课件：胆道疾病刘斌双语.ppt

* Figure 50-11 A, The gallbladder is retracted cephalad using the grasper on the gallbladder fundus and laterally at the infundibulum. The peritoneum overlying the gallbladder infundibulum and neck and the cystic duct is divided bluntly exposing the cystic duct. B, Once the gallbladder cystic duct junction has been clearly identified, clips are placed proximally and distally on the cystic duct and the duct is sharply divided. ( A and B, From Cameron JC: Atlas of Surgery, Vol. 2. Philadelphia, BC Decker, 1994.) * Infection. Bacterial contamination of the bile (bacterbilia) is relatively common in patients with hilar cholangiocarcinoma [51]. However, in the absence of prior biliary intubation, frank cholangitis is uncommon at initial presentation. Endoscopic or percutaneous instrumentation as well as previous operation significantly increase the incidence of bacterial contamination and the risk of infection. * * * * Carcinoma of Bile Duct Signs 肝肿大、触痛 脾肿大、腹水——门静脉受侵犯 胆囊肿大——胆囊管开口以下 Clinical Presentation Physical examination. Lab examinations AKP、SGPT、BIL升高、CA19-9、CA125、CEA升高 BUS、CT、MRI、PTC、ERCP MRCP Carcinoma of Bile Duct Treatment 手术治疗 上段胆管癌：切除后行胆肠吻合术切除范围：肝外胆管、胆囊及胆囊管、肝十二指肠韧带内脂肪及淋巴结，（部分肝脏）。 中段胆管癌：切除后行胆肠吻合术 下段胆管癌：胰十二指肠切除术 Carcinoma of Bile Duct 姑息治疗 梗阻以上胆管-空肠Roux-en-Y吻合 置管胆肠转流术 通过肿瘤置支撑管引流术 经PTC、ERCP置入内支架 放疗和化疗: 疗效不佳 本节重点内容 胆囊息肉的手术指征 胆囊癌、胆管癌的临床诊断 ANATOMY Extrahepatic Biliary Tract 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： 与肝动脉、门静脉前后、分叉关系。 胆管、门静脉和肝动脉的关系 ANATOMY ANATOMY Extrahepatic Biliary Tract 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 胆囊（The gallbladder）分底、体、颈三部（fundus, body, and neck）。 胆囊管 （The cystic duct） 后面内容直接删除就行 资料可以编辑修改使用 资料可以编辑修改使用 主要经营：网络软件设计、图文设计制作、发布广告等 公司秉着以优质的服务对待每一位客户，做到让客户满意！ 致力于数据挖掘，合同简历、论文写作、PPT设计、计划书、策划案、学习课件、各类模板等方方面面，打造全网一站式需求 * * * * * * * * * Figure 50-6 Triangular phase diagram with axes plotted in per