协和外科课件2.ppt
- 文档编号:1996958
- 上传时间:2022-10-26
- 格式:PPT
- 页数:54
- 大小:1.34MB
协和外科课件2.ppt
《协和外科课件2.ppt》由会员分享,可在线阅读,更多相关《协和外科课件2.ppt(54页珍藏版)》请在冰豆网上搜索。
门脉高压的外科治疗门脉高压的外科治疗中国协和医科大学北京协和医院外科唐伟松Table1.Aetiologicalfactorsinextrahepaticportalvenoushypertensioninadults.Intra-abdominalinfectionsIntra-abdominalinfectionsHypercoagulableHypercoagulablestatesstatesAppendicitisAppendicitisMyeloproliferativeMyeloproliferativesyndromesyndromeOtherformsofperitonitisOtherformsofperitonitisPregnancyPregnancyInflammatoryboweldiseaseInflammatoryboweldiseaseOralcontraceptivedrugsOralcontraceptivedrugsBiliaryBiliarytractinfectiontractinfectionCollagendiseasesCollagendiseasesPancreatitisPancreatitisThrombophlebitisThrombophlebitismigransmigransPostoperativefactorsPostoperativefactorsRetroperitonealfibrosisRetroperitonealfibrosisSplenectomySplenectomyIncreasedportalvenousflowIncreasedportalvenousflowPortosystemicPortosystemicshuntsshuntsHepaticHepaticarteriovenousarteriovenousfistulaefistulaeBiliaryBiliarysurgerysurgeryTraumaTraumaUnknownUnknownTumourTumourinvasionandcompressioninvasionandcompressionHepatocellularHepatocellularcarcinomacarcinomaOthermalignantOthermalignanttumourstumoursTable1.Numberofcasesofbleedingectopicvaricesreportedintheliterature.SitesofSitesofEctopicEctopicVaricesVaricesNumberofReportedCasesNumberofReportedCasesDuodenumDuodenum2828JejunumandIleumJejunumandIleum2929ColonColon2424RectumRectum1414IleostomyIleostomyorColostomyorColostomy4444PeritoneumPeritoneum1616CommonBileDuctandGallbladderCommonBileDuctandGallbladder33VaginaVagina22BladderBladder11门脉高压症外科治疗的解剖基础门脉高压症外科治疗的解剖基础门脉高压的侧枝门脉高压的侧枝冠状V.1.门V.胃底食道V.奇V.胃短V.2.直肠上V.直肠下V.腹壁上V.上腔V.3.脐旁V.腹壁下V.下腔V.4.肠系膜上、下、V.下腔V.(Retzius静脉丛)正常门静脉系统的局解剖正常门静脉系统的局解剖胃食道静脉曲张出血的外科治疗胃食道静脉曲张出血的外科治疗门体静脉吻合(分流)术门体静脉吻合(分流)术门体静脉吻合(分流)术门体静脉吻合(分流)术1.1.门、腔门、腔V.V.吻合吻合2.2.脾肾静脉吻合脾肾静脉吻合远端脾肾远端脾肾V.V.吻合术(吻合术(WarrensWarrens术)术)近端近端脾肾脾肾V.V.吻合术吻合术3.3.肠系膜肠系膜V.V.、下腔下腔V.V.吻合吻合(侧例吻合、(侧例吻合、HH形吻合)形吻合)下腔下腔V.-V.-肠系膜上肠系膜上V.V.端侧吻合端侧吻合4.4.冠状冠状V.V.、上腔上腔V.V.吻合吻合5.5.经颈内静脉穿刺、肝内门、体经颈内静脉穿刺、肝内门、体V.V.