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【医学ppt课件】原发性腹膜后肿瘤

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医学ppt课件 原发性腹膜后肿瘤PPT课件 原发性腹膜后肿瘤课件 原发性腹 膜后肿瘤 原发性腹膜后肿瘤 】原发性腹膜后肿瘤
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Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 原发性腹膜后肿瘤 昆明医学院第三附属医院 寸英丽 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 目的要求 了解腹膜后间隙的解剖。 •掌握腹膜后肿瘤的诊断及鉴别诊断。 •掌握腹膜后肿瘤的病理类型。 •熟悉腹膜后肿瘤的治疗。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 概述 • 发病率:占全身肿瘤的0.07 -- 0.2% • 常见为软组织肿瘤 ,可起源于胚胎、泌 尿生殖系残留组织 、交感神经系统 • 多为恶性,以各种肉瘤最多见。 • 手术不易切净,局部复发及远处转移仍 是主要致死原因。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 腹膜后间隙的解剖范围 • 上 界 :横膈 • 下 界:提肛肌和尾骨肌所组成的盆膈 • 外侧界:腰方肌的外侧缘 • 前 方 :后腹膜、肠系膜根部以及肝右叶后方裸 • 面、十二指肠、升结肠、降结肠和直肠 • 后 方 :腰大肌、腰小肌、腰方肌和腹横肌的腱 • 部,在盆腔内其后壁则为髂腰肌的连续 • 部、闭孔内肌和梨状肌。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 腹 膜 后 间 隙 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 腹膜后的脉管系 统及输尿管 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 肾上腺 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 腹膜后的神经 分支: 灰交通支:连于5对腰神经 腰内脏神经:包括腹主动脉丛和 肠系膜下丛 腰神经节: 12胸椎体下半到腰骶椎间盘范围 内的交感神经节,一般为5个,数 目由于节的融合或缺如而有变异 。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 肿瘤的组织来源 • 来自胚胎生殖泌尿残留组织 • 来自间叶组织 • 来自神经组织 • 来源不明的肿瘤和肿瘤样病变 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 来自胚胎生殖泌尿残留组织 • 畸胎瘤 • 绒毛膜上皮瘤 • 内胚窦瘤 • 浆液性囊肿和黏液性囊性瘤 • 子宫内膜瘤及Mullehan管囊肿 • 脊索瘤 • Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 来自间叶组织 • 多见 少见 • 脂肪肉瘤 横纹肌肉瘤 • 平滑肌肉瘤 滑膜肉瘤 • 纤维肉瘤 腺泡状软组织肉瘤 • 恶性纤维组织细胞瘤 间叶性软骨肉瘤 • 间皮肉瘤 未能分类的软组织肉瘤 • 血管肉瘤 • 恶性神经鞘瘤 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 腹膜后脂肪肉瘤 病理图片 •图1 多形性脂肪肉瘤 HE×160图2 硬化性脂肪肉瘤,梭形细胞间散在奇异型巨细胞 HE×160图3 硬化性 脂肪肉瘤,梭形细胞区细胞稀疏、纤维纤细,图中心部是一个巨细胞,胞浆内含细小空泡 HE×160图4 硬化 性脂肪肉瘤,部分梭形细胞肌动蛋白阳性表达 LSAB法×160 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 来自神经组织 • 来源于体神经(脊神经): • 神经鞘瘤 和恶性神经鞘瘤 • 神经纤维瘤和神经纤维肉瘤 • 来源于交感神经: • 神经母细胞瘤 • 嗜铬细胞瘤 • 副神经节瘤 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 来源不明的肿瘤和肿瘤样病变 • 腹膜后纤维性变 • Castleman疾病,又称血管滤泡型淋巴结增生、 • 淋巴错构瘤、巨淋巴结增生或滤泡型淋 • 巴网状内皮瘤。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 诊断 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 症状和体征 • 压迫性表现 • 占位性表现 • 毒性反应表现 • 内分泌功能紊乱性表现 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 压迫性表现 • 胀、酸、麻、痛 • 上腹饱胀感、恶心、呕吐 • 肛门排气和大便不畅感 • 小便不畅、尿急、尿频、尿潴留 • 腹壁、会阴部和下肢静脉怒张 、下肢和会阴部 • 肿胀和沉重感 • 腹水 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 占位性表现 • 腹部肿块 • 盆腔肿块 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 毒性反应表现 • 发热 • 全身营养不良 • 尿毒症 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 内分泌功能紊乱性表现 • 低血糖 :巨大肿瘤的首先症状 • 阵发性高血压:腹膜后-肾上腺外嗜铬细 • 胞瘤的特有症状 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 检查方法 • 临床检查 • X线摄片 • 胃肠钡剂检查 • 实验室检查 • 泌尿系造影术 • 血管造影术 • B超检查 • CT • MRI • 针吸细胞学检查 • 病理诊断 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 临床检查 • 病史 • 体格检查 • 肛门指检 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. X线 和造影检查 • X线摄片 :无特异性 ,价值有限 • 胃肠钡剂检查:缺乏特异性,但有一定的定位价 • 值。 • 泌尿系造影术 :判断泌尿系是否梗阻及梗阻程 • 度。了解肾脏功能。 • 通过胃肠钡剂检查、泌尿系造影术 可间接诊断 腹膜后肿瘤。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. X线 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 胃肠钡剂检查 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 血管造影术 • 目的:了解血管内侵犯情况 ,以帮助制定治疗 • 措施 • 动脉造影术: • 腹主动脉造影 • 选择性腹腔动脉造影 • 下腔静脉造影等 • 静脉造影术: • 下腔静脉造影术 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 肾动脉造影 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 肝动脉造影 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 选择性动脉造影诊 断腹膜后肿瘤的意义 • ①发现肿瘤的血供,通过选择性注射,可确立肿 • 瘤的起源; • ②根据动脉造影所显示的腹主动脉及其分支的行 • 经、分布及形态等改变,可以区分腹腔内 • 或腹膜后肿瘤; • ③了解肿瘤内血管分布情况; • ④排除肾及肾上腺病变,确定肿瘤大小及位置, • 尚可提示肿瘤的良恶性。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 动脉造影的表现 • 动脉移位:最重要的征象,以肾动脉移位最常见 • 血管异常 :扩张、拉长、延伸、分离、簇状等 • 动脉包绕 :是恶性征象之一,但较少见 • 动脉梗阻:常提示该动脉血供之器官被肿瘤犯。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. B超检查 • 因肠襻阻挡 ,B超诊断腹膜后肿瘤并非理想,其 意义在于: • ①能显示出肿块的位置、大小、数目、实体或 • 囊性,以及与周围器官的关系; • ②鉴别腹腔内肿瘤和腹膜后肿瘤,可显示临床 • 上尚不能触及的肿瘤; • ③B超诊断是非特异性的,不能明确肿块的组 • 织学类型,但近年来B超引导下细针穿刺活 • 检术弥补了这一不足; • ④B超这一非侵入性的诊断方法还可用于腹膜后肿瘤 • 患者术后的长期随访。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. B超:腹膜后纤维肉瘤 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. B超:腹膜后纤维肉瘤 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. CT、MRI检查 • CT:是腹膜后肿瘤术前最有用的影像学检查。它 用于发现腹膜后肿瘤、判定肿瘤特征、分析肿瘤 来源,显示肿瘤侵犯周围器官的程度,周围器官 、血管的移位情况及腹膜后淋巴结肿大情况,具 有较强可靠性。 • MRI:可提供比CT更多的信息,不用造影剂术前 即可判断腹膜后肿块的血管特征及血管受累程度 。 • Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. CT • 腹膜后肿瘤:左肾上腺嗜铬细胞瘤 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. CT •肠系膜下静脉向前移位。CT增强显示胰腺后方一个边界清楚的强化肿块,但未压迫临近器官; CT显示肠系膜下静脉向前移位(箭头),肿块位于腹膜后间隙。证实为:腹膜后毛细血管瘤 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. CT •CT增强显示胰腺后方一个边界清楚的强化肿块,但未压迫临近器官; CT显示肠系膜下静脉向前 移位(箭头),肿块位于腹膜后间隙。证实为:腹膜后毛细血管瘤 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. MRI •腹主动脉向前移位,轴位T2WI MRI显示腹主动脉周围一个均匀低信号肿块。证实为 : 腹膜后淋巴瘤。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 针吸细胞学检查 • 主要目的:是鉴别腹膜后肿块良、恶性 ,尽可能确定肿瘤的病理类型,协助外 科医师确定手术的意义,制定手术方案 。 • 存在一定的假阴性,约占l0~20% • 并发症:出血、腹膜炎、菌血症、肿瘤 扩散等 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 病理诊断 • 对确定诊断和确定手术方案等有重要意 义,包括: • 术中冰冻 • 取材活检:腹腔镜及腹腔镜直视活检 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 实验室检查 • 尿液香草扁桃酸(VMA):嗜铬细胞瘤 、 • 神经母细胞瘤 • 甲胎蛋白(AFP) :内胚窦瘤 • 低血糖 :巨大的腹膜后肿瘤 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 鉴别诊断 • 多囊肾、肾积水及肾上腺肿瘤 • 胰腺肿瘤及假性囊肿 • 肝肿瘤、肝囊肿及脓肿 • 脾、胃病变 • 盆腔、卵巢、子宫肿瘤以及膀胱本身 • 腹主动脉及髂动脉动脉瘤 • 副脾 • 最常误诊的腹膜后器官肿瘤是肾上腺、肾、胰腺 的肿瘤 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help
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