胆系课件课件篇.pptVIP

　胆道肿瘤 一、胆囊息肉和良性肿瘤 （一）、胆囊息肉 １、肿瘤性息肉 ２、非肿瘤性息肉 （二）、胆囊腺瘤 * 胆囊息肉样病变 * * * * * 诊治参考 良性 恶性 大小，增长速度 1cm,增长慢 1cm,短期迅速增大 数目 多发 单发，腺瘤也为单发 形状 乳头状，蒂细长 不规则、基底宽或局部胆囊壁增厚 部位 腺肌样增生好发胆囊底部 胆囊体部 症状 一般无 有 * 二、胆囊癌 病因 70%~98%的胆囊癌并存有胆囊结石 临床表现 实验室检查 CEA,CA-199,CA-125等在胆囊癌肿均可呈阳性 * 胆囊腺癌 * * * With the development of economy and the improvement of medical science and technology, liver transplantation will undoubtedly be facing a promising future in Mainland China. From our experiences, the recurrence of tumor, the reinfection of HBV as well as the biliary and vascular complications are the main obstacles. We need a “brain death” ordinance to facilitate cadaveric liver transplantation. We should establish an efficient system for organ sharing and allocation. Special attention should be given to LRLT, split liver transplantation and xenotransplantation, which could be the hope in the future. With the development of economy and the improvement of medical science and technology, liver transplantation will undoubtedly be facing a promising future in Mainland China. From our experiences, the recurrence of tumor, the reinfection of HBV as well as the biliary and vascular complications are the main obstacles. We need a “brain death” ordinance to facilitate cadaveric liver transplantation. We should establish an efficient system for organ sharing and allocation. Special attention should be given to LRLT, split liver transplantation and xenotransplantation, which could be the hope in the future. 临床表现 静止性胆囊结石：约20%~40% 有症状性胆囊结石： 一般表现——消化不良 “胃病” 典型表现——胆绞痛 特殊类型——Mirizzi综合症 特殊概念——白胆汁 继发性疾病——胆总管结石、胆源性胰腺炎、胆管炎、胆囊癌 * 诊断 病史 体检 影像学检查： 超声——首选 CT MRI 鉴别诊断 * 胆囊结石 * * * CT所示：胆囊结石 超声所示：胆囊结石 * 胆管结石 概述 分类： 成分： 原发性胆管结石：胆色素结石或 混合性结石 继发性胆管结石：胆固醇性结石 部位： 肝外胆管结石 肝内胆管结石 * 肝外胆管结石 病理： ①胆管梗阻：胆管扩张、管壁增厚 ②继发感染：梗阻性化脓性胆管炎、胆道出血 ③梗阻并感染：胆源性肝脓肿、胆汁性肝硬化 ④胆石嵌顿：胆源性胰腺炎 * 临床表现 典型的症状为Charot三联症 １．腹痛： 阵发性绞痛 持续性疼痛阵发性加剧 右肩放射痛 恶心、呕吐 ２．寒战高热：弛张热 ３．黄疸： 间歇性、波动性 梗阻性黄疸表现：尿深、便浅、皮痒 * 诊断 Charcot三联征 体检：剑突、右上腹压痛、腹膜刺激征 实验室检查：WBC↑尿胆红素↑粪尿胆原↓ 影像学检查： B超 MRCP