16肝脏疾病.ppt

16肝脏疾病.ppt

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LIVERDISEASESZhengrongshiDepartmentofHepatobiliarySurgeryTheFirstAffiliatedHospitalChongqingMedicalUniversityAnatomicfeaturesAdualbloodsupply:

PortalVein（PV）andHepaticArtery（HA）Aspecificarchitecturalarrangementofsinglecellsandcellmassesthatfacilitatesexchangebetweenbloodandhapatocytes.VenkateshMurthyShashidharVenkateshMurthyShashidharAssociateProfessorofPathologyFijiSchoolofMedicineLiverFunctionsMetabolismchangeCarbohydrate,Fat&ProteintoGlycogenSecretorybile,Bileacids,saltsExcretoryBilirubin,drugs,toxinsSynthesisAlbumin,coagulationfactorsStorageVitamins,carbohydratesetc.Detoxificationtoxins,ammonia,etc.LIVERABSCESSBacterialliverabscessBacterialliverabscessPyogenicabscessPyogenicabscessHEPATICABSCESSMaybebacterial,parasitic,orfungalinorigin.InChina,pyogenicabscessesarethemostcommon.Spreadoforganismtolivermayoccurthrough:

ThepotalsystemAscensionfromthebiliarytreeThehepaticarteryduringgeneralizedsepticemiaDirectextensionfromsubhepaticorsubdiaphragmaticinfectionAdirectroutefollowingtraumaClassificationSingleabscess90%:

rightlobe10%:

leftlobeMutipleabscessClinicalManifestationsFever（90%）39-41epigastricpainhepatomegalyChillsJaundiceWeightlossNausea,vomitingWeaknessUltrasound:

85%-95%CTscanCTisthemostsensitiveoftheimagingprocedures:

95%-100%.Theappearanceisvariable,andlesionsmayappearcysticorisodense,withsolidmetastaticlesions.Aminorityofhepaticlesionscontaingas.DiagnosissymptomImagingUltrasoundCTMicrobialculturesAspirationSerology:

WBCDifferentialDiagnosisSimplecystnoelements/strandinginwallsMalignancy（tumor）solidAmebicabscesscannotbedistinguishedbyimagingRightsubphrenicabscessBiliaryinfection,cholangitisTreatment1.Antibiotics:

2.Drainage:

3cm

（1）.Percutaneousbyimaging;

（2）.drainagelaparoscope（3）.drainagebytraditionalwayDrainageDrainagebypercutaneouslyunderultrasoundorCT80%canbeadequatelytreatedbysuctioncathetersinsertedpercutaneouslyunderultrasoundorCTguidance.Surgicaloperation1.drainagelaparoscope2.drainagebytraditionalwaysometimeslobectomyNoclinicalresponsetoPercutaneousdrainagewithin4-7daysMultiple,largeorloculatedabscessesconfinedtoasinglelobeAssociateddisease（e.g.,biliarytract）PrognosisOverallmortalityrateis15%Themortalityrateisabout40%inpatientswithmalignantdisease.Hugeabscessmayrupture.cancerofliverZhengrongshiDepartmentofHepatobiliarySurgeryTheFirstAffiliatedHospitalChongqingMedicalUniversityPrimarylivercancerisquitecommoninworld,andthenumberisincreasing.Approximately250000peoplearediagnosedwiththistypeofcancereachyearintheChina.Typesofprimarylivercancer.qPathologygrossclassificationmassivemultinodulardiffusedmicroscopicclassificationhepatocellularcarcinoma（HCC）cholangiocellularcarcinomamixedtypeHepatomaHepatomaorhepatocellularcarcinomahepatocellularcarcinoma（HCC）isusuallyconfinedtotheliver,althoughoccasionallyitspreadstootherorgans.Itismorecommoninmenandoccursmostlyinpeoplewithaliverdiseasecalledcirrhosis（肝硬化）.ThreemaincellulartypesofprimarylivercancerHepatocellularcarcinoma-hepatomaCholangiocellularcarcinoma-cholangiocarcinomaAmixedform-hepatocholangiomaThreetypesofgrossmorphologyAmassiveform:

asinglepredominantmassclearlydemarcatedfromthesurroundingliver,occasionallywithsmallsatellitenodulesAnodularform:

multiplenodulars,oftendistributedthroughouttheliverAdiffusevariety:

infiltrationoftumorthroughouttheremainingparenchymaSymptomsandsignsRightupperquadrantpainWeightlossJaundiceHepatomegalyIntermittentfeverAscitesorgastrointestinalbleedingindicatesadvanceddiseaseNoclinicalfindingsHOWISCANCEROFTHELIVERFOUND?

Bloodtestsofliverfunction.Bloodtestsofliverfunction.AFPbloodtestAFPbloodtestBloodtestsforHepatitisBandCBloodtestsforHepatitisBandCHBV-DNAcopiesHBV-DNAcopiesUltrasoundoftheliver.Ultrasoundoftheliver.CTscanorMRIscanofliverCTscanorMRIscanofliverBiopsyBiopsyAngiogramAngiogramLaparoscopyLaparoscopyValueofAFPAlpha-fetoprotein（AFP）:

normalypretentonlyinthefetalcirculation.Elevatedintheserumofmanypatientswithprimaryhepatomasandtesticulartumors.Normaly20ng/mL;200ng/mLhepatoma.TheprognosisisworsewhenAFPlevaelsarehigh.ComplicationSpontaneousbleeding:

rupture,intra-Spontaneousbleeding:

rupture,intra-abdominalhemorrhageabdominalhemorrhagePortalhypertension:

obstructionoftheportalPortalhypertension:

obstructionoftheportalveinveinBudd-Chiarisyndrome:

obstructionoftheBudd-Chiarisyndrome:

obstructionofthehepaticveinhepaticveinLiverfailureLiverfailureTreatmentPartialhepatectomyLivertransplantationEthanolinjectionRadiofrequencyablationArterialchemoembolizationHepatectomyResectionofthetumorofferstheonlypossibilityofcure.Thecriteriaofrespectab