研究生课程-外科学总论新进展2.ppt

肿瘤组成 三、外科疾病介入治疗 1、外科疾病介入治疗技术 以现代影像学技术为基础 经血管或非血管途径 导管接近病变部位 相应介入治疗 2、经血管途径的介入治疗 ----技术操作 基本操作：血管造影＋Seldinger手法 术前准备：碘试验、肾功能、血凝 并发症： 穿刺部位：出血 假性动脉瘤 局部动脉：内膜剥脱 血栓形成 肾毒性 全身反应 经血管途径的介入治疗 ----技术 经导管动脉内药物灌注术(TII) 经导管动脉栓塞术(TAE) 经皮血管腔内成形术(PTA) 经皮血管内导管药盒植入术 经颈静脉肝内门体静脉分流术(TIPS) 经皮血管内支架置放术 经皮血管内异物血栓取出术 心血管瓣膜成形术 经血管途径的介入治疗 ----常用方法 药物灌注：恶性肿瘤辅助化疗 TACE 化疗+栓塞 TAE 栓塞 PTA：经皮经血管腔血管成形术 TIPS 经皮血管内导管药盒系统置入术 3、经非血管途径的介入治疗 经皮穿刺胆道外引流术(PBD) 经皮胆道球囊扩张术(BCT) 经皮肝穿刺胆道内支架置入术(PBSP) 微波组织凝固术(MTC) 冷冻外科消融术(CSA) 射频消融术(RFA) 电化学治疗 腹腔积液经皮穿刺外引流术 * 谢谢大家的参与！ Thank you ! * FIGURE 28-1. A genetic model for colorectal tumorigenesis. Tumorigenesis proceeds through a series of genetic alterations involving oncogenes (ras) and tumor suppressor genes (particularly those on chromosomes 5q, 12p, 17p, and 18q). The three stages of adenomas in general represent tumors of increasing size, dysplasia, and villous content. In patients with familial adenomatous polyposis (FAP), a mutation on chromosome 5q (APC gene) is inherited. This alteration may be responsible for the hypoproliferative epithelium present in these patients. Hypomethylation is present in very small adenomas in patients with or without polyposis, and this alteration may lead to aneuploidy, resulting in the loss of suppressor gene alleles. The ras gene mutation appears to occur in one cell of a preexisting small adenoma and, through clonal expansion, produces a larger and more dysplastic tumor. Allelic deletions of chromosome 17p and 18q usually occur at a later stage of tumorigenesis than do deletions of chromosome 5q or ras gene mutations. The order of these changes is not invariant, however, and accumulation of these changes, rather than their order with respect to one another, seems most important. Tumors continue to progress once carcinomas have formed, and the accumulated loss of suppressor genes on additional chromosomes correlates with the ability of the carcinomas to metastasize an