《胆道疾病刘斌双语》ppt课件

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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胆管左右肝管三级二级一级AnatomyoftheBiliarySystemandi

2、tsRelationshiptoSurroundingStructures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AnatomyoftheBiliarySystemanditsRelationshiptoSurroundingStructures胆囊（Thegallbladde

3、r）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VeinLymph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、

4、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---re

5、gulationofbiledischarge1.18kPa0.98kPa3.83kPa0.79kPa1.18kPaBiliaryPhysiologyPhysiologicalfunctionofgallbladderConcentrationandstorageofbileDischargebileSecretion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Diagnosisofgallst

6、one：强回声光团+声影Differentiationofjoundic：胆管扩张DetectionofgallbladderfunctionOtherbiliaryillnessIntraoperativeUS：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

7、诊断、造影CT、MRI（MRCP）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