肝脏疾病生理概要和解剖特点
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6
肝脏解剖生理概要–6 -middle hepatic vein
7
肝脏解剖生理பைடு நூலகம்要–7 - hepatic vein & portal vein
8
肝脏解剖生理概要–8 - portal vein plane
9
“精准肝脏外科时代”
—保留肝中静脉的左半肝切除
10
“精准肝脏外科时代”
—保留肝右静脉的右后叶肝切除
2
肝脏解剖生理概要-2
The American (lobar) system & the French (Couinaud segmental) system.
3
肝脏解剖生理概要-3
4
肝脏解剖生理概要–4
-Cauinaud segmentation
5
肝脏解剖生理概要–5 -left hepatic vein
肝脏疾病生理概要和解剖特点
肝脏解剖生理概要-1
The liver lies in the right upper quadrant of the abdomen, under the protective rib cage, beneath the diaphragm and connected to the digestive tract by means of portal vein and biliary drainage system.
凝血 免疫调节 再生 肝功能指标:
1. 转氨酶: aspartate phosphatase (AST), alanine phosphatase (ALT)
2. Alkaline phosphatases (ALP), Gamma-glutamyl transpeptidase (GGT)
3. Albumin 4. Child-Pugh肝功能分级; ICG15min渚留率
13
Hepatic Trauma
肝脏创伤
Hepatic trauma
-Classification and characteristics
Penetrating hepatic-trauma
1. Due to bullets, knives etc.—less devitalization of liver parenchyma
2. Due to missiles –shatter massive parenchyma
Blunt hepatic-trauma
1. Due to direct blow to the upper abdomen or lower right rib cage, or sudden deceleration.
In a review of 1842 liver injuries from 19751999 in USA, nonsurgical therapy is used in more than 80% of blunt injuries.
-Clinical findings
Symptoms and signs: hypovolemic shock (hypotension, decreased urinary output, low central venous pressure)
Laboratory findings: no detectable anemia due to rapid blood loss. Leukocytosis is common.
Gilsson’s capsule, bare area, falciform lig., coronary lig., gastrohepatic lig., hepatoduodenal lig. foramen
1: liver; 2: rib cage; 3: spine; 4: pelvis
2. Might be explosive bursting wounds or linear lacerations. 3. The posterior superior segment (SVII) is mostly vulnerable due to
its location. 4. Damage to the hepatic veins is catastrophic and difficult to
11
肝脏解剖生理概要–9 - circulation
1. 双重血供 (75% via 门静脉 & 25% via 肝动脉)
肝动脉携氧量占50％ 门静脉两端是毛细血管网，无功能
性静脉瓣 门静脉不可结扎或切断 肝脏血流阻断时间~15-20min
12
肝脏解剖生理概要–10
代谢: bilirubin, carbohydrate, lipid, protein, vitamin, drugs & toxins, ect.
expose during exploration.
(The staging system is for your reference only, but pls pay attention to by what index it score the damage)
15
Hepatic trauma
16
Hepatic trauma -imaging findings
17
Hepatic trauma
-imaging findings
Hydrops at the adrenal gland
Hepatic trauma with fracture of left rib
18
Hepatic trauma -Treatment
Imaging findings: 1. CT scan is prior to other techniques among stable patients. It can estimate the type and severity of the injury, which is useful information for both triaging and exploration if necessary. 2. Sonography is of limited value; angiography is diagnostic in hemobilia.
肝脏解剖生理概要–6 -middle hepatic vein
7
肝脏解剖生理பைடு நூலகம்要–7 - hepatic vein & portal vein
8
肝脏解剖生理概要–8 - portal vein plane
9
“精准肝脏外科时代”
—保留肝中静脉的左半肝切除
10
“精准肝脏外科时代”
—保留肝右静脉的右后叶肝切除
2
肝脏解剖生理概要-2
The American (lobar) system & the French (Couinaud segmental) system.
3
肝脏解剖生理概要-3
4
肝脏解剖生理概要–4
-Cauinaud segmentation
5
肝脏解剖生理概要–5 -left hepatic vein
肝脏疾病生理概要和解剖特点
肝脏解剖生理概要-1
The liver lies in the right upper quadrant of the abdomen, under the protective rib cage, beneath the diaphragm and connected to the digestive tract by means of portal vein and biliary drainage system.
凝血 免疫调节 再生 肝功能指标:
1. 转氨酶: aspartate phosphatase (AST), alanine phosphatase (ALT)
2. Alkaline phosphatases (ALP), Gamma-glutamyl transpeptidase (GGT)
3. Albumin 4. Child-Pugh肝功能分级; ICG15min渚留率
13
Hepatic Trauma
肝脏创伤
Hepatic trauma
-Classification and characteristics
Penetrating hepatic-trauma
1. Due to bullets, knives etc.—less devitalization of liver parenchyma
2. Due to missiles –shatter massive parenchyma
Blunt hepatic-trauma
1. Due to direct blow to the upper abdomen or lower right rib cage, or sudden deceleration.
In a review of 1842 liver injuries from 19751999 in USA, nonsurgical therapy is used in more than 80% of blunt injuries.
-Clinical findings
Symptoms and signs: hypovolemic shock (hypotension, decreased urinary output, low central venous pressure)
Laboratory findings: no detectable anemia due to rapid blood loss. Leukocytosis is common.
Gilsson’s capsule, bare area, falciform lig., coronary lig., gastrohepatic lig., hepatoduodenal lig. foramen
1: liver; 2: rib cage; 3: spine; 4: pelvis
2. Might be explosive bursting wounds or linear lacerations. 3. The posterior superior segment (SVII) is mostly vulnerable due to
its location. 4. Damage to the hepatic veins is catastrophic and difficult to
11
肝脏解剖生理概要–9 - circulation
1. 双重血供 (75% via 门静脉 & 25% via 肝动脉)
肝动脉携氧量占50％ 门静脉两端是毛细血管网，无功能
性静脉瓣 门静脉不可结扎或切断 肝脏血流阻断时间~15-20min
12
肝脏解剖生理概要–10
代谢: bilirubin, carbohydrate, lipid, protein, vitamin, drugs & toxins, ect.
expose during exploration.
(The staging system is for your reference only, but pls pay attention to by what index it score the damage)
15
Hepatic trauma
16
Hepatic trauma -imaging findings
17
Hepatic trauma
-imaging findings
Hydrops at the adrenal gland
Hepatic trauma with fracture of left rib
18
Hepatic trauma -Treatment
Imaging findings: 1. CT scan is prior to other techniques among stable patients. It can estimate the type and severity of the injury, which is useful information for both triaging and exploration if necessary. 2. Sonography is of limited value; angiography is diagnostic in hemobilia.