肝疾病(外科學(xué)第8版課件)

肝疾病LiverDisease學(xué)習(xí)要求掌握肝膿腫、肝癌的診斷和外科治療。熟悉肝臟的解剖特點(diǎn)，細(xì)菌性和阿米巴性肝膿腫的鑒別診斷。了解肝囊腫、肝海綿狀血管瘤的診斷和治療原則。SurgicalAnatomy標(biāo)志血管肝門分葉分段Liverfunctions分泌膽汁代謝功能凝血功能解毒作用吞噬和免疫作用再生能力強(qiáng)缺氧耐受力差肝膿腫LiverabscessPathogenesisBiliarytreeHepaticarteryPortalveinNearbyinfectionTraumaClinicalFeaturesFeverandchillsRUQpainandtendernessHepatomegalyJaundiceNonspecificsymptomsLab.andimagingWBC,HGBUltrasound,X-Ray,CTFNADifferentialdiagnosisAmebicliveabscessIntrahepaticbiliaryinfectionsCanceroftheliverSubphrenicabscessTreatmentSupportivetherapyEnergyandnutritionElectrodesandfluidBloodtransfusionTreatmentAntibioticsASAP,ifsuspectedBroadspectrum,coveringG+,G-andanaerobesDuration≥2w,recommendedTreatmentDrainagePercutaneousLaparotomyLaparoscopicTreatmentHepatectomyTraditionalmedicine肝囊腫(Cystoftheliver)肝囊腫非寄生蟲性先天性單發(fā)性多發(fā)性創(chuàng)傷性炎癥性腫瘤性寄生蟲性肝棘球坳病

Echinococcosisoftheliver肝包蟲?。℉ydatid……）牧區(qū)生活史血清學(xué)+影像學(xué)手術(shù)治療為首選先天性肝囊腫

congenitalcystofliver囊壁內(nèi)層附有內(nèi)皮細(xì)胞液體清亮，多不含膽汁大而有癥狀者需適當(dāng)治療腹腔鏡下開窗術(shù)首選，也可選穿刺。注意：與膽道相通囊腫、病變廣泛的多囊肝。肝腫瘤（tumorofliver)肝腫瘤良性惡性原發(fā)性繼發(fā)性肝海綿狀血管瘤

Cavernoushemangiomaofliver生長(zhǎng)緩慢較小時(shí)多無癥狀CT、MRI不難診斷小而無癥狀者隨訪手術(shù)切除適應(yīng)證小結(jié)肝臟解剖肝膿腫臨床表現(xiàn)與阿米巴性肝膿腫的鑒別治療方法原發(fā)性肝癌PrimarylivercancerEpidemiologyCommon600000newcasesfoundannually55%occursinChinaM＞FHighincidenceintheageof40s,andatendencytodevelopearlierEtiologyLivercirrhosisHBVAflatoxin(AFT)ChronicalcoholabuseHCVChemicals:nitrites,hydrocarbons,solvents,pesticides,vinylchloridePathologyCategoriesCancercellsMorphologySizeMetastasisintrahepaticextrahepaticClinicalPresentationRUQabdominalpainNonspecificsymptomsHepatomegalyDiagnosisHCCmarkersAlphafetoprotein(AFP)SerumenzymologyImagingUltrasoundCTandMRIDSAX-raysFNAandBiopsyDiagnosisTreatment治療原則

早期診斷，早期治療，根據(jù)不同病進(jìn)行綜合治療首選方法

早期施行手術(shù)治療TreatmentSurgicaltreatmentResectable

Hepatectomy(Radical,Palliative)Unresectable(op.inprocedure)

HAL,EI,RFA,MWA,CryotherapyRecurrentPerforatedLivertransplantation肝切除術(shù)TreatmentPercutaneousablationRFAMWAPEITreatmentChemotherapyTACE:reco-Generalchemotherapy:notreco-SustainedreleaseagentRadiotherapyBiologi