腎上腺疾病的外科治療課件

匯報(bào)人：xxx20xx-03-15腎上腺疾病的外科治療ppt課件目錄腎上腺疾病概述腎上腺疾病的診斷方法腎上腺疾病的外科治療原則腎上腺皮質(zhì)腫瘤的外科治療腎上腺髓質(zhì)腫瘤的外科治療腎上腺意外瘤的處理原則01腎上腺疾病概述腎上腺的解剖位置01腎上腺位于腎臟上方，左右各一，與腎臟緊密相連。腎上腺的zu織結(jié)構(gòu)02腎上腺由皮質(zhì)和髓質(zhì)兩部分組成，皮質(zhì)外層為球狀帶，分泌鹽皮質(zhì)激素；中層為束狀帶，分泌糖皮質(zhì)激素；內(nèi)層為網(wǎng)狀帶，分泌性激素。髓質(zhì)則分泌兒茶酚胺等激素。腎上腺的生理功能03腎上腺分泌的激素對(duì)維持人體正常的生理功能具有重要調(diào)節(jié)作用，如調(diào)節(jié)水鹽代謝、糖代謝、性激素分泌等。腎上腺的解剖與生理腎上腺疾病的分類腎上腺皮質(zhì)疾病包括皮質(zhì)醇增多癥、原發(fā)性醛固酮增多癥、腎上腺皮質(zhì)功能減退癥等。腎上腺髓質(zhì)疾病包括嗜鉻細(xì)胞瘤、腎上腺髓質(zhì)增生等。腎上腺其他疾病如腎上腺意外瘤、腎上腺囊腫、腎上腺結(jié)核等。以下附贈(zèng)各項(xiàng)管理制度英文版（不需要可刪）急救藥品、器材管理制度:1.Rescuedrugsandequipmentshouldbe"fivefixed"(fixedquantityandvariety,designatedplacement,designatedpersonstorage,regulardisinfectionandsterilization,regularinspectionandmaintenance)and"twotimely"(timelyinspectionandmaintenance,timelyreceiptandsupplementation).Theitemisclearlymarkedandcannotbeusedarbitrarily.2.Thenecessaryrescueequipmentiscomplete,ingoodperformance,andinstandbycondition.3.Therescuedrugsarecomplete,withcleardruglabelsandnodiscoloration,deterioration,expiration,ordamage.Theyshouldbeplacedandusedintheorderofdrugexpirationdates(fromrighttoleft).4.Emergencydrugsanditemsforeachdepartment'srescuevehicleshallbeuniformlyequippedaccordingtorequirements.Specializedemergencydrugsanditemsmustbereviewedandapprovedbythedepartmentdirectortodeterminethetype,quantity,specifications,anddosagetobeequipped.Rescuevehiclesmustbeplacedindesignatedlocationsandmanagedbydesignatedpersonneltoensuresafetyandeaseofuse.5.Afterusingrescuedrugsandequipment,theyshouldbefullyreplenishedwithin24hours.Iftheycannotbereplenishedduetospecialreasons,theyshouldbenotedonthehandoverregistrationformandreportedtotheheadnurseforcoordinationandresolutiontoensuretimelyuseduringpatientrescue.6.Thereisaregistrationbookfortheprovisionofdrugsandequipment.Ensureconsistencybetweenaccountsandmaterials,andhandoverbetweenshifts.7.Managementofsealedrescuevehicles:Beforesealing,theheadnurse(ornurseincharge)andanothernurseshallcountthedrugsandequipmentaccordingtotheregistrationbookofdrugandequipmentequipment,verifytheiraccuracy,andsealthemwithaseal.Twopeopleshallsignandfillinthesealingtime.Nurseschecktheconditionofthesealsoncepershiftandcompletethehandover.Theresponsiblenursescheckonceaweek,andtheheadnurseandresponsiblenursesopenthesealsandinspectthedrugsandequipmentintheambulanceonceamonth,withrecordskept.8.Nonsealedrescuevehiclemanagement:Eachshiftshallcountthedrugsandequipmentaccordingtotheregistrationbookandcompletethehandover.Theresponsiblenurseshallinspectonceaweek,andtheheadnurseshallinspectonceeverytwoweeksandkeeprecords,ensuringthattheaccountsmatchthematerials.護(hù)理文書書寫制度:

