肝疾病(外科学第8版课件)

肝疾病LiverDisease学习要求掌握肝脓肿、肝癌的诊断和外科治疗。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。了解肝囊肿、肝海绵状血管瘤的诊断和治疗原则。SurgicalAnatomy标志血管肝门分叶分段Liverfunctions分泌胆汁代谢功能凝血功能解毒作用吞噬和免疫作用再生能力强缺氧耐受力差肝脓肿LiverabscessPathogenesisBiliarytreeHepaticarteryPortalveinNearbyinfectionTraumaClinicalFeaturesFeverandchillsRUQpainandtendernessHepatomegalyJaundiceNonspecificsymptomsLab.andimagingWBC,HGBUltrasound,X-Ray,CTFNADifferentialdiagnosisAmebicliveabscessIntrahepaticbiliaryinfectionsCanceroftheliverSubphrenicabscessTreatmentSupportivetherapyEnergyandnutritionElectrodesandfluidBloodtransfusionTreatmentAntibioticsASAP,ifsuspectedBroadspectrum,coveringG+,G-andanaerobesDuration≥2w,recommendedTreatmentDrainagePercutaneousLaparotomyLaparoscopicTreatmentHepatectomyTraditionalmedicine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……）牧区生活史血清学+影像学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PrimarylivercancerEpidemiologyCommon600000newcasesfoundannually55%occursinChinaM＞FHighincidenceintheageof40s,andatendencytodevelopearlierEtiologyLivercirrhosisHBVAflatoxin(AFT)ChronicalcoholabuseHCVChemicals:nitrites,hydrocarbons,solvents,pesticides,vinylchloridePathologyCategoriesCancercellsMorphologySizeMetastasisintrahepaticextrahepaticClinicalPresentationRUQabdominalpainNonspecificsymptomsHepatomegalyDiagnosisHCCmarkersAlphafetoprotein(AFP)SerumenzymologyImagingUltrasoundCTandMRIDSAX-raysFNAandBiopsyDiagnosisTreatment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TreatmentSurgicaltreatmentResectable

Hepatectomy(Radical,Palliative)Unresectable(op.inprocedure)

HAL,EI,RFA,MWA,CryotherapyRecurrentPerforatedLivertransplantation肝切除术TreatmentPercutaneousablationRFAMWAPEITreatmentChemotherapyTACE:reco-Generalchemotherapy:notreco-SustainedreleaseagentRadiotherapyBiologi