外科新技术资料.ppt

内镜下息肉治疗术 热活检钳咬除 内镜下息肉治疗术 电凝电切、EMR及ESD 内镜下息肉治疗术 套扎 ESD （三）： 介入性超声内镜 超声内镜引导下细针穿刺活检术(FNAB) 超声内镜引导粘膜切除术（EMR） 超声内镜下注射技术(FNI) 超声内镜引导下腹腔神经丛阻滞术 CPN) 超声内镜下胰腺假性囊肿穿刺引流术(drainage of pancreatic pseudocysts) 超声内镜下肿瘤射频切除术（radiofrequency ablation） 介入药物灌注 局部血管溶栓治疗心脑肢体血管栓塞 尿激酶、链激酶 组织型纤溶酶原激活剂t-PA 缺血性疾病 肠系膜上动脉缺血 消化道出血 血管加压素 恶性肿瘤的介入化疗 血管栓塞技术 经导管将栓塞材料有控制的注入到病变或器官的供血血管内，以达到减少血供、闭塞血管或消除器官功能之目的。 大血管损伤、出血 脾功能亢进症 恶性肿瘤 栓塞剂： 碘油 明胶海绵颗粒 弹簧圈 聚乙烯醇颗粒 丝线 球囊扩张与支架置入技术 应用球囊扩张和支架置入使病理性的腔道或血管恢复正常、或将人为开通的管道按人们预计的目标完成功能性的工作。如食管、胆管、血管、TIPS分流道的开通与重建等。 动脉粥样硬化狭窄 消化管道狭窄 门体分流（TIPs） J. PERISSAT 未来 ？？？ Australopythecus apharensis Homo erectus Homo abilis Homo sapiens Homo laparoscopicus (sapiens, sapiens) - 5 M.Y. - 3 M.Y. - 1 M.Y. -130000 to1990 Today 刀魂镜道 传统开放手术的“刀魂”是就近不就远 以腹腔镜手术为代表的微创手术的“镜道”恰恰是舍近求远达四方。 像阴阳太极一样二者此消彼长、 相得益彰,充分体现了远近整合总相宜的辨证统一关系。 谢 谢杨春yang111chun@163.com * * Over 80% of GISTs have c-KIT gene mutations Exon 11: mutations in the intracellular juxtamembrane region occur in mast cell tumors and GIST Comprise ~70% of all mutations in GIST Are generally point mutations (missense), in-frame deletions, or duplications Are associated with constitutive ligand-independent receptor dimerization and activation of the kinase domain (gain-of-function mutations) Occur more frequently in high-risk GIST than in intermediate-risk GIST (and are rarely or never found in leiomyomas or leiomyosarcomas) Predict a poor prognosis: 5-year patient survival rate of 49% compared with 86% for patients with non-exon 11 mutations Exon 9: mutations in the extracellular juxtamembrane region involve a similar activation mechanism Exon 13: mutations in the split tyrosine kinase domain also occur in GIST Other c-KIT mutations have been identified in other diseases Exon 17: mutations in the phosphotransferase domain occur in mast cell and germ cell tumors and result in tyrosine kinase activation that requires no dimerization. Exon 17 mutations render these tumors resistant to imatinib mesylate Exon 2: a mutation