外科学大题.doc

外科名解+简答+问答 一、胆道疾病（能出的历年题基本都出了，比较重要） 1. 胆囊结石手术指征（06级问答） 1）口服胆囊造影胆囊不显影 2）结石直径超过2cm 3）B超提示胆囊壁局限性增厚 4）病程5年以上，年龄大于50岁的女性病人 5）胆囊颈部嵌顿结石 6）胆囊萎缩或瓷样胆囊 7）以往曾行胆囊造瘘术 2. Reynolds五联征（Reynolds pentad）（06级名解） Charcot triad plus shock and CNS inhibition, seen in AOSC. 3. 陶土样便A triangle bounded by inferior border of the liver, cystic duct and common hepatic duct. The cystic artery runs through the triangle 5. 内镜鼻胆管引流术ENBD ERCP下，经鼻导管引流，常用于急性梗阻化脓性胆管炎（AOSC） 6. 急性梗阻化脓性胆管炎AOSC 临床：1）多有胆道病史 2）病起骤急，体温骤升 3）Reynolds五联征：Charcot三联征+休克+CNS抑制 1) History of biliary tract disease 2) Sudden attack, fever 3) Reynolds pentad 治疗：1）目的：解除梗阻胆道减压引流 obstruction, reduce pressure, biliary drainage 2) Non-surgical treatment: Anti-infection, Correct fluid and electrolyte imbalance, Anti-shock, etc. 3) Surgical treatment: Open exploration and T tube placement 4) Emergency biliary decompression: PTCD, ENBD 7. Mirizzi综合征ssociation of recurrent cholecystitis, cholangitis and obstructive jaundice. It is caused by cystic duct stones resulting in constriction of the common bile duct 8. Charcot三联征 Abdominal pain, fever and jaundice 9. 胆囊结石（gallbladder stone）临床表现、诊断及治疗 临床：1）胃肠道症状：消化不良，厌油 2）胆绞痛：典型表现，尤夜间阵发，向肩背放射 3）Mirizzi综合征 4）Murphy征 5）其他：胆囊积液 1) Intestinal symptoms 2) Biliary colic 3) Mirizzi syndrome 4) Murphy’s sign 5) Others: Effusion, pancreatitis, etc. 诊断：1）结合病史、临床 2）B超：检出率96% 3）必要时CT\MRI 1) History 2) BUS: 96% 3) CT/MRI: if necessary 治疗：1）无症状者可不需要治疗 2）有症状患者：腹腔镜胆囊切除术或开腹胆囊切除术 3）对于部分患者应在手术时行胆总管探查 4）不能耐受手术者可考虑溶石治疗 1）Asymptomatic: in most cases treatment is not necessary 2）Symptomatic: laparoscopic cholecystectomy (LC) or open cholecystectomy (OC) 3）Common bile duct exploration may be needed in some conditions 10. 肝外胆管结石手术原则（Surgery principle） 手术原则——去除病灶，取尽结石，解除梗阻，通畅引流 Remove nidus; Deplete stone; Relieve obstruction; Biliary drainage 二、阑尾疾病腹外疝（非重点，阑尾记住两个点就差不多了，一系历年题貌似没出过腹外疝的，熟悉三个名解就差不多了） 1. McBurney点Rovsing test） 仰卧位，按压左下腹降结肠，压力传导至肓肠和阑尾处，出现右下腹部疼痛 In supine position, when pressing the desc