外科黄疸的诊断与处理2014 -课件.pptVIP

外科黄疸的处理Treatment of surgical jaundice 针对病因治疗 围手术期处理 减黄治疗 针对病因治疗Etiological treatment tumor：切除 lithiasis：取尽结石，去除病灶，通畅引流 围手术期处理Perioperational management 保肝 纠正凝血功能：vitK1 维持水电酸碱平衡 防治感染 营养支持 减黄治疗biliary drainage 介入：PTGD PTCD 内镜：ERBD ENBD 腹腔镜或开腹：外引流 内引流 Etiological treatment or biliary drainage? biliary drainage:姑息治疗 或 术前准备 介入：PTGD经皮肝穿刺胆囊引流 介入：PTCD经皮肝穿刺胆道外引流（B-US guidance） 介入：PTC +内支架置入（B-US guidance） endoscope endoscope ：导管 ERCP 内镜：ERCP 置管 ENBD内镜下鼻胆管引流（重症胆管炎） ERBD内镜逆行胆管引流（胆管良性狭窄 、肿瘤对症处理或术前准备） 内镜：ERBD内镜逆行胆管引流（塑料：可更换；金属：永久性） operation：T tube biliary drainage 手术：胆汁内引流(切除后重建 、姑息短路) summary obstruction CB 反流入血 liver Surgical jaundice summary Etiology of surgical jaundice lithiasis tumor foreign matter stricture and atresia biliary injury （iatrogenic/trauma） summary Diagnosis of surgical jaundice Surgical jaundice CB/TB0.5 ALP GGT summary Diagnosis of surgical jaundice Obstructive site B-US: cholangiectasis MRCP ERCP 、PTC(治疗时应用，一般不单独用于诊断) summary Treatment of surgical jaundice Removal of lesions Biliary drainage Questions??? THANK YOU! Bile duct：biliary injury （iatrogenic/trauma） 外科黄疸的常见病因 Etiology of surgical jaundice a d c b ERCP Bile duct：biliary injury （iatrogenic/trauma） 外科黄疸的常见病因 Etiology of surgical jaundice MRCP Outside bile duct：tumor a b c 外科黄疸的常见病因 Etiology of surgical jaundice MRCP Outside bile duct：tumor 外科黄疸的常见病因 Etiology of surgical jaundice Outside bile duct： Chronic pancreatitis b a c 外科黄疸的常见病因 Etiology of surgical jaundice ERCP Outside bile duct： duodenal diverticulum(十二指肠憩室) a upper gastrointestinal contrast 外科黄疸对机体的影响Effects of surgical jaundice Liver cirrhosis Endotoxemia: gut barrier ;Kupffer cell Renal function: Hyperbilirubin; bile acid; endotoxin Gastric mucosa: bile acid Cardiovascular system: Hyperbilirubin; bile acid; endotoxin Immunologic function:T cell Skin irritation： bile acid 梗阻性黄疸对机体的影响effects of obstructive jaundice 外科黄疸的鉴别诊断Differential diagnosis of surgical jaundice medical history： Physical examinati