《先天性巨结肠与胆道剖析ppt课件》由会员分享，可在线阅读，更多相关《先天性巨结肠与胆道剖析ppt课件（45页珍藏版）》请在金锄头文库上搜索。
1、2019 先天性巨结肠Congenitalmegacolon 1 定义Defination 由于直肠或者结肠远端的肠管持续痉挛 粪便淤积在近端结肠 使该肠管肥厚 扩张Rectalorcolonicintestinalhaspersistentspasmandfecaldepositionintheproximalcolonresultsinhypertrophyanddilatationinproximalsegment 2019 2 Hirschsprung sDisease HD赫什朋氏病Aganglionosis先天性无神经节细胞症 英文名称Englishname 2019 3 概述Su
2、mmary 一种常见的消化道畸形Acommondigestivetractmalformation有遗传倾向 约1 4 7 8 Geneticpredisposition about1 4 7 8 发病率为1 2000 5000Incidencerateof1 2000 5000男 女 4 1Male female 4 1 2019 4 病因Etiology 病变肠管肌间及粘膜下神经节细胞缺如 是一种发育停顿 停顿越早 无神经节细胞段越长 Absenceofganglioncellsinmuscleandsubmucosaoflesionbowel Itisadevelopmentpause
3、Themoreearlythepauseoccurs thelongerintestinalsegmentwithoutganglioncellsis 2019 5 胚胎期第5周消化道神经母细胞从头端向尾端移行NeuroblastomacellsofdigestivetractmigratefromthebeginningtotheendInthefifthweekoffetal 2019 6 Normaldefecationphysiology 直肠壶腹潴便 经大脑整合 决定排便与否 便意 直肠肛管抑制反射肛管感受粪便性质 骶髓低级中枢 肠壁感受器 2019 7 Absenceofgangl
4、ioncells Smoothmuscleoflesionintestinesustainescontraction Anorectalreflexloopisinterrupted Stoolcannotbedischarged Proximalnormalintestinehascompensatorydilatationandhypertrophyandformshugeexpansiveintestinalsegment Pathologyofcongenitalmegacolon 2019 8 病变肠段呈痉挛样改变 Spasmsegment 近端肠管扩张肥厚 形成巨大结肠 Enlar
5、gedsegment 二者之间过度肠段呈漏斗状称移行段 Transformedsegment 正常结肠Normalcolon Pathologicalanatomyofcongenitalmegacolon 2019 9 按病变长度Accordingtothelengthoflesionsegment常见型Ordinarytype commontype megacolon 85 Lesionislimitedinrectumandsigmoidcolon 短段型Shortsegmenttypemegacolon 10 Lesionislimitedinthedistal3 4cmofrectu
6、m 长段型Longsegmenttypemegacolon 10 Lesionreachessplenicflexure andeventheentirecolon 全结肠型Totalcolonictype 1 Lesionreathesentirecolonorevevterminalileum 分型Pathologictypesofcongenitalmegacolon 2019 10 临床表现Clinicalmanifestations 新生儿期Theneonatalperiod acutelowincompleteintestinalobstruction Delayoffetaldi
7、schargeAbdominaldistentionandvomitingConstipationWastingandmalnutrition 2019 11 Clinicalmanifestations 婴幼儿期 慢性低位肠梗阻Infantandchildhood subacuteorchroniclowincompleteintestinalobstruction反复便秘Recurrentconstipation进行性腹胀Progressiveabdominaldistension发育迟缓 营养不良Growthretardation malnutrition 2019 12 并发症Comp
8、lications 多在2个月内发生Occurringwithin2months肠梗阻Intestinalobstruction小肠结肠炎Enterocolitis肠穿孔 腹膜炎Bowelperforationandperitonitis继发败血症 肺炎Secondarysepsisandpneumonia 2019 13 1 肛门指诊Rectaltouch2 钡灌肠Bariumenema3 直肠肛管测压Anorectalmanometry4 直肠活检Biopsy5 肌电图Electromyogram 辅助检查Accessoryexamination 2019 14 2019 15 2019
