肝脏疾病的诊断与治疗幻灯片.pptVIP

2．CT检查：CT- scaning ,with or without intravenous material, apperars to be increasing in accuracy and may detect lesion as small as 1 cm in diameter 3．选择性腹腔动脉或肝动脉造影：hepatic arteriography may be helpful in identifying the number and location of multiple lesion. 对肿瘤血管丰富的肿瘤，1CM~2CM小肝癌其诊断小肝癌的阳性率可达90%，是目前对小肝癌的定位检查的各种方法中最有效的方法。 4．MRI ： 5．放射性核素肝扫描： 6．X线检查： 腹部透视或平片可见右侧膈肌升高、活动受限或呈局限性隆重起。 7．肝穿刺针吸细胞学检查.Percutaneous needle biopsy or fine – needle aspiration for cytodiagnosis is important in diagnosis, but less for the evaluation of potentially resectable, indeteminant liver masses 鉴别 原发性肝细胞癌需与继发性肝癌、肝脓肿相鉴别。 治疗(Treatment) The overall survival of patients with untreated hepatocellular carcinoma is approximately 3 to 4 months after symptoms appear.If the lesion is resected, average survival is reported to be approximately 3 years. 5 year survival rates after resection in large series are 11 to 46 percent 1. 手术治疗 （1）手术切除：A.癌局限一个肝叶者，可作肝叶切除；B.癌侵犯一叶或累及邻叶者，可作半肝切除；C.已累及半肝但没有肝硬变者，可作肝三叶切除；D.肿瘤位于肝边缘可选肝段或次肝段或局部切除。 小肝癌：距肿瘤2CM根治性局部切除术。 ◆ 禁忌症 ◆.癌肿侵润第一、第二肝门及下腔静脉(not correct)，以及心、肺、肾功能严重受损； ◆.有明显腹水、黄疸； ◆.远处转移者和全身衰竭的晚期患者。 * * LIVER SURGERY 肝脏疾病 肝蒂 肝十二指肠韧带：含有门静脉、肝动脉、胆总管、淋巴结、淋巴管和神经。 第一肝门(porta hepatis) 由门静脉、肝动脉、肝总管在肝脏面横沟各自分出，向左向右的支干，再进入肝实质内，此处称第一肝门。 门静脉系统(Portal system) 在肝实质内，由于门静脉、肝动脉和肝胆管的管道分布大体上相一致，共同被包裹在Glisson纤维鞘内，因此可以由门静脉的分布来代表，称为门静脉系统。 第二肝门 是由肝血液的流出管道，其分布与门静脉系统不相一致。 三条主要的肝静脉在肝静脉窝进入下腔静脉，此处称第二肝门。 Lobar Anatomy Portal Fissure :Pass from the left side of the gallbladder fossa to the left side of the inferior vena cava to divide the liver into right and left lobes The left lobe consists a medial segment to the right of the falciform ligament and umbilical fissure plus a lateral segment to the left of the falciform ligament The right lobe consists of an anterior and posterior segment No visible surface marking designates this segmental separation French “Segmen