分流术(分流术(TIPSTIPS)Riskoffuturebleedingaccordingtovaricealsize.W.G.RECTORJrANDT.B.REYNOLDSRiskoffuturebleedingaccordingtoRiskoffuturebleedingaccordingtovaricealvaricealsize.size.SizeofSizeofvaricesvaricesSmallornoneMediumLargeSmallornoneMediumLarge13/519/4111/230-4913/519/4111/230-492/347/3913/380-62/347/3913/380-60/344/249/171-860/344/249/171-860/160/2412/60120/160/2412/601215/13530/12845/13815/13530/12845/138(11%)(23%)(33%)(11%)(23%)(33%)FollowupFollowup(months)(months)门奇静脉断流术门奇静脉断流术nn贲门周围血管离断术nn食管下端横断术nn胃底模断术nn食管下端胃底切除术nn冠状V.栓塞术LiverFunction(Childs)ClassificationBilirubin3mg3albumin3.5mg13-3.5mg23.0mg3ascitesnone1easilycontrolled2difficultcontrolled3hepatoencephalopathynone1moderate2severe3nutritionalstategood1moderate2poor3A5-8B9-11C12-15肝功能分级标准(1983年分级标准)IIIIIIIIIIIISGPTSGPT正常正常222倍正常值倍正常值白蛋白白蛋白3.53.5g2.5-3.5g2.5gg2.5-3.5g2.5g胆红素胆红素1.22.0mgmg1.2-2.0mg2.0mg腹水腹水-少量、易控少量、易控大量大量脑病脑病-IIIIII沉血酶元时间沉血酶元时间正常正常延长延长3-63-6秒秒延长延长66秒以上秒以上血管栓塞术nn冠状静脉栓塞nn胃短静脉栓塞nn脾动脉栓塞nn曲张静脉栓塞脾肿大、脾亢的外科治疗脾肿大、脾亢的外科治疗nn脾切除nn脾A部分栓塞顽固性腹水的治疗顽固性腹水的治疗nn腹腔、上下腔V.转流术nnLeeven氏管nnDever氏管门脉高压症手术并发症门脉高压症手术并发症nn创面出血nn胃肠道出血nn腹水nn腹腔感染nn肠系膜静脉血栓形成nn肝功能衰竭nn肝性脑病各种治疗的生存率各种治疗的生存率11year2years5years10yearsyear2years5years10yearsPSS89.280.577.067.5Disconection88.782.279.868.1S+D90.385.482.14ChinesJsurg2000;38
(2):
85选择手术方式的有关因素选择手术方式的有关因素1.肝功能分级Childs分级中华医学会分级2.脾功能亢进的程度3.医生的经验各种手术的死亡率手术方式手术方式手术死亡率手术死亡率作者作者年代年代门门-腔分流(急症)腔分流(急症)42%42%OrloffOrloff19841984SugiuraSugiura术术12%12%SugiuraSugiura19731973食管下段横断食管下段横断18%18%CuirentCuirentHepatologyHepatology吻合吻合吻合吻合急症急症33%33%择期择期12%12%SugiuraSugiura术术33.5-9.7%5-9.7%Sugiura1988Sugiura1988WarrensWarrens术术dsrs4dsrs4.4%.4%脾脾-肾分流肾分流1.5%1.5%吴光汉等吴光汉等19881988脾脾-肾分流肾分流8.7%8.7%协和协和19861986主要手术种类nn分流术nn近端脾近端脾-肾静脉吻合肾静脉吻合nn远端脾远端脾-肾静脉吻合肾静脉吻合nn门腔静脉吻合门腔静脉吻合nn肠腔静脉吻合肠腔静脉吻合nn冠状静脉冠状静脉-下腔静脉吻合下腔静脉吻合nn门奇静脉阻断术nn食道下段贲门周围血管食道下段贲门周围血管离断术离断术nn冠状静脉结扎术冠状静脉结扎术nn胃底静脉缝扎术胃底静脉缝扎术nn食道下段贲门切除术食道下段贲门切除术食道静脉曲张的手术选择食道静脉曲张的手术选择肝功能手术方式1分流术2分流术或断流术3断流术门脉高压的治疗门脉高压的治疗n肝移植
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- 协和 外科 课件