肝疾病(外科学第八版课件).ppt

肝疾病 Liver Disease 学习要求 掌握肝脓肿、肝癌的诊断和外科治疗。 熟悉肝脏的解剖特点，细菌性和阿米巴性肝脓肿的鉴别诊断。 了解肝囊肿、肝海绵状血管瘤的诊断和治疗原则。 Surgical Anatomy 标志 血管肝门 分叶 分段 Liver functions 分泌胆汁 代谢功能 凝血功能 解毒作用 吞噬和免疫作用 再生能力强 缺氧耐受力差 肝脓肿 Liver abscess Pathogenesis Biliary tree Hepatic artery Portal vein Nearby infection Trauma Clinical Features Fever and chills RUQ pain and tenderness Hepatomegaly Jaundice Nonspecific symptoms Lab. and imaging WBC,HGB Ultrasound, X-Ray, CT FNA Differential diagnosis Amebic live abscess Intrahepatic biliary infections Cancer of the liver Subphrenic abscess Treatment Supportive therapy Energy and nutrition Electrodes and fluid Blood transfusion Treatment Antibiotics ASAP, if suspected Broad spectrum, covering G+,G- and anaerobes Duration ≥2w, recommended Treatment Drainage Percutaneous Laparotomy Laparoscopic Treatment Hepatectomy Traditional medicine 肝囊肿(Cyst of the liver) 肝囊肿 非寄生虫性 先天性 单发性 多发性 创伤性 炎症性 肿瘤性 寄生虫性 肝棘球坳病Echinococcosis of the liver 肝包虫病 （Hydatid ……） 牧区生活史 血清学+影像学 手术治疗为首选 先天性肝囊肿congenital cyst of liver 囊壁内层附有内皮细胞 液体清亮，多不含胆汁 大而有症状者需适当治疗 腹腔镜下开窗术首选，也可选穿刺。 注意：与胆道相通囊肿、病变广泛的多囊肝。 肝肿瘤 （tumor of liver) 肝肿瘤 良性 恶性 原发性 继发性 肝海绵状血管瘤Cavernous hemangioma of liver 生长缓慢 较小时多无症状 CT、MRI不难诊断 小而无症状者随访 手术切除适应证 小 结 肝脏解剖 肝脓肿 临床表现 与阿米巴性肝脓肿的鉴别 治疗方法 原发性肝癌 Primary liver cancer Epidemiology Common 600000 new cases found annually 55% occurs in China M＞F High incidence in the age of 40s, and a tendency to develop earlier Etiology Liver cirrhosis HBV Aflatoxin (AFT) Chronic alcohol abuse HCV Chemicals: nitrites, hydrocarbons, solvents, pesticides, vinyl chloride Pathology Categories Cancer cells Morphology Size Metastasis intrahepatic extrahepatic Clinical Presentation RUQ abdominal pain Nonspecific symptoms Hepatomegaly Diagnosis HCC markers Alpha fetoprotein (AFP) Serum enzymology Imaging Ultrasound CT and MRI DSA X-rays FNA and Biopsy Diagnosis Treatment 治疗原则 早期诊断，早期治疗，根据不同病进行综合治疗 首选方法 早期施行手术治疗 Treatment Surgical treatment Resectable Hepatectomy (Radical, Palliative) Unre