly 55% of our patients consulted for cervical swelling; on an anatomopathological level; almost 64% of our patients had an inflammatory smear. 42.5% of the lesions treated were of thyroid location and the number of alcohol sessions depended on the organ treated, the content of the alcoholic lesion, gender without forgetting the volume of the alcoholic mass. Radiologically, the success rate was 95%, apart from one treatment failure in four patients who were asymptomatic. No complications; haemorrhagic or infectious has been encountered; except for one case of hypoglycemic shock, which was quickly corrected. Conclusion: Ethanol 96% is an effective liquid sclerosing agent treating benign cystic lesions: thyroid EU-TIRADS2, parathyroid, hepatic, renal Bosniak Ia, osteoarticular, inguino-scrotal as well as ovarian. Given the ease of obtaining ethanol in sub-Saharan hospital environments; Kinshasa in particular, the simplicity of the procedure, the low morbidity rate and its effectiveness; obliges us to recommend percutaneous ethanol sclerotherapy as a treatment of first choice instead of other complex percutaneous ablation techniques. The average volume of ethanol used was 12.85 ml; the largest volume of ethanol was 40 ml and the smallest volume was estimated at 2 ml. The average volume of treated lesions was 106.12 ml, the smallest lesion volume was 4 ml, and the large volume was 814 ml.
