肝疾病(外科学第八版)PPT课件.ppt

肝疾病LiverDisease,1,.,学习要求,掌握肝脓肿、肝癌的诊断和外科治疗。熟悉肝脏的解剖特点，细菌性和阿米巴性肝脓肿的鉴别诊断。了解肝囊肿、肝海绵状血管瘤的诊断和治疗原则。,2,.,SurgicalAnatomy,标志血管肝门分叶分段,3,.,Liverfunctions,分泌胆汁代谢功能凝血功能解毒作用吞噬和免疫作用,再生能力强,缺氧耐受力差,4,.,肝脓肿Liverabscess,5,.,Pathogenesis,BiliarytreeHepaticarteryPortalveinNearbyinfectionTrauma,6,.,ClinicalFeatures,FeverandchillsRUQpainandtendernessHepatomegalyJaundiceNonspecificsymptoms,7,.,Lab.andimaging,WBC,HGBUltrasound,X-Ray,CTFNA,8,.,Differentialdiagnosis,AmebicliveabscessIntrahepaticbiliaryinfectionsCanceroftheliverSubphrenicabscess,9,.,Treatment,SupportivetherapyEnergyandnutritionElectrodesandfluidBloodtransfusion,10,.,Treatment,AntibioticsASAP,ifsuspectedBroadspectrum,coveringG+,G-andanaerobesDuration2w,recommended,11,.,Treatment,DrainagePercutaneousLaparotomyLaparoscopic,12,.,Treatment,HepatectomyTraditionalmedicine,13,.,肝囊肿(Cystoftheliver),14,.,肝棘球坳病Echinococcosisoftheliver,肝包虫病（Hydatid）牧区生活史血清学+影像学手术治疗为首选,15,.,先天性肝囊肿congenitalcystofliver,囊壁内层附有内皮细胞液体清亮，多不含胆汁大而有症状者需适当治疗腹腔镜下开窗术首选，也可选穿刺。注意：与胆道相通囊肿、病变广泛的多囊肝。,16,.,肝肿瘤（tumorofliver),17,.,肝海绵状血管瘤Cavernoushemangiomaofliver,生长缓慢较小时多无症状CT、MRI不难诊断小而无症状者随访手术切除适应证,18,.,小结,肝脏解剖肝脓肿临床表现与阿米巴性肝脓肿的鉴别治疗方法,19,.,原发性肝癌Primarylivercancer,20,.,Epidemiology,Common600000newcasesfoundannually55%occursinChinaMFHighincidenceintheageof40s,andatendencytodevelopearlier,21,.,Etiology,LivercirrhosisHBVAflatoxin(AFT)ChronicalcoholabuseHCVChemicals:nitrites,hydrocarbons,solvents,pesticides,vinylchloride,22,.,Pathology,CategoriesCancercellsMorphologySizeMetastasisintrahepaticextrahepatic,23,.,ClinicalPresentation,RUQabdominalpainNonspecificsymptomsHepatomegaly,24,.,Diagnosis,HCCmarkersAlphafetoprotein(AFP)SerumenzymologyImagingUltrasoundCTandMRIDSAX-raysFNAandBiopsy,25,.,Diagnosis,26,.,27,.,28,.,Treatment,治疗原则早期诊断，早期治疗，根据不同病进行综合治疗首选方法早期施行手术治疗,29,.,Treatment,SurgicaltreatmentResectableHepatectomy(Radical,Palliative)Unresectable(op.inprocedure)HAL,EI,RFA,MWA,CryotherapyRecurrentPerforatedLivertransplantation,30,.,肝切除术,31,.,Treatment,PercutaneousablationRFAMWAPEI,32,.,Treatment,ChemotherapyTACE:reco-Generalchemotherapy:notreco-SustainedreleaseagentRadiotherapyBiologicaltreatme