全科中级辅导外科和急救

1、全科中级辅导外科急救内容全科中级辅导外科急救内容多根多处肋骨骨折多根多处肋骨骨折连枷胸形成连枷胸形成 儿童儿童: 头面颈头面颈=9+(12-年龄）年龄） 双下肢双下肢=46-(12-年龄）年龄） 女性：双侧臀部女性：双侧臀部=双足双足=6%隐神经鞘瘤neurofibromacapillary hemangiomadermoid cystsebaceous cystepidermoid cystthyroid adenoma papillary thyroid carcinoma 治疗：乳房纤维腺瘤虽属良性，但亦有恶变可能，一经发现，应予手术切除。Calcified FibroadenoamaF

2、ibroadenoma Breast cancer causing “orange peel” skin in the left breast and that has spread to the left armpit. This spread has caused a large lump in the tail of the left breast/left armpit region.急性阑尾炎- -病理病理Suppurative appendicitisSimple appendicitisGangrenous appendicitisAppendix perforation胆囊结石

3、胆囊结石 胆固醇结石胆固醇结石含胆固醇为主，多呈椭圆形（单含胆固醇为主，多呈椭圆形（单发者）或多面形（多发者），表面平滑或稍发者）或多面形（多发者），表面平滑或稍呈结节状，淡灰色，质硬，剖面呈放射状线呈结节状，淡灰色，质硬，剖面呈放射状线纹，纹，X线平片上不显影。此种结石多在胆囊线平片上不显影。此种结石多在胆囊内。内。 胆色素性结石胆色素性结石以胆红素为主要成分，多为泥以胆红素为主要成分，多为泥沙样，质软而脆，有的如泥团状，有的如沙沙样，质软而脆，有的如泥团状，有的如沙粒，为棕黑或棕红色。大小不等，因含钙少，粒，为棕黑或棕红色。大小不等，因含钙少，X线平片上多不显影。多在肝内、外胆管中。线平片

4、上多不显影。多在肝内、外胆管中。 (forty,fat.female,fruitful 4F)（A）病人站立，大腿上1/3扎上止血带；（B）交替伸屈膝关节10余次或行走；（C）静脉曲张益形明显，小腿胀痛，即为深静脉通畅试验阳性This is a renal cell carcinoma arising in the lower pole of the kidney. It is fairly circumscribed. The cut surface demonstrates a variegated appearance with yellowish areas, white areas,

5、 brown areas, and hemorrhagic red areas. Though these neoplasms are usually slow-growing, they can often reach a considerable size before detection because there is a lot of room to enlarge in the retroperitoneum, and there is another kidney to provide renal function. Thus, presenting symptoms and s

6、igns usually include flank pain, mass effect, and hematuria.This is a much more advanced renal cell carcinoma involving the left kidney (top). Notice a huge mass of necrotic yellowish brown material replacing the lower pole of the kidney. Also notice that the vena cava in the center of the picture i

7、s filled with tumor. This is typical of this neoplasm. In the upper pole of this kidney is a well circumscribed tumor which has a yellowish-brown color and shows central necrosis. This is a renal cell carcinoma. 膀胱癌膀胱癌Tis膀胱癌膀胱癌Ta-Ta-1膀胱癌临床分类分期膀胱癌临床分类分期膀胱癌临床分类分期膀胱癌临床分类分期膀胱癌膀胱癌T T2-3膀胱癌膀胱癌T T4膀胱肿瘤治疗治疗

8、 手术治疗为主。手术治疗为主。（一）表浅膀胱肿瘤（一）表浅膀胱肿瘤原位癌原位癌 细胞分化不良、已经有浸润的应及早行膀胱全切术；细胞分细胞分化不良、已经有浸润的应及早行膀胱全切术；细胞分化良好的可行经尿道手术。化良好的可行经尿道手术。（二）浸润性膀胱肿瘤（二）浸润性膀胱肿瘤1、分化良好、局限的、分化良好、局限的T2期肿瘤可行经尿道手术。期肿瘤可行经尿道手术。2、一般根据肿瘤浸润范围、大小、数目选择膀胱全切术或膀胱部分切、一般根据肿瘤浸润范围、大小、数目选择膀胱全切术或膀胱部分切除术，部分切除范围应包括距离肿瘤除术，部分切除范围应包括距离肿瘤2cm以内的全层膀胱壁。以内的全层膀胱壁。3、膀胱全切术后的尿流改道、膀胱全切术后的尿流改道4、浸润性肿瘤的新辅助化疗：、浸润性肿瘤的新辅助化疗：MVAC方案，若结合髂内动脉埋泵