全科中级辅导外科和急救.ppt

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1、全科中级辅导外科急救内容,秦啸龙,多根多处肋骨骨折连枷胸形成,儿童:头面颈=9+(12-年龄)双下肢=46-(12-年龄)女性:双侧臀部=双足=6%,Company Logo,Company Logo,Company Logo,Company Logo,隐神经鞘瘤,neurofibroma,capillary hemangioma,dermoid cyst,sebaceous cyst,epidermoid cyst,thyroid adenoma,papillary thyroid carcinoma,Company Logo,Company Logo,治疗:乳房纤维腺瘤虽属良性,但亦有恶变

2、可能,一经发现,应予手术切除。,Calcified Fibroadenoama,Fibroadenoma,Breast cancer causing“orange peel”skin in the left breast and that has spread to the left armpit.This spread has caused a large lump in the tail of the left breast/left armpit region.,传统张力手术(tension operation),无张力手术(tension-free operation),显著地降低了手

3、术后疝的复发率 有效地减少了术后患者的不适感,急性阑尾炎-病理,Suppurative appendicitis,Simple appendicitis,Gangrenous appendicitis,Appendix perforation,胆囊结石,胆固醇结石含胆固醇为主,多呈椭圆形(单发者)或多面形(多发者),表面平滑或稍呈结节状,淡灰色,质硬,剖面呈放射状线纹,X线平片上不显影。此种结石多在胆囊内。胆色素性结石以胆红素为主要成分,多为泥沙样,质软而脆,有的如泥团状,有的如沙粒,为棕黑或棕红色。大小不等,因含钙少,X线平片上多不显影。多在肝内、外胆管中。,(forty,fat.femal

4、e,fruitful 4F),Company Logo,Company Logo,Company Logo,Company Logo,(A)病人站立,大腿上1/3扎上止血带;(B)交替伸屈膝关节10余次或行走;(C)静脉曲张益形明显,小腿胀痛,即为深静脉通畅试验阳性,Company Logo,Company Logo,Company Logo,Company Logo,This is a renal cell carcinoma arising in the lower pole of the kidney.It is fairly circumscribed.The cut surface

5、demonstrates a variegated appearance with yellowish areas,white areas,brown areas,and hemorrhagic red areas.Though these neoplasms are usually slow-growing,they can often reach a considerable size before detection because there is a lot of room to enlarge in the retroperitoneum,and there is another

6、kidney to provide renal function.Thus,presenting symptoms and signs usually include flank pain,mass effect,and hematuria.,Company Logo,This is a much more advanced renal cell carcinoma involving the left kidney(top).Notice a huge mass of necrotic yellowish brown material replacing the lower pole of

7、the kidney.Also notice that the vena cava in the center of the picture is filled with tumor.This is typical of this neoplasm.,In the upper pole of this kidney is a well circumscribed tumor which has a yellowish-brown color and shows central necrosis.This is a renal cell carcinoma.,Company Logo,Compa

8、ny Logo,膀胱癌Tis,膀胱癌Ta-1,膀胱癌临床分类分期,Company Logo,膀胱癌临床分类分期,膀胱癌T2-3,膀胱癌T4,Company Logo,Company Logo,膀胱肿瘤,治疗 手术治疗为主。(一)表浅膀胱肿瘤原位癌 细胞分化不良、已经有浸润的应及早行膀胱全切术;细胞分化良好的可行经尿道手术。(二)浸润性膀胱肿瘤1、分化良好、局限的T2期肿瘤可行经尿道手术。2、一般根据肿瘤浸润范围、大小、数目选择膀胱全切术或膀胱部分切除术,部分切除范围应包括距离肿瘤2cm以内的全层膀胱壁。3、膀胱全切术后的尿流改道4、浸润性肿瘤的新辅助化疗:MVAC方案,若结合髂内动脉埋泵化疗效果更佳(三)膀胱肿瘤术后的随访术后每周一次膀胱灌注化疗共8次,后改每月一次,总共持续1年。术后每3个月复查膀胱镜。,Company Logo,Company Logo,Company Logo,Company Logo,Company Logo,Company Logo,Company Logo,Company Logo,Company Logo,Company Logo,Company Logo,Thank You!,

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