胆石症的诊断与治疗及病例分析.pptxVIP

胆石症的诊断与治疗及病例分析;胆道解剖;第3页/共56页;第4页/共56页;胆道生理;临床表现;胆石症的主要并发症;病 例 ; 结果一 ; 结果二 ;结果一与结果二的比较;急性胆囊炎的手术治疗;手术方式; 结果三; 结果三;急性胆源性胰腺炎;诊断;急性胰腺炎的临床表现;;Extent of amylase ? is not parallel to severity, ~10% of patients never have hyperamylasemia (including fatal cases) Amylase measurement is very valuable for identifying ascites or pleural effusion of pancreatic origin. Urine amylase may remain elevated for 7-10 days in AP. It is also useful for the diagnosis of macroamylasemia, when Camylase/CCr is 1% (N ? 4%) Srum lipase: may remain elevated for 7-14 days in AP.;CT扫描严重程度分级;胆道梗阻的临床表现;B超的作用;Significant but transient hyperbiliru-binemia Significant but transient elevation of ALP Ultrasonography reveals gallstones ALT/AST elevated, fluctuation 50% within 24 hrs Serum amylase 2000~4000U/L If elevation of amylase lasts 7-10 days, should be considered: obstruction of pancreatic duct.;急性胆源性胰腺炎的诊断要点;治疗;急性胆源性胰腺炎的治疗; 结果四; 结果四; 结果四; 结果四;;急性胆管炎;急性梗阻性化脓性胆管炎;实验室检查： 感染的表现：血WBC上升，可有血培阳性 淤疸的表现： 血胆红素上升，直胆为主 尿胆红素阳性，粪胆原和尿胆原多阴性 ALP上升 影像学检查： 超声：表现为肝内外胆管的扩张，结石，胆囊壁增厚，胆囊增大等 ERCP检查：疑难病例;重症急性胆管炎的诊断;重症急性胆管炎的处理;B超：胆囊颈部结石; B超：急性胆囊炎，胆囊壁水肿; CT：急性胆囊炎;ERCP: Mirizzi Syndrome;ERCP: Mirizzi Syndrome;; MRCP：胆总管结石; MRCP：胆总管结石; ERCP：胆总管结石; ERCP：胆总管结石; ERCP：胆总管结石; CT：肝内胆管结石; MRCP：胆总管及肝内胆管结石; MRCP：肝内胆管结石; ERCP：肝内胆管结石; B超引导下PTC：肝内胆管结石; PTC：肝内胆管结石;第55页/共56页;感谢观看!