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ID:39679908
大小:2.07 MB
页数:143页
时间:2019-07-09
《《胆道疾病刘斌双语》PPT课件》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、DiseasesoftheBiliaryTractLiuBinAssociateProfessorandVice-chairmanDepartmentofGeneralSurgeryXuzhouMedicalCollegeHospital胆道疾病(P559)ANATOMYIntrahepaticBiliaryTractExtrahepaticBiliaryTractThegallbladderOddi’ssphincterANATOMYIntrahepaticBiliaryTract毛细胆管小叶间胆管肝段胆管肝叶
2、胆管左右肝管三级二级一级AnatomyoftheBiliarySystemanditsRelationshiptoSurroundingStructures左右肝管Theleftandrighthepaticducts左:2.5-4cm,右:1-3cm肝总管Thecommonhepaticduct长:2-4cm,直径:0.4-0.6cm副肝管:胆总管(Thecommonbileduct)长:7-9cm,直径:0.6-0.8cm,>1cm病理分段:十二指肠上段、后段、胰腺段、十二指肠壁内段胆管、门静脉和肝动脉的关系
3、AnatomyoftheBiliarySystemanditsRelationshiptoSurroundingStructures胆囊(Thegallbladder)分底、体、颈三部(fundus,body,andneck)。胆囊管(Thecysticduct)SheathofGlissonPouchofHartmannValvesofHeisterTriangleofCalotPapillaofVaterSphincterofOddiANATOMYArtery术中注意:胆囊A、胆管A走行与分布VeinLymp
4、h肿瘤转移Nerve胆心反射BiliaryPhysiology胆汁的分泌、成分和功能:分泌:肝细胞、胆管细胞,量?成分:97%为水,胆汁酸、胆盐、胆固醇、卵磷脂(phospholipid)……功能:?800-1200ml/日乳化脂肪、抑制细菌、刺激肠蠕动、中和胃酸。BiliaryPhysiologyRegulationofbilesecretion促胰液素、CCK:胃酸、脂肪、蛋白质的刺激。Metabolismofbile:胆固醇的溶解:胆盐、磷酯酰胆碱微胶粒(micelles)胆固醇磷脂泡:磷酯+胆固醇胆盐
5、池的稳定:肠肝循环肠肝循环AdmirandandSmallTriangleBiliaryPhysiologyMetabolismofbilirubin胆红素的溶解:胆红素+葡萄糖醛酸——结合胆红素肝脏代谢异常胆道细菌感染BiliaryPhysiologyPhysiologicalfunctionofbileduct---regulationofbiledischarge1.18kPa0.98kPa3.83kPa0.79kPa1.18kPaBiliaryPhysiologyPhysiologicalfunctio
6、nofgallbladderConcentrationandstorageofbileDischargebileSecretion解剖生理概要重点内容胆管、门静脉和肝动脉的关系胆总管:直径:0.6-0.8cm,>1cm病理TriangleofCalot胆汁的功能:胆固醇、胆红素的溶解DiagnosticApproachesUS:B-typeUltrasonography首选Diagnosisofgallstone:强回声光团+声影Differentiationofjoundic:胆管扩张Detectionofga
7、llbladderfunctionOtherbiliaryillnessIntraoperativeUS:干扰小胆石超声图像DiagnosticApproachesConventionalRadiologyKUBfilm:钙化结石15%,瓷化胆囊,胆道积气Oralcholecystography:功能测定、充盈缺损Veinalcholangiography:胆管显影DiagnosticApproachesSpecialRadiologyPTC:黄疸鉴别、PTCDERCP:乳头部病变、定性诊断、造影CT、MRI(M
8、RCP)Intra-orpostoprativecholangiographyPTC影像DiagnosticApproachesEndoscopicExaminations胆道镜检查术中、术后诊断、治疗十二指肠引流本节重点内容胆道疾病的首选检查方法BUS、CT、PTC、PTCD、ERCP、MRI、MRCPLiuBinSurgeoninChiefandVice-Chair
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