肝疾病(外科学第八版课件)

学习要求1.掌握肝脓肿、肝癌的诊断和外科治疗。2.熟悉肝脏的解剖特点，细菌性和阿米巴性肝脓肿的鉴别诊断。3.了解肝囊肿、肝海绵状血管瘤的诊断和治疗原则。SurgicalAnatomyLiverfunctions1.分泌胆汁2.代谢功能3.凝血功能4.解毒作用5.吞噬和免疫作用肝脓肿LiverabscessPathogenesis1.Biliarytree2.Hepaticartery3.Portalvein4.Nearbyinfection5.TraumaClinicalFeatures1.Feverandchills2.RUQpainandtenderness3.Hepatomegaly4.Jaundice5.NonspecificsymptomsLab.andimaging1.WBC,HGB2.Ultrasound,X-Ray,CT3.FNADifferentialdiagnosis1.Amebicliveabscess2.Intrahepaticbiliaryinfections3.Canceroftheliver4.SubphrenicabscessTreatment1.Supportivetherapy•Energyandnutrition•Electrodesandfluid•BloodtransfusionTreatment2.Antibiotics•ASAP,ifsuspected•Broadspectrum,coveringG+,G-andanaerobes•Duration≥2w,recommendedTreatment3.Drainage•Percutaneous•Laparotomy•LaparoscopicTreatment4.Hepatectomy5.Traditionalmedicine肝囊肿(Cystoftheliver)肝囊肿非寄生虫性先天性单发性多发性创伤性炎症性肿瘤性寄生虫性肝棘球坳病Echinococcosisoftheliver肝包虫病（Hydatid……）1.牧区生活史2.血清学+影像学3.手术治疗为首选先天性肝囊肿congenitalcystofliver囊壁内层附有内皮细胞液体清亮，多不含胆汁大而有症状者需适当治疗腹腔镜下开窗术首选，也可选穿刺。注意：与胆道相通囊肿、病变广泛的多囊肝。肝肿瘤（tumorofliver)肝肿瘤良性恶性原发性继发性肝海绵状血管瘤Cavernoushemangiomaofliver生长缓慢较小时多无症状CT、MRI不难诊断小而无症状者随访手术切除适应证小结肝脏解剖肝脓肿–临床表现–与阿米巴性肝脓肿的鉴别–治疗方法原发性肝癌PrimarylivercancerEpidemiologyCommon600000newcasesfoundannually55%occursinChinaM＞FHighincidenceintheageof40s,andatendencytodevelopearlierEtiologyLivercirrhosisHBVAflatoxin(AFT)ChronicalcoholabuseHCVChemicals:nitrites,hydrocarbons,solvents,pesticides,vinylchloridePathologyCategories–Cancercells–Morphology–SizeMetastasis–intrahepatic–extrahepaticClinicalPresentationRUQabdominalpainNonspecificsymptomsHepatomegalyDiagnosisHCCmarkers•Alphafetoprotein(AFP)•SerumenzymologyImaging•Ultrasound•CTandMRI•DSA•X-raysFNAandBiopsyDiagnosisTreatment治疗原则早期诊断，早期治疗，根据不同病进行综合治疗首选方法早期施行手术治疗Treatment1.Surgicaltreatment–ResectableHepatectomy(Radical,Palliative)–Unresectable(op.inprocedure)HAL,EI,RFA,MWA,Cryotherapy–Recurrent–Perforated–Livertransplantation肝切除术Treatment2.Percutaneousablation–RFA–MWA–PEITreatment3.Chemotherapy–TACE:reco-–Generalchemotherapy:notreco-–Sustainedreleaseagent4.Radiotherapy5.Biologicaltreatment6.Traditionalmedicine继发性肝癌血行转移最常见器官多来自消化道肿瘤临床表现：原发灶诊断：影像学+肿瘤标记物，活检治疗：取决于原发肿瘤情况结直肠癌并肝转移的治疗谢谢！