全科中级辅导外科和急救

全科中级辅导外科急救内容秦啸龙多根多处肋骨骨折——连枷胸形成儿童:头面颈=9+(12-年龄）

双下肢=46-(12-年龄）女性：双侧臀部=双足=6%隐神经鞘瘤neurofibromacapillaryhemangiomadermoidcyst

sebaceouscyst

epidermoidcystthyroidadenoma

papillarythyroidcarcinoma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。CalcifiedFibroadenoamaFibroadenomaBreastcancercausing“orangepeel”skinintheleftbreastandthathasspreadtotheleftarmpit.Thisspreadhascausedalargelumpinthetailoftheleftbreast/leftarmpitregion.传统张力手术(tensionoperation)无张力手术(tension-freeoperation)显著地降低了手术后疝的复发率有效地减少了术后患者的不适感急性阑尾炎--病理SuppurativeappendicitisSimpleappendicitisGangrenousappendicitisAppendixperforation胆囊结石胆固醇结石含胆固醇为主，多呈椭圆形（单发者）或多面形（多发者），表面平滑或稍呈结节状，淡灰色，质硬，剖面呈放射状线纹，X线平片上不显影。此种结石多在胆囊内。胆色素性结石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。(forty,fat.female,fruitful4F)（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Thisisarenalcellcarcinomaarisinginthelowerpoleofthekidney.Itisfairlycircumscribed.Thecutsurfacedemonstratesavariegatedappearancewithyellowishareas,whiteareas,brownareas,andhemorrhagicredareas.Thoughtheseneoplasmsareusuallyslow-growing,theycanoftenreachaconsiderablesizebeforedetectionbecausethereisalotofroomtoenlargeintheretroperitoneum,andthereisanotherkidneytoproviderenalfunction.Thus,presentingsymptomsandsignsusuallyincludeflankpain,masseffect,andhematuria.Thisisamuchmoreadvancedrenalcellcarcinomainvolvingtheleftkidney(top).Noticeahugemassofnecroticyellowishbrownmaterialreplacingthelowerpoleofthekidney.Alsonoticethatthevenacavainthecenterofthepictureisfilledwithtumor.Thisistypicalofthisneoplasm.Intheupperpoleofthiskidneyisawellcircumscribedtumorwhichhasayellowish-browncolorandshowscentralnecrosis.Thisisarenalcellcarcinoma.膀胱癌Tis膀胱癌Ta-1膀胱癌临床分类分期膀胱癌临床分类分期膀胱癌T2-3膀胱癌T4膀胱肿瘤治疗手术治疗为主。（一）表浅膀胱肿瘤原位癌细胞分化不良、已经有浸润的应及早行膀胱全切术；细胞分化良好的可行经尿道手术。（二）浸润性膀胱肿瘤1、分化良好、局限的T2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除术，部分切除范围应包括距离肿瘤2cm以内的全层膀胱壁。3、膀胱全切术后的尿流改道4、浸润