《外科学》教学课件53、男泌生系肿瘤.pptVIP

* Scan of liver containing multiple metastases,manifested by increased uptake of 99mTc * A rounded tufted tumour. Sessile tumouir on the base of the bladder. * LEFT :An ultrasound recording demontrates an unsuspected tumor at the mouth of a deverticulum.With further experience staging of bladder tumours may be possible with ultrasound. RIGHT:normal. * IVU of large superficial tumour anterior to the ureteric orifice.This is not involved as the ureter is clearly shown behind tumour causing the filling defect. IVU of a large T2 tumor showing the villous structure and the absence of penetration as the bladder outline is smooth and regular. * CT scanning. * Urine cytology.Many atypical transitional cells,some multinucleate,from the urine of a patient with a transitional cell carcinoma of the bladder. Higher magnification showing the abnormal chromation pattern in the nucleus of the transitional cells. * The diagnosis is only proved by exploration.The groin is explored and the cord occluded with a noncrushing clamp.this expanded testis with its engorged veins is obviously grossly pathological. 病理分期 Ⅰ：手术标本偶然发现 Ⅱ：局限于前列腺包膜内 Ⅲ：肿瘤穿透包膜，侵犯邻近组织 Ⅳ：局部淋巴结或远处转移 * 转移途径 血行转移：以脊柱、骨盆多见 淋巴转移 局部侵犯 * 临床表现 早期多无明显临床表现 无痛性血尿 尿潴留 晚期可出现转移灶症状 * 诊断 临床表现 肛诊：质地变硬，结节 血PSA B超、CT及MRI 前列腺活检 膀胱、尿道镜检 * 治疗 Ⅰ期：严密随诊 Ⅱ期：根治性前列腺切除 Ⅲ、Ⅳ期：手术或药物去势 放疗对前列腺癌局部控制效果较好 * 第五节 睾丸肿瘤 睾丸肿瘤95％为恶性 多发于20～40岁 隐睾为高危因素 * 诊 断 临床表现不明显，睾丸肿大，疼痛 发现睾丸硬结、肿物要高度警惕 B超检查 首选方法 CT、MRI可以发现腹膜后淋巴结转移 AFP、HCG对诊断和预后判断有意义 * * * 防 治 早期治疗隐睾，2岁前 睾丸肿瘤治疗—手术为主、放化疗为辅 * 第四节 阴茎癌 发病率变化 鳞状细胞癌为主，基底细胞癌 和腺癌罕见 病因不清，与包茎、包皮过长 有关 * 病理分类 乳头状型 外向生长、易溃疡、菜花样 浸润型 质硬、向深部浸润、易转移 转移途径 淋巴转移为主， 腹股沟浅淋巴结→ 腹股沟深淋巴结→ 髂外动脉周围淋巴结 * 临床表现 40~60岁男性 有包皮过长或包茎 阴茎头、包皮内板丘疹、疣、溃疡等，继而形成结节或菜花状 疼痛 恶臭 腹股沟淋巴结肿大 * * * 预防：包茎应早期手术 注意个人卫生 治疗：手术为主、放化疗为辅 阴茎部分切除术 阴茎全切术 双侧淋巴结清扫术 * 复习提问 肾癌的典型临床表现 膀胱肿瘤的临床分期及相应治 疗原则 前列腺癌的特异血清学指标 * 谢谢！ * * The whole of the lower pole is occupied by the tumo