肝脏疾病本科彭涛.pptxVIP

肝脏疾病本科彭涛第1页/共102页 Liver Diseases肝脏疾病彭涛 教授、博士生导师外科学教研室（肝胆血管外科） 2011-10-17 第2页/共102页 3肝脏解剖生理概要-1The 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.Gilsson’s capsule, bare area, falciform lig., coronary lig., gastrohepatic lig., hepatoduodenal lig. foramen?1: liver; 2: rib cage; 3: spine; 4: pelvis 第3页/共102页 4肝脏解剖生理概要-2The American (lobar) system the French (Couinaud segmental) system.第4页/共102页 5肝脏解剖生理概要-3第5页/共102页 6肝脏解剖生理概要–4-Cauinaud segmentation第6页/共102页 7肝脏解剖生理概要–5-left hepatic vein第7页/共102页 8肝脏解剖生理概要–6-middle hepatic vein第8页/共102页 9肝脏解剖生理概要–7- hepatic vein portal vein第9页/共102页 10肝脏解剖生理概要–8- portal vein plane第10页/共102页 11“精准肝脏外科时代”—保留肝中静脉的左半肝切除第11页/共102页 12“精准肝脏外科时代” —保留肝右静脉的右后叶肝切除第12页/共102页 13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肝脏解剖生理概要–9- circulation第13页/共102页 14代谢: bilirubin, carbohydrate, lipid, protein, vitamin, drugs toxins, ect.凝血免疫调节再生肝功能指标: 转氨酶: aspartate phosphatase (AST), alanine phosphatase (ALT)Alkaline phosphatases (ALP), Gamma-glutamyl transpeptidase (GGT)AlbuminChild-Pugh肝功能分级; ICG15min渚留率肝脏解剖生理概要–10第14页/共102页 Hepatic Trauma 肝脏创伤第15页/共102页 16Hepatic trauma -Classification and characteristics Penetrating hepatic-traumaDue to bullets, knives etc.—less devitalization of liver parenchymaDue to missiles –shatter massive parenchymaBlunt hepatic-traumaDue to direct blow to the upper abdomen or lower right rib cage, or sudden deceleration.Might be explosive bursting wounds or linear lacerations.The posterior superior segment (SVII) is mostly vulnerable due to its location.Damage to the hepatic veins is catastrophic and difficult to expose during exploration. (The staging system is for your reference only, but pls pay attention to by what index it score the damage) 第16页/共102页 17Symptoms and signs: hypovolemic shock (hypotension, decreased urinary o