肝疾病(外科学第八版课件)

肝肿瘤 （tumor of liver)
良性
恶性
肝肿瘤
原发性 继发性
肝海绵状血管瘤
Cavernous hemangioma of liver 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
肝脏解剖 肝脓肿
结ຫໍສະໝຸດ Baidu
–临床表现 –与阿米巴性肝脓肿的鉴别 –治疗方法
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！
Diagnosis
HCC markers
• Alpha fetoprotein (AFP) • Serum enzymology
Imaging
• Ultrasound • CT and MRI • DSA • X-rays
FNA and Biopsy
Diagnosis
Treatment
肝囊肿 非寄生虫性 炎症性
肿瘤性
肝棘球坳病
Echinococcosis of the liver
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
congenital cyst of liver
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。
Treatment
3. Drainage
• Percutaneous • Laparotomy • Laparoscopic
Treatment
4. Hepatectomy 5. Traditional medicine
肝囊肿(Cyst of the liver)
单发性
先天性 寄生虫性 多发性
创伤性
原发性肝癌
Primary liver cancer
Epidemiology
Common 600000 new cases found annually 55% occurs in China M＞F High incidence in the age of 40s, and a tendency to develop earlier
Etiology
Liver cirrhosis HBV Aflatoxin (AFT) Chronic alcohol abuse HCV Chemicals: nitrites, hydrocarbons,
solvents, pesticides, vinyl chloride
Treatment
1. Supportive therapy
• Energy and nutrition • Electrodes and fluid • Blood transfusion
Treatment
2. Antibiotics
• ASAP, if suspected • Broad spectrum, covering G+,G- and anaerobes • Duration ≥2w, recommended
Pathology
Categories
–Cancer cells –Morphology –Size
Metastasis
–intrahepatic
–extrahepatic
Clinical Presentation
RUQ abdominal pain Nonspecific symptoms Hepatomegaly
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。
Surgical Anatomy
Liver functions
1. 2. 3. 4. 5. 分泌胆汁 代谢功能 凝血功能 解毒作用 吞噬和免疫作用
肝切除术
Treatment
2. Percutaneous ablation
–RFA –MWA –PEI
Treatment
3. Chemotherapy
–TACE: reco–General chemotherapy: not reco–Sustained release agent
4. Radiotherapy 5. Biological treatment 6. Traditional medicine
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
Treatment
1. Surgical treatment
–Resectable Hepatectomy (Radical, Palliative) –Unresectable (op. in procedure) HAL, EI, RFA, MWA, Cryotherapy –Recurrent –Perforated –Liver transplantation
肝脓肿 Liver abscess
Pathogenesis
1. 2. 3. 4. 5. Biliary tree Hepatic artery Portal vein Nearby infection Trauma
Clinical Features
1. 2. 3. 4. 5. Fever and chills RUQ pain and tenderness Hepatomegaly Jaundice Nonspecific symptoms
Lab. and imaging
1. WBC,HGB 2. Ultrasound, X-Ray, CT 3. FNA
Differential diagnosis
1. 2. 3. 4. Amebic live abscess Intrahepatic biliary infections Cancer of the liver Subphrenic abscess