外科-胰腺疾病PPT.ppt

sometimes, it is called endoscopic therapy. some of them can receive laparoscopic cholecystectomy. Chronic Pancreatitis Pancreatic Cyst Periampullary Carcinoma carcinoma of head of pancreas ampullary carcinoma duodenal papillary carcinoma carcinoma of distal common bile duct carcinoma of Vaters ampulla Symptoms and signs upper abdominal pain (vague → severe, back pain) 70％ jaundice (painless) 80% weight loss 75％ Trousseau’s syndrome, Courvoisier’s sign others: nausea, vomiting, anorexia, steatorrhea, panceatitis, changes of stools, diabetes mellitus, etc Blood test bilirubin, alkaline phosphatase ↑↑, transaminase↑ CA19-9,CEA Perampullary Carcinoma Imaging studies ultrasound (initial) BM barium meal CT ERCP PTCD MRI, MRCP angiography EUS endoscopic ultrasonography Surgical procedures Whipple procedure, pancreatoduodenectomy PPPD, pylorus-preserving pancreatoduodenectomy Palliative surgical management CHJ，cholangiojejunostomy gastrojejunostomy celiac plexus block THANKS Good afternoon, ladies and gentlemen. in this lecture, the topic is about the pancreas, a very important and the deepest organ inside your abdomen. generally speaking, pancreatic disease includes… among them, acute pancreatitis is the most common disease. moreover, it frequently appear in examinations. so it is the major part in today’s lecture. and we will also take some time on pancreatic cancer or perampullary carcinoma. the left, you can selfstudy. now, let’s have a review about the anatomy and physiology of the pancreas. here is the pancreas, duodenum, and the most important vessels in pancreatic surgery- mesenteric vein and artery. usually, head and uncinate are considered as one part. the several arteries become a ring around the head. the chart shows the venous drainage. all venous blood flows into portal v. namely… when the common duct goes into duodenum, there are 3 type