肝疾病(外科學第8版課件)

肝疾病LiverDisease學習要求掌握肝膿腫、肝癌的診斷和外科治療。熟悉肝臟的解剖特點，細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肝包蟲病（Hydatid……）牧區(qū)生活史血清學+影像學手術治療為首選先天性肝囊腫

congenitalcystofliver囊壁內(nèi)層附有內(nèi)皮細胞液體清亮，多不含膽汁大而有癥狀者需適當治療腹腔鏡下開窗術首選，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生長緩慢較小時多無癥狀CT、MRI不難診斷小而無癥狀者隨訪手術切除適應證小結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)不同病進行綜合治療首選方法

早期施行手術治療TreatmentSurgicaltreatmentResectable

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

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