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1、,Biliary Tract Anatomy and Procedures 胆道解剖和手术过程,The Procedure操作过程,The Procedure操作过程,The Procedure操作过程,Treatment Alternatives: PTCA Procedure 选择性治疗：经皮冠状动脉内成形术操作过程,Angioplasty Balloon Inflation 球囊扩张血管成形术,Treatment Alternatives: PTCA Procedure 选择性治疗：经皮冠状动脉内成形术操作过程,Treatment Alternatives: Peripheral Ste
2、nt Procedure 选择性治疗：外周血管支架置入术,Stent Implant 支架置入,Peripheral Procedures and Equipment 胆道解剖生理,胸主动脉,肱动脉,腋动脉,右髂总动脉,右髂外动脉,腹主动脉,左髂内动脉,左股动脉,右肾动脉,肝总动脉,肠系膜下动脉,脾动脉,左胃动脉,肠系膜上动脉,腹腔干,头臂动脉,左锁骨下动脉,左颈总动脉,Copyright 1983. Principles of Human Anatomy. Third Edition. Gerard J. Tortora.This material is used by permission
3、 of John Wiley & Sons, Inc.,Biliary Tract Anatomy 胆道解剖,The biliary tract is made up of the liver, pancreas, gallbladder, pancreatic duct, common bile duct, hepatic duct . 胆道由肝脏，胰腺，胆囊，胰管，总胆管，肝管组成。,The biliary tract is part of the digestive system. 胆道是消化系统的一部分,Liver肝脏,Function功能:Metabolism of: carbohy
4、drates, fat, protein 代谢碳水化合物，脂肪，蛋白质 Removal of drugs and hormones代谢药物和激素 Excretion of bile分泌排出胆汁,Copyright 1989. Novartis. Reprinted with permission from the Atlas of Human Anatomy, illustrated by Frank H. Netter, M.D. All rights reserved.,Biliary Tract Anatomy 胆道解剖,Copyright 1989. Novartis. Reprint
5、ed with permission from the Atlas of Human Anatomy, illustrated by Frank H. Netter, M.D. All rights reserved.,Biliary Tract Anatomy 胆道解剖,Bile is secreted by the liver, through the hepatic ducts, and stored in the gallbladder.胆汁由肝脏分泌并储存在胆囊,Bile exits gallbladder via cystic duct into common bile duct
6、into small intestine. 胆囊中的胆汁经过总胆管进入小肠Function功能:,Copyright 1989. Novartis. Reprinted with permission from the Atlas of Human Anatomy, illustrated by Frank H. Netter, M.D. All rights reserved.,Digestion of fatty foods and fat-soluble vitamins 消化食物中的脂肪和脂溶性维生素,Gallbladder胆囊,Biliary Tract Anatomy胆道解剖,Co
7、pyright 1989. Novartis. Reprinted with permission from the Atlas of Human Anatomy, illustrated by Frank H. Netter, M.D. All rights reserved.,Pancreas胰腺,Secretes hormones 分泌激素insulin胰岛素glucagon胰高血糖素 to aid digestion帮助消化,Pancreatic duct胰管,Common bile duct总胆管,Biliary Tract Anatomy 胆道解剖,Biliary Stenting
8、: Purpose 胆道支架：目的,To treat symptoms of patients with malignant tumors (due to cancer of the biliary tract) which block the flow of bile into the intestines. 治疗因为胆道恶性肿瘤阻塞胆管，影响胆汁进入小肠引起的症状。,Diagnosis of Biliary Stricture 胆道结构的检查,Percutaneous Transhepatic Cholangiography (PTHC/PTC) approach 经皮经肝胆管造影术 En
9、doscopic Retrograde Cholangiopancreatography (ERCP) 内镜下逆行胆管胰造影术,Portal Venous System Anatomy and Procedures 门静脉系统解剖和手术过程,Feeds blood into the liver输送血液进入肝脏Consists of superior, inferior mesenteric, splenic, gastric, and cystic arteries 收集肠系膜上、下动脉，脾动脉，胃动脉，和胆囊动脉来的血液。,Portal Vein System门静脉系统,Portal Vei
10、n System门静脉系统,Liver receives blood from the portal vein and hepatic artery.肝脏收集门静脉和肝 动脉来的血液Blood leaves the liver through the hepatic vein. 血液经肝静脉离开肝脏,Copyright 1989. Novartis. Reprinted with permission from the Atlas of Human Anatomy, illustrated by Frank H. Netter, M.D. All rights reserved.,Hepati
11、c artery肝动脉,Hepatic vein 肝静脉,Portal vein 门静脉,Cause病因: A blocked vessel in the liver due to cancer,tissue scarring by cirrhosis, hepatitis, etc. 因为癌症、肝炎或肝硬化所致的组织纤维疤痕化造成的肝血管受压。Blood flow is forced backward causing veins to enlarge, resulting in variceal bleeding. 血液被迫反流造成静脉扩张，静脉曲张破裂出血。Clinical Symptom
12、s临床症状: Jaundice, ascites, edema, respiratory distress, GI hemorrhage, hepatic encephalopathy 黄疸，腹水，浮肿，呼吸性窘迫，胃肠道出血和肝性脑病。,Portal Hypertension门静脉高压,Portal Vein System 门静脉系统,Portal Hypertension: Treatment TIPS Procedure 门静脉高压治疗措施,A procedure used to treat portal hypertension in the liver as a result of
13、blocked blood flow in the portal vein. 用于治疗因门静脉阻塞所致的肝内门静脉高压措施。,Transjugular 经颈静脉的 Intrahepatic 肝内的 Portosystemic门体循环的 Shunt 分流,TIPS Procedure治疗措施,This shunt (TIPS) will take blood from the vein feeding the liver (portal vein) to another vein that takes blood out of the liver (hepatic vein).这一分流术将流进肝
14、脏的门静脉的血液分流到别的静脉将血液带离肝脏。,This decreases the pressure in the portal vein and may help reduce the symptoms of portal hypertension.这将减少门静脉的压力并帮助减轻门脉高压症状。,Copyright 1989. Novartis. Reprinted with permission from the Atlas of Human Anatomy, illustrated by Frank H. Netter, M.D. All rights reserved.,A chann
15、el is created between the hepatic vein and the portal vein. Tract of liver tissue between veins is dilated with a 8mm or larger balloon. 在肝静脉和门静脉间建立通道，并在肝脏组织间的静脉内用直径8毫米或更大的球囊扩张。Sheath is reintroduced into the portal vein after dilatation. 分流后在门静脉里重新置入鞘Shunt or stent is placed to maintain patency. 分流
16、术或支架置入术是为了维持通道的开放状态。,TIPS Procedure 治疗措施,shunt,Copyright 1989. Novartis. Reprinted with permission from the Atlas of Human Anatomy, illustrated by Frank H. Netter, M.D. All rights reserved.,TIPS Procedure,Portal Vein门静脉,Hepatic Vein肝静脉,Shunt分流术,Shunt enables blood to flow normally through the liver to the hepatic vein. This decompresses portal hypertension and allows veins to shrink to normal size stopping the variceal bleeding.分流术是为了使得血液能够经肝脏流向肝静脉，使得门静脉高压减轻、扩张的血管收缩到正常大小、中止静脉曲张出血。,
