胆道疾病刘斌双语幻灯课件.ppt

Diseases of the Biliary Tract Liu Bin Associate Professor and Vice-chairman Department of General Surgery Xuzhou Medical College Hospital ANATOMY Intrahepatic Biliary Tract Extrahepatic Biliary Tract The gallbladder Oddi’s sphincter ANATOMY Intrahepatic Biliary Tract ANATOMY Artery术中注意：胆囊A、胆管A走行与分布 Vein Lymph肿瘤转移 Nerve胆心反射 Biliary Physiology 胆汁的分泌、成分和功能：分泌：肝细胞、胆管细胞, 量? 成分：97%为水，胆汁酸、胆盐、胆固醇、卵磷脂(phospholipid) ……功能：? Biliary Physiology Regulation of bile secretion 促胰液素、CCK：胃酸、脂肪、蛋白质的刺激。 Metabolism of bile：胆固醇的溶解： 胆盐、磷酯酰胆碱微胶粒(micelles) 胆固醇磷脂泡：磷酯+胆固醇 胆盐池的稳定：肠肝循环 Biliary Physiology Metabolism of bilirubin 胆红素的溶解：胆红素+葡萄糖醛酸——结合胆红素肝脏代谢异常胆道细菌感染 Biliary Physiology Physiological function of bile duct---regulation of bile discharge Biliary Physiology Physiological function of gall bladder Concentration and storage of bile Discharge bile Secretion 解剖生理概要重点内容 胆管、门静脉和肝动脉的关系 胆总管: 直径：0.6-0.8cm，1cm病理 Triangle of Calot 胆汁的功能： 胆固醇、胆红素的溶解 Diagnostic Approaches US：B-type Ultrasonography 首选 Diagnosis of gallstone：强回声光团+声影 Differentiation of joundic：胆管扩张 Detection of gallbladder function Other biliary illness Intraoperative US：干扰小 Diagnostic Approaches Conventional Radiology KUB film：钙化结石15%，瓷化胆囊，胆道积气 Oral cholecystography：功能测定、充盈缺损 Veinal cholangiography：胆管显影 Diagnostic Approaches Special Radiology PTC：黄疸鉴别、PTCD ERCP：乳头部病变、定性诊断、造影 CT、MRI（MRCP） Intra- or postoprative cholangiography Diagnostic Approaches Endoscopic Examinations 胆道镜检查术中、术后 诊断、治疗 十二指肠引流 本节重点内容 胆道疾病的首选检查方法 BUS、CT、PTC、PTCD、ERCP、MRI、MRCP Liu Bin Surgeon in Chief and Vice-Chairman Division of General Surgery 胆石病 Cholelithiasis 常见病、多发病 结石分类 胆固醇结石(Cholesterol Gallstones) ：80%位于胆囊 胆色素结石(Pigment Gallstones) ：主要发生于胆管 混合性结石：胆囊60%、胆管40% 胆囊结石Cholecystolithiasis、Gall stone 结石性质 发病年龄、性别 (4F: Forty, Female, Fatty, Fertility) 发病机制： 胆汁胆固醇过饱和 促成核因子：均相成核、异相成核 胆囊功能 胆囊结石Cholecystolithi