上海交通大学医学院外科学各论（英文）课件第十二章 胆道疾病.ppt

Anatomy and Pathophysiology Diagnostic techniques Stones of Biliary tract Infection of Biliary tract Biliary Tumors Anatomhy of biliary tract Common bile duct Diameter 0.6-0.8cm > 1cm abnormal Length 7-9cm supraduodenal segment retro duodenal segment retro pancreatic segment duodenal wall segment The papilla of Vater pancreatic sphincter  common sphincter biliary sphincter Gallbladder Length:8-12cmwidth:3-5cm variablesize:40-60mlshape: pearshaped  fundus  body  the neck  The physiological function of Gallbladder Store and concentrate hepatic bile Secretion of water and electrolytes Empty bile into the common bile duct Bile secretion Hepatocytes secrete bile 800-1200ml Bile composition: bile acids, bile pigments,cholesterol, phospholipids,inorganic electrolytes ,water Diagnostic techniques Abdominal ultrasonography 1.untraumal2.low cost3.flexibicity4.first choice Abdominal ultrasonography Diagnose biliary stone Identify the cause of jaundice PTCD by β-ultrasound guided Doppler blood flow Percutaneous Transhepatic Cholangiography Show the dilated bile duct above obstruction site Drainage of bile by PTCD Traumatic methods Complications Bile leakage Haemorrhage Sepsis Endoscopic Retrograde Cholangiopancreatography ERCP Directly observe papilla lesion and biopsy Show the entire biliary tract Show the biliary tract proximal to obstruction site Drain bile  Complications acute pancreatitis postprocedure cholangitis Other complications Operative and postoperative direct cholangiography Show the entire biliary tract Display the stone and stenosis Tube cholangiography done before biliary drainge with drawn CT and MRI High resolution More accurate Expensive Show the stone ,tumor, dilated duc