肝疾病外科学第八版

肝疾病Liver Disease,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。,Surgical Anatomy,标志血管肝门分叶分段,Liver functions,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,肝脓肿Liver abscess,Pathogenesis,Biliary tree Hepatic artery Portal vein Nearby infection Trauma,Clinical Features,Fever and chillsRUQ pain and tenderness Hepatomegaly JaundiceNonspecific symptoms,Lab. and imaging,WBC,HGB Ultrasound, X-Ray, CTFNA,Differential diagnosis,Amebic live abscessIntrahepatic biliary infectionsCancer of the liverSubphrenic abscess,Treatment,Supportive therapyEnergy and nutritionElectrodes and fluidBlood transfusion,Treatment,AntibioticsASAP, if suspectedBroad spectrum, covering G+,G- and anaerobesDuration 2w, recommended,Treatment,DrainagePercutaneousLaparotomyLaparoscopic,Treatment,HepatectomyTraditional medicine,肝囊肿(Cyst of the liver),肝棘球坳病Echinococcosis of the liver,肝包虫病 （Hydatid ）牧区生活史血清学+影像学手术治疗为首选,先天性肝囊肿congenital cyst of liver,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。,肝肿瘤 （tumor of liver),肝海绵状血管瘤Cavernous hemangioma of liver,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,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,原发性肝癌Primary liver cancer,Epidemiology,Common600000 new cases found annually55% occurs in ChinaMFHigh incidence in the age of 40s, and a tendency to develop earlier,Etiology,Liver cirrhosisHBVAflatoxin (AFT)Chronic alcohol abuse HCVChemicals: nitrites, hydrocarbons, solvents, pesticides, vinyl chloride,Pathology,CategoriesCancer cellsMorphologySizeMetastasisintrahepaticextrahepatic,Clinical Presentation,RUQ abdominal painNonspecific symptomsHepatomegaly,Diagnosis,HCC markersAlpha fetoprotein (AFP)Serum enzymologyImagingUltrasoundCT and MRIDSAX-raysFNA and Biopsy,Diagnosis,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,Treatment,Surgical treatmentResectable Hepatectomy (Radical, Palliative)Unresectable (op. in procedure) HAL, EI, RFA, MWA, CryotherapyRecurrentPerforatedLiver transplantation,肝切除术,Treatment,Percutaneous ablationRFAMWAPEI,Treatment,ChemotherapyTACE: reco-General chemotherapy: not reco-Sustained release agentRadiotherapyBiologic