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胰 腺 疾 病 杨 勇 PowerPoint PPT Presentation


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胰 腺 疾 病 杨 勇. 第一节 解剖生理概要. 胰腺位于腹膜后,分为头、颈、体、尾四部分,胰头部钩状突 胰管与胰腺长轴平行 约85%的人主胰管与胆总管汇合形成共同通路开口于十二指肠乳头; 部分病人虽有共同开口,但两者之间有分隔; 少数病人两者分别开口于十二指肠。副胰管( Santorini 管). 共同通道 是胆道疾病与胰腺疾病相互关联的 解剖基础. 胰腺血液供应 静脉回流系统.

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胰 腺 疾 病 杨 勇

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3501586


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  • 85%

  • Santorini


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  • 1A--A--A--AA 2A--A--AAA 3AAAA 4AAAVV


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  • 7501500ml


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  • B

    A

    D

  • PPVIP


Acute pancreatitis

acute pancreatitis


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Vater


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  • oddi


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  • A

  • A


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MODS

ARDS


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  • Oddi


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  • A


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  • 1


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2


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  • 1 2 3 4


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538

Grey-TurnerCullenDIC


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1

1

24

500U/ dl401807

h80300U/dl

23300 U/L


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2

DIC


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  • B

  • X

  • CTMRI


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CT


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3


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  • 16109/L

    11.1mmol/L)1.87mmol/LPaO28kPa60mmHgARDSDIC


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APACH II8


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1123

45678


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2

    • MODS


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1


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2

  • 72h

  • Oddi

  • 24


Chronic pancreatitis

chronic pancreatitis

  • -


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  • 1/3

  • 1/4


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5mm3mm

CT

CT

CT


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1

2


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  • pancreatic pseudocyst


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  • B

  • X

  • CTB


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  • 6

  • Roux-en-Y


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B


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CT


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  • 100

  • Morgagni

  • 1882Tren-delenberg

    1887Kappeler14Weir

    1898Weir9


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  • 1898Coutivilla

  • 1914Hirschel1

  • 1944WhippleWhipple


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  • cancer of the pancreas

  • 40

  • 90%

  • 51%3%

  • 14%


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7080%2030%

(1)(Adenocarcinoma)90%

(2)(Mucinous adenocarcinoma)

(3)(Cystadenocarcinoma and papillary cystadenocarcinoma)

(4)(Anaplastic carcinoma)


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(<2cm),

MotojimaPCRK-ras6%

------

Tashiro25%51.9%


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  • 22.51015


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  • 1966Burch83156515

  • Ishii2

  • Heuch16713635.4


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  • 24

    100

    2057


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  • 5


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  • Sommers1414141Kras


2004 8

(:2004-8)

  • 40

  • 6040

  • 20


Uicc 1992

T

Tx

T0

T1

T1a 2cm

T1b >2cm

T2

T3

N

N0

N1

M

M0

M1

I T1 N0 M0

T2 N0 M0

II T3 N0 M0

III T N1 M0

IVT N M1

UICC1992


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1993JPN-SCUICC-SC

  • JPN-SCWV ADWE T S RP PV N M1 T10-2cm S0 RP0 PV0 N0 M02 T22.1-4.0 S1 RP1 PV1 N1 M03 T14.1-6.0 S2 RP2 PV2 N2 M04 T1>6.1cm S3 RP3 PV3 N3 M1

  • TSR PPV

  • S0RP0RV0S1RP1PV1S2RP2PV2S3RP3PV3

  • NN0N1N2N1N3N33

  • MM0M1


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  • 1

    21)2) 3)


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  • 20 CEA CA50 CA199 POA CA195 CA242 span1 dupan2

  • carcinoembryonic antigen , CEA CEA CEA

  • pancreatic oncofetal antigen , POA POAPOAPOAPOAPOA


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  • CA19-9 CA19-91979CA19-9

  • pancreatic cancer associated antigenPCAAPCAA

  • 80K -ras K- ras


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  • ras p53 c-erB2 c-myc p21

  • k-ras c-K-ras kon-do k-ras1292 gGTGAT gTT cGT kimura2 k-ras k-ras bartsch81213 k-ras52 pCR-RFLP c-K-ras947 k-ras

  • p53 p21 p5350 p534050 p21 p53 p53


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  • 3


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B

  • ERCP CT


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CT

  • CT CT94 % 1.0cm CT

  • CT: CT


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CT


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ERCP

  • ERCP7496


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ERCP


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IEUS

  • IEUS IEUSIEUS


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PTC

  • PTC PTCD


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  • 60-90 % 2cm


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  • 31


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  • MRIMRCP MRCP ERPERPMRCP


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  • 14-69 .1 B CT


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  • ERCP


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  • 90 10


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  • 90


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  • 5

  • 5%-22%512%-24%5-7

  • 52535

  • 5102cm541

  • bottger18627326


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whipple

regional pancreatectomy

fortner35 235 whipple25105402cm40


Whipple

Whipple

3cm


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Fortner O

Fortner Fortner O

Fortner


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  • ---


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  • WhippleChildCattelY

  • T


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  • 5570

  • bartoli

  • tsuji1204mm4-6F42118172

  • pancreatogastrostomy pG ma-son733 pG pJ10 pG5


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  • 2 -4cm


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  • pancreatic fistula10 amylase concentration aMS1000u l aMS2000u l

  • 12345 bottger

  • TEN5-Fu02mg12157


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  • 80


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  • 95%


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Loyer

Loyer

A B C D E F

A-B

E-F

C-D


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RouxY


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  • CT

  • 2


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  • 20

  • 5-5-fluorouracll, 5-FUC (mitomycin C, MMC streptozotocin , STZ


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  • 20 5-Fu MMC STZadriamycin , ADM FAM 5-Fu ADM MMC FSM 5-Fu STZMMC


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  • pH


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  • picibanil, OK-432 II ( IL-II )IFNlymphokinase activated killer cellsLAK


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  • 70 ( )

  • 342molL(20mgd1)

  • (PTCD)(stent)

  • -

  • PTCD


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  • (totalparenteralnutritionTPN)

    (enteralnutritionEN)ENEN

  • 1>10000uL

  • 10T


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  • periampullary adenocarcinoma

  • 5


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  • insulinoma95%


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  • 2cm10


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  • 140mg/dL2.12mmol/LWhipple50mg/dL 2.8mmol/L

  • 2BCTMRI1B1.5cm30402CTCT403MRI450605ASVS6PTPC


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1a b c

2a b c

3


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12


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  • 1)2)3)StreptozotocinB


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  • Whipple


Gastrinoma

Gastrinoma

  • G


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  • BAO15mmol/h

  • BAO 5mmol/h

  • BAO/MAO 0.6

  • :1000pg/ml(N:100-200)

  • 200pg/ml


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