1.Nursingstaffstrictlyfollowthelatestrequirementswhenwritingnursingmedicalrecords.2.Thecontentofnursingrecordsshouldbeobjective,truthful,accurate,timely,complete,andstandardized.3.Allnursingdocumentsshouldbewrittenwithablueblackorcarboninkpen.4.AllnursingdocumentsshouldbewritteninArabicnumeralsfordateandtime,withdatesinyears,months,anddays,usinga24-hoursystem,specifictominutes.5.WritingshoulduseChinese,medicalterminology,andcommonlyusedforeignlanguageabbreviations;Completerecorditems;Thetextisneat,thehandwritingisclear,andthelayoutisclean;Accurateexpression,fluentsentences,simpleandconcise:correctformatandpunctuation,notypos.6.Whenerrorsoccurduringthewritingprocess,doublelinethemonthewrongwords,keeptheoriginalrecordclearanddistinguishable,signthemodifier,indicatethemodificationtime,continuetowritethecorrectcontent,anddonotusescraping,sticking,paintingorothermethodstocoveruporremovetheoriginalhandwriting.Eachpageshouldbemodifiednomorethantwotimes,otherwisetheoriginalrecorderwillpromptlycopyagain(exceptformodificationsmadebysuperiors).7.Nursingrecordswrittenbyinternnurses,probationarynurses,orunregisterednursesshouldbereviewedandsignedbynurseswithlegalprofessionalqualificationsinthismedicalinstitution.8.Furthertrainingnursescanonlywritenursingdocumentsafterbeingrecognizedbythemedicalinstitutionreceivingthetrainingfortheirworkability.9.Superiornursingstaffhavetheresponsibilitytoreviewandmodifythewrittenrecordsofsubordinatenursingstaff.Whenmakingmodifications,reddoublelinesshouldbeusedtomarkerrors,writethemodifiedcontent,signandindicatethemodificationtime.10.Temperaturerecords,medicalorders,patientcarerecords,andsurgicalinventoryrecordsshouldbearchivedontime.表現(xiàn)為向心性肥胖、滿月臉、水牛背、皮膚紫紋、高血壓等。腎上腺疾病的癥狀與體征皮質(zhì)醇增多癥表現(xiàn)為高血壓、低血鉀、肌無(wú)力、周期性癱瘓等。原發(fā)性醛固酮增多癥表現(xiàn)為乏力、納差、惡心、嘔吐、低血糖、低血壓等。腎上腺皮質(zhì)功能減退癥表現(xiàn)為陣發(fā)性高血壓、頭痛、心悸、多汗等。嗜鉻細(xì)胞瘤表現(xiàn)與嗜鉻細(xì)胞瘤相似，但癥狀較輕。腎上腺髓質(zhì)增生多數(shù)無(wú)癥狀，部分可出現(xiàn)腰背部疼痛或上腹部不適等。腎上腺意外瘤02腎上腺疾病的診斷方法包括電解質(zhì)、血糖、皮質(zhì)醇、醛固酮、兒茶酚胺等激素水平檢測(cè)，有助于判斷腎上腺功能狀態(tài)。血液檢查24小時(shí)尿兒茶酚胺、尿17-羥皮質(zhì)類固醇、尿17-酮類固醇等檢測(cè)，可輔助診斷相關(guān)腎上腺疾病。尿液檢查生化檢查方便快捷，對(duì)腎上腺腫瘤的定位和大小有初步判斷價(jià)值。B超檢查CT檢查MRI檢查能準(zhǔn)確顯示腎上腺腫瘤的部位、大小及與周圍臟器的關(guān)系，是腎上腺疾病最常用的影像學(xué)檢查方法。對(duì)腎上腺腫瘤的定性診斷有一定幫助，尤其對(duì)于功能性腎上腺腫瘤的診斷和鑒別診斷具有重要意義。