上海交大外科学上血PBLPPT课件-精选.ppt

医学课件 * Hypertensive Portal Gastropathy 医学课件 * Injection of Sclerosant硬化剂 医学课件 * Band Ligation皮圈套扎 医学课件 * Hemoclip止血夹 医学课件 * Laser Application激光止血 医学课件 * Heater Probe加热探针 医学课件 * What Is Your Decision What are the therapeutic options for each common etiology病因 of massive UGIB after initial resuscitation? 医学课件 * For Reference Medicine Endoscope Surgery 医学课件 * Non-Variceal Bleeding therapeutic endoscope with/without medicine if effective then continue drug therapy eradication of H. pylori mucous protection 2 attempts of endoscopic failure pursue surgery other surgical indications severe life-threatening bleeding not responsive to resuscitation coexisting reason of perforation,obstruction or malignancies second hospitalization of peptic ulcer 医学课件 * Variceal Bleeding drug therapy with/without balloon temponade endoscopic binding or sclerotherapy transjugular intrahepatic portosystemic shunt (TIPS) 经颈静脉肝内门体分流术 effective rate 90% rebleeding rate in one year 16-30% shunt disfunction rate in 6 months 50-60% inducing encephalopathy rate 25-35% 30 day mortality rate 14-16% can be used as a temporary method before transplantation Child A B – surgery Child C – transplantation 医学课件 * TIPS 8-12mm 医学课件 * What Is Your Decision How to perform the operation? 医学课件 * For Reference Exploration探查 Hemostasis止血 Radical Operation根治 医学课件 * Exploration Sequence most popular site: stomach duodenum胃十二指肠 cirrhosis or not: liver and spleen肝脾 gallbladder and common bile duct胆道系统 upper portion of jejunum上段空肠 医学课件 * Non-Variceal Bleeding peptic ulcer or stress gastritis消化性溃疡和应激性胃炎 vagotomy迷走神经切除术 gastrectomy胃切除 sewing of bleeding ulcer溃疡缝扎 stomach neoplasm胃肿瘤 gastrectomy胃切除 hemobilia胆道出血 self-limited, seldom needs operation自限性，很少需要手术 医学课件 * Variceal Bleeding emergency: devascularization procedure断流术 splenectomy脾切除 gastroesophageal devascularization胃底食管血管离断 esophageal transection食管下段横断 Child A/B: decompressive shunt分流术 total portal systemic shunt非选择性分流 excellent control of bleeding止血效果好 40-50% en