结肠、直肠疾病.ppt

Colonandrectumdiseases,colorectalcanceranalfissureanorectalabscessanalfistulahemorrhoids,Colorectaldiseases,Anatomy,Arteriesandvenous,Threefeaturesofcolon,epiploicappendices肠脂垂colicbands结肠带haustraofcolon结肠袋,Colonandrectumcancer,Etiologyandcharacteristics:1.increasing;highfatandprotein,lowfibre,adenoma，ulcerativecolitis,Schistomiasis2.maininrectumandsigmoidflexure；3.relativelygoodprognosisSomefamilialintestinalpolyposis,isprecancerouslesions,Introduction,Rectumcancerfeatures,1.Incidenceishigherthancoloncancer,1.5:1,butcoloncancerincreasedquicker;2.Thelowrectumcannerismore;3.Youngpatient(30)rateishigh,10-15%4.prognosis:5yearsurvivalrate：morethan60%,Polypus:adenomatouspolyp,polyposiscoliDiet:highprotein,highfat,lowfabrin3.Schistomiasis4.ulcerativecolitis,Etiology,adenomatouspolyp:Tubularadenomavillus-tubiformadenomavillousadenoma,7,Pathology,EarlystageConfinedinmucosaandsubmucosa,nolymphmetastasisPolypoidgrowthnonPolypoidgrowth,Advancedstages,MassivetypeinfiltrativetypeUlcerativetype,MassivetypeRightcolon,cecum,rectumeccentric,InfiltrativetypeleftcolonandrectumAroundtheintestinal,resultinstenosisandobstruction,Ulcerativetypegrowdeep,andinfiltratethenearbytissue,UndermicroscopeObservationAdenocarcinomamucouscarcinomaundifferentiatedcarcinoma,Brodersmethod：:lowmalignance；：moderatemalignance：highmalignance：undifferentiate,classificationandstage,A：confinedinmucosa,nolymphmetastasis；B：beyondmucosaorserosa,nolymphmetastasis；C：withlymphmetastasisD：withdistantmetastasisandperitonumcavitymetastasis,Dukesstages(colon)：,directextensionlymphmetastasishematogenousmetastasisimplantationmetastasis,Spreadandmetastasis,clinicalfindings,semi-rightcoloniccarcinoma,abdomenmassesanemiageneralsymptom,Semi-leftcoloncarcinoma,BowelobstructionAlterationsinbowelhabitsandfecesGeneralsymptoms,Manifestationsofrectalcarcinoma,irritantsymptomruptureandinfectionofmassesstenosissymptomGeneralsymptoms,Generalsymtoms,Chronichemorrhage,festering,infection,anemia,lowfever,slimdown,hepatomegaly,jaundice,edema,ascites,Diagnosis,Earlydiagnosis,AlterationofbowelhabitsandfecesprogressiveanemiaandweightlossabdomenmassesFamilyhistory,digitalrectalexamination,positionmethodattention,Digitalexam,lithotomyposition截石位lateralposition侧卧位squattingposition蹲位,Commonproblems,hemorrhoidsanalfistularectalpolypusanorectalcarcinoma,Endoscope,rigidendoscope(硬质镜)Fibroscope(纤维镜)advantagesandproblemattentionandcomplication,Fibroscopicreport,12cmfromanus，thereisamasswithdiameterof5cm,surfaceisfesteringanderrhysis,couliflowerlike,镜检报告(fibroscopicreport),横结肠中段可见环形肿块、狭窄，内镜不能通过，观察肿块全貌欠佳，肿块表面充血、溃烂、渗血。,Bariumenema,advantagesproblem,pathologicinspect,itisveryimportantforrectumcarcinoma,otherinspects,B-USCTCEAcarcinoembryonicantigen,Treatments,Surgeryisthemainmethodpreparationofbowel,semi-rightcolonresectionsemi-leftcolonresectionsigmoidcolonresectionMilesprocedureDixonprocedureHartmannprocedure,commonprocedure,artificialanusbag,enterostomy,DixonsurgeryPreservetheanus,Diseasesofrectumandanal,Anatomy,dentallineandthefunctionanorectalsphinctericringpara-anorectalspace,para-anorectalspace,Pelvicrectumfossaischiorectalfossa,ANALFISSURE,Definition：smallulcerofanaltubeskinunderthedentatelineFeatures：longitudinal,0.5-1cm,alwaysinthemedialbackwall.Periodicpain,bleedinglittle,maininyouthEtiologyandpathologydryfecalmechanicdamagethebackwallhaspoorelastic,poorvascularizedacute:split,elastic,noscarchronic,traid:“sentinelpile”fissureAnalPapillaeHypertrophy,Etiology,Pathology,manifestations1.constipation2.pain:defecationpainreleasedspasmpainofthesphincter3.haemorrhage:freshbloodonthesurfaceofthefecaldiagnosis：treatments:1.nonsurgicaltreatment:spasmolytic,anagesia,relaxingthebowel,hipbath2.surgicaltreatment:analfissureresect,analfissure,FissuretriadClinicfindingsTherapy:medicienandoperation,perianalabscess,PerianalsubcutaneousabscessischiorectalabscessPelvicrectumabscess,Perianorectalabscess,Etiologyandpathologyanalsinusesinfection,Analglandinflammation,SphincterinfectionDerivedfromsecondaryInfection（analfissure,internalhemorrhoids,injection,Crohnsdisease,injury）,Clinicalfindings,Diagnosis1.symptoms,diseasehistory,physicalsigns2.chemicaltests3.digitalexam4.puncture5.Bultrasound/CTTreatments1.nonsurgicaltreatment:antibiotics,relaxingthebowel,hipbath,physicaltherapy2.surgicaltreatment:incisionanddrainage,Hemorrhoids,internalhemorrhoidsexternalhemorrhoids,Anatomy,Varicoseveinstheory,Hemorrhoidsisthevaricoseveinsofrectummucosaandanusskin,distendingandformasoftveinmass,canbebleedingandembolismIsthepathologicalchangeofvessels,Therectumbloodsupply,MilestheroySuperiorrectalartery:(middlerectum)leftandrightbranches.,Definition,ChineseMedicalAssociation:AnalCushionpathologicalhypertrophyandmigration,vesselsbloodstasisneartheanus,formingpathologicalmass,Treatmentprinciples,Explicittheessence,somedonotneedtreatmentTreatmentstandard:releasesymptoms,butnoteliminatethehemorrhoidNosymptoms:donotneedtreatmentWithsymptoms:donotneedradicalcureStrictfollowoperationindications,Classifications,1Outerhemorrhoids:underthedentateline2Innerhemorrhoids:abovethedentateline,underthemucosa,varicosedvenousplex3Mixedhemorrhoids:：位于齿状线上、下，由痔内、外静脉丛扩张而成。,Stagingofinternalhemorrhoid,Istage:Nointernalhemorrhoidprolapse,bleedingstopafterdefecateIIstage:withinternalhemorrhoidprolapse,canrepositionbyitselfIIIstage:internalhemorrhoidprolapsewhendefecating,repositionwithhandhelpIVstage:internalhemorrhoidprolapseforever,cannotreposition,Knownfactors,Diarrheadisease一ulcerativecolitis一Functionaldiarrhea一Noninfectiousgastroenteritis一Infectiousdiarrhea一Crohnsdisease一Ischemiccolitis,RectumemptyingdifficultForfemale一Premenstrualsyndrome一pregnance一deliverySit,standandlieforlong,Clinicalmanifestations,1.Hematochezia2.Hemorrhoidprolapse3.Pain4.pruritusDiagnosisanddifferentialdiagnosis1.Illnesshistory,physicalexam,anoscopeexam2.Differentiatewithrectumcancer,rectumpolyp,rectumprolapseandCrhonsdisease,Treatmentsnonsurgicalmethods:ahipbath,injection,infrared,loopligationsurgicaltreatment:simpleresection,Milligan-Morganoperations,PPHsurgery(ProcedureForProlapseandHemorrhoids),“cutoff”cutoffthearterybloodsupplyofsubmucosafromsuperiorrectumartery,whichmadethehemorrhoidsdiminish“overhang”Resectthemucosaandsubmucosainaringshapeabovethedentateline,overhangthep