030201影像學(xué)檢查定位診斷技術(shù)靜脈采血定位技術(shù)通過分別采集腎上腺靜脈和腔靜脈血樣，測(cè)定激素水平，以判斷病變側(cè)腎上腺的功能狀態(tài)。影像學(xué)檢查定位結(jié)合CT、MRI等影像學(xué)檢查技術(shù)，對(duì)腎上腺腫瘤進(jìn)行精確定位。需與腎上腺皮質(zhì)增生、腎上腺腺瘤、嗜鉻細(xì)胞瘤、皮質(zhì)癌等腎上腺疾病進(jìn)行鑒別診斷。根據(jù)患者的臨床表現(xiàn)、生化檢查及影像學(xué)檢查結(jié)果，綜合評(píng)估腎上腺疾病的病情嚴(yán)重程度及手術(shù)風(fēng)險(xiǎn)。鑒別診斷與評(píng)估病情評(píng)估鑒別診斷03腎上腺疾病的外科治療原則手術(shù)適應(yīng)癥功能性腎上腺腫瘤、有惡性風(fēng)險(xiǎn)的非功能性腎上腺腫瘤、腎上腺腫瘤存在轉(zhuǎn)移或ju部侵fan等。禁忌癥嚴(yán)重心、肺、肝、腎功能不全，不能耐受手術(shù)者；腎上腺疾病晚期，已發(fā)生遠(yuǎn)處轉(zhuǎn)移者等。手術(shù)適應(yīng)癥與禁忌癥術(shù)前準(zhǔn)備完善相關(guān)檢查，如血尿常規(guī)、生化全項(xiàng)、凝血功能、心電圖、胸片等；控制血壓、血糖等基礎(chǔ)疾病；糾正電解質(zhì)紊亂等。術(shù)前評(píng)估評(píng)估患者病情及手術(shù)耐受能力，確定手術(shù)方式和范圍；與患者及家屬充分溝通，簽署手術(shù)知情同意書。術(shù)前準(zhǔn)備與評(píng)估手術(shù)方式開放手術(shù)和腹腔鏡手術(shù)是腎上腺疾病常用的手術(shù)方式。開放手術(shù)適用于腫瘤較大、與周圍zu織粘連緊密或疑有惡性變的情況。腹腔鏡手術(shù)適用于腫瘤較小、與周圍zu織界限清楚的情況。選擇依據(jù)根據(jù)患者病情、腫瘤性質(zhì)、大小、位置以及與周圍zu織的毗鄰關(guān)系等因素綜合考慮選擇合適的手術(shù)方式。手術(shù)方式與選擇依據(jù)密切觀察患者生命體征變化，及時(shí)處理異常情況；保持引流管通暢，記錄引流液的顏色、性質(zhì)和量；鼓勵(lì)患者早期下床活動(dòng)，促進(jìn)胃腸功能恢復(fù)等。術(shù)后處理針對(duì)可能出現(xiàn)的并發(fā)癥如出血、感染、腎上腺功能不足等采取相應(yīng)的預(yù)防措施，如使用止血藥物、抗生素、激素替代治療等；對(duì)于已經(jīng)發(fā)生的并發(fā)癥，積極采取措施進(jìn)行治療。并發(fā)癥防治術(shù)后處理與并發(fā)癥防治04腎上腺皮質(zhì)腫瘤的外科治療術(shù)前準(zhǔn)備手術(shù)方式術(shù)后處理預(yù)后評(píng)估皮質(zhì)醇增多癥的外科治療糾正高血壓、低血鉀等代謝紊亂，控制感染，改善心功能監(jiān)測(cè)生命體征，防治并發(fā)癥，如腎上腺危象、感染等腎上腺切除術(shù)，包括腎上腺腫瘤切除和腎上腺全切除定期隨訪，檢查激素水平，評(píng)估手術(shù)效果和復(fù)發(fā)情況原發(fā)性醛固酮增多癥的外科治療通過臨床表現(xiàn)、實(shí)驗(yàn)室檢查和影像學(xué)檢查明確診斷確診為醛固酮瘤或單側(cè)腎上腺增生且對(duì)側(cè)腎上腺正常者腹腔鏡下腎上腺腫瘤切除術(shù)或腎上腺部分切除術(shù)監(jiān)測(cè)血壓、血鉀和醛固酮水平，調(diào)整治療方案術(shù)前診斷手術(shù)指征手術(shù)方式術(shù)后管理全面評(píng)估患者病情，包括腫瘤大小、位置、侵犯范圍等術(shù)前評(píng)估根治性腎上腺切除術(shù)，包括腫瘤及周圍組織的整塊切除手術(shù)方式對(duì)于懷疑有淋巴結(jié)轉(zhuǎn)移的患者，進(jìn)行區(qū)域淋巴結(jié)清掃淋巴結(jié)清掃根據(jù)病理分期和患者情況，選擇化療、放療等輔助治療手段術(shù)后輔助治療腎上腺皮質(zhì)癌的外科治療完善相關(guān)檢查，明確腫瘤性質(zhì)和位置術(shù)前準(zhǔn)備手術(shù)方式術(shù)中注意事項(xiàng)術(shù)后隨訪腹腔鏡下腎上腺腫瘤切除術(shù)或開放性手術(shù)保護(hù)周圍臟器，避免損傷血管和神經(jīng)定期檢查激素水平，觀察腫瘤有無(wú)復(fù)發(fā)或轉(zhuǎn)移腎上腺皮質(zhì)腺瘤的外科治療05腎上腺髓質(zhì)腫瘤的外科治療03術(shù)后處理監(jiān)測(cè)生命體征，及時(shí)處理可能出現(xiàn)的并發(fā)癥，如腎上腺皮質(zhì)功能減退、感染等01術(shù)前準(zhǔn)備控制高血壓、糾正心律失常和代謝紊亂，擴(kuò)容治療以防術(shù)中或術(shù)后出現(xiàn)低血壓休克02手術(shù)方式根據(jù)腫瘤大小和位置選擇開放式或腹腔鏡手術(shù)，盡可能保留腎上腺zu織嗜鉻細(xì)胞瘤的外科治療確定增生的腎上腺髓質(zhì)是否具有分泌功能，以及是否導(dǎo)致臨床癥狀術(shù)前評(píng)估對(duì)于具有分泌功能且導(dǎo)致臨床癥狀的腎上腺髓質(zhì)增生，可考慮手術(shù)治療手術(shù)指征根據(jù)增生程度和位置選擇開放式或腹腔鏡手術(shù)，切除增生的腎上腺髓質(zhì)zu織手術(shù)方式腎上腺髓質(zhì)增生的外科治療術(shù)前