外科学课件整理-外科第48章门静脉高压症bilingual.pptxVIP

门静脉高压症 门静脉高压症 Portal hypertension 门静脉高压症教学内容★ Anatomy of portal vein system★ Etiology , Pathophysiology★ Clinical presentation,diagnosis and differential diagnosis ★ Treatment门静脉高压症概 念 Portal hypertension is a pathologic state that the liver or associated structures obstruct portal blood flow and result in the portal vein system hypertensionpresents as splenomegaly and hypersplenism, hematemesis and melena from esophageal and gastric varices rupture, and ascites.门静脉高压症概 念门脉压正常值 1.27～2.35 kPa(13～24cmH2O) 平均 1.76 kPa(18cmH2O)门脉高压 ＞25cmH2O 30～50cmH2O门静脉高压症门静脉解剖门静脉高压症门静脉解剖The portal vein system is between two capillary networks No valves in portal vein system and the blood flow can be reversedFour ramus communicans between portal and systemic circulations 门静脉高压症门静脉解剖esophageal and gastric veinsanterior abdominal wall veinsretroperitoneal venous plexusinferior rectal-anal veins门静脉高压症门静脉高压症产生原因血流阻力增加动静脉交通支开放,门静脉血流量增多静脉血栓形成血吸虫病肝炎后肝硬化布-加综合征门静脉高压症门静脉高压症产生原因门静脉高压症门静脉高压症分型pre-hepaticintra-hepaticpre-sinusoidal Sinusoidal post-sinusoidalpost-hepatic门静脉高压症门静脉高压症病理生理 congestive splenomegaly 充血性脾肿大 ramus communicans dilatation 交通支扩张 ascites 腹水门静脉高压症门静脉高压症病理改变临床表现脾肿大门静脉血流受阻---充血性脾肿大，脾内纤维组织增生程度不一，大者达盆腔脾功能亢进脾窦扩张，脾内纤维组织增生，单核-吞噬细胞增生和吞噬红细胞现象外周血细胞减少。白细胞计数＜3×109／L， 血小板计数减少至70～80×109／L门静脉高压症门静脉高压症脾肿大门静脉高压症 病理改变临床表现交通支扩张食管下段、胃底形成曲张静脉，破裂。立刻发生急性大出血，呕吐鲜红色血液，一次出血量常达500 ～1000ml，不易自止，柏油样便，黑便直肠上、下静脉丛扩张继发性痔脐旁静脉与腹上、下深静脉交通支扩张前腹壁静脉曲张腹膜后小静脉扩张、充血门静脉高压症门静脉高压症门静脉高压症前腹壁交通支门静脉高压症门静脉高压症胃底、食管下段交通支前腹壁交通支门静脉高压症门静脉高压症食管下段、胃底形成曲张静脉，破裂门静脉高压症门静脉高压症前腹壁静脉曲张门静脉高压症门静脉高压症病理改变临床表现 腹水 压力高；肝功能减退，白蛋白合成障碍；胶体渗透压下降及淋巴液生成增加；醛固酮的作用，钠水潴留蛙腹，移动性浊音门静脉高压症门静脉高压症腹水门静脉高压症门静脉高压症病理改变临床表现门静脉高压性胃病胃壁淤血、水肿；胃黏膜下层动-静脉交通支广泛开放，胃黏膜微循环发生障碍，黏膜防御屏障破坏黏膜和黏膜下层细血管、毛细血管扩张、扭曲；黏膜红斑征；上消化道出血肝性脑病门体血流短路或手术分流或肝实质细胞功能严重受损---有毒物质直接进入体循环精神神经综合征：昏迷门静脉高压症门静脉高压性胃病门静脉高压症门脉高压症诊断病史 肝炎和血吸虫等临床表现 脾大、脾功能亢进、呕血或黑便、腹水等辅助检验 血象、肝功能检查、术中直接测压、影像学检查（腹部超声、食管吞钡x线、腹腔动脉造影的静脉相或直接肝静脉造影、计算机体层成像）、内镜门静脉高压症门脉高压症诊断腹部超声门静脉高压症门脉高压症诊断食管吞钡x线门静脉高压症门脉高压症诊断腹腔动脉造影的静脉相或直接肝静脉造影门静脉高压症门脉高压症诊断计