9、16 钡灌肠X表现BariumenemaX ray 葛X 2y 长段型巨结肠 soave 2019 17 2019 18 Anorectalmanometry reflectionofnormalanorectalreflexdisappears 正常直肠肛管反射 2019 19 2019 20 肠壁粘膜腺体Intestinalmucosalglands 酶阳性神经Enzymepositivenerve 正常人Normalchild 巨结肠患儿Megacolonchild 2019 21 诊断Diagnosis 1 病史Medicalhistory2 钡灌肠Bariumenema3 直肠肛管测
10、压力Anorectalmanometry3 直肠黏膜组织活检Rectalmucosalbiopsy 2019 22 1 胎粪性便秘Meconiumconstipation2 新生儿肠闭锁Neonatalintestinalatresia3 特发性巨结肠Idiopathicmegacolon4 巨结肠类缘病Neuronalintestinaldysplasia5 肛门内括约肌失弛症Internalanalsphincterachalasia6 继发性巨结肠Secondarymegacolon7 内分泌性Endocrinedisease8 乙状结肠过长症Redundantsigmoidcolon
11、鉴别诊断Differentialdiagnosis 2019 23 先天性巨结肠Congenitalmegacolon 继发性巨结肠Secondarymegacolon 2019 24 治疗Treatment 治疗原则 手术治疗 切除病变肠段以及扩张肥厚的肠管Treatmentprinciple Operationtreatment Resectionofthelesionbowelanddilatationbowel 2019 25 术前准备 保守治疗 Preoperativepreparation conservativetreatment 1 洗肠Intestinallavage2 括肛
12、 通便Enlargeanusandinducingdefeation3 缓泻药ApplicationofLaxativedrug 2019 26 手术方式Operationmethods Sewnon soperationSoave soperationDuhamel soperationRehbein soperationMartin soperation 2019 27 Swenson改良术 结肠经直肠内拖出 Pull through 切除术 2019 28 Soaveprocedure手术的基本步骤 2019 29 Duhameloperation 2019 30 术后并发症Postop
13、erativecomplications 吻合口感染 泄漏Anastomoticinfectionandleakage尿潴留Retentionofurine小肠结肠炎Enterocolitis吻合口狭窄 便秘复发Anastomoticstenosisandrecurrentconstipation肛门内括约肌损伤Internalanalsphincterinjury远期生活质量下降Declinedqualityoflifeinlong term 2019 31 要点Keypoints 1 概念Conceptofmegacolon2 分型Pathologicaltypeofmegacolon3
14、临床特征Clinicalcharacteristicsanddiagnosisofmegacolon4 治疗原则Thesurgicalprinciplesofmegacolon 2019 32 肛门直肠畸形的分类Classificationofanorectalmalformation 2019 33 没有X影像学资料前不要轻易手术WeshouldnotdooperationeasilywithoutX ray 2019 34 MR 2019 35 针形电刀Needletypeelectricknife电刺激仪Electricalstimulationinstrument 2019 36 先天
15、性胆道闭锁Congenitalbiliaryatresia 2019 37 Diagnosisanddifferentialdiagnosis MRCP laparoscopicexplorationandintraoperativecholangiography Cholestasissyndrome 2019 38 Operationtreatmentofcongenitalbiliaryatresia 纤维三角板的切除Excisionoffibroustriangleplate肝门部与肠吻合AnastomosisofjejunumandHilar 2019 39 胆道闭锁术后用药Medi
16、cationafterbiliaryatresiaoperation 激素应用Hormonedrugs抗生素应用Antibiotics利胆药应用Cholagogue 2019 40 先天性胆总管囊肿Congenitalcholedochalcyst 2019 41 MRCP 2019 42 后面内容直接删除就行资料可以编辑修改使用资料可以编辑修改使用资料仅供参考 实际情况实际分析 感谢您的观看和下载 Theusercandemonstrateonaprojectororcomputer orprintthepresentationandmakeitintoafilmtobeusedinawiderfield 治疗 囊肿切除 Roux en Y吻合 抗反流瓣Treatment cystexcision Roux en Yanastomosis antirefluxvalve 2019 45
