胆道疾病刘斌双语幻灯PPT.pptVIP

Diseases of the Biliary Tract Liu Bin Associate Professor and Vice-chairman Department of General Surgery Xuzhou Medical College Hospital (P559) ANATOMY Intrahepatic Biliary Tract Extrahepatic Biliary Tract The gallbladder Oddi’s sphincter ANATOMY Intrahepatic Biliary Tract 毛细 胆管 小叶间胆管 肝段 胆管 肝叶 胆管 左右 肝管 三级 二级 一级 Anatomy of the Biliary System and its Relationship to Surrounding Structures 左右肝管 The left and right hepatic ducts左：2.5-4cm, 右：1-3cm 肝总管 The common hepatic duct长：2-4cm, 直径：0.4-0.6cm副肝管： 胆总管（The common bile duct）长：7-9cm，直径：0.6-0.8cm，1cm病理分段：十二指肠上段、后段、胰腺段、十二指肠壁内段 胆管、门静脉和肝动脉的关系 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：? 800-1200ml/ 日 乳化脂肪、抑制细菌、刺激肠蠕动、中和胃酸。 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 肠肝循环 Admirand and Small Triangle 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 1.18kPa 0.98kPa 3.83kPa 0.79kPa 1.18kPa 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 胆石超声图像 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 PTC影像 Diagnostic Approaches Endoscopic Examinations 胆道镜检查术中、术后 诊