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Jingdong book

胆道外科:要点和盲点(第2版)(翻译版)

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胆道外科:要点和盲点(第2版)(翻译版)

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将那些奋斗在第一线的外科专家的宝贵经验和智慧与严谨的科学相结合,并使之成为一种“艺术”而得到广泛传播!
·传授日常诊疗常规中的一些需特别注意、操作性强的“要点”及容易失误、值得借鉴的“盲点”,即临床工作的“秘诀”。
·不仅有手术技巧的详解,还包括影像诊断、介入操作和围手术期管理的相关知识,全面满足临床的需要。
·分专题加以阐述,与之相关的小知识或方法以“一点建议”、“咖啡时间”等形式“点缀”其中。
·文字简洁易懂,配以真实清晰的术中照片和精美的彩色插图。
·从年轻医生到资深专家,都可根据自己的兴趣和水平选择相应的章节以汲取“营养”。
Content Description

近20年来,生物医学科学的蓬勃发展以及循证医学和人文医学的兴起,导致外科学理念出现了深刻的变革,这一变革推动着传统经验外科模式向着现代精准外科模式的转变。
精准外科是在新世纪人文医学、微创外科、循证医学和个体化医学兴起的背景下,依托当前高度发达的生物医学和信息科学技术形成的一种全新外科理念和技术体系,旨在追求以最小创伤获取最大脏器保有和最佳康复效果。肝脏、胆道、胰腺的解剖生理复杂、空间位置深在、其内部和周围各种脉管交织,同时肝胆胰疾病的病理和临床表现极为复杂,因而肝胆胰外科手术在现今的消化器外科手术中仍然最具挑战性,尤其需要精准外科的理念和技术。
肝胆胰精准外科的基础是对器官解剖结构、生理功能和病理特征的现代认识。首先,精准外科是依赖于对器官外科解剖精确认识的解剖性外科手术,在彻底切除目标病灶的同时,要充分保证剩余器官脉管结构的完整。再者,器官代偿和再生潜能是精准外科的生理基础,肝切除前要在精确评估肝脏储备功能和再生能力的基础上,准确掌握肝实质安全切除量,避免发生手术后肝功能不全。与此同时,肝胆胰疾病的疾病本质、病变特征、病理分期是决定手术方式、切除范围和辅助疗法的依据。如肝细胞癌呈沿肝段门静脉分支在荷瘤肝段内播散的特征,而肝胆管结石病具有沿着病变胆管树在肝内区段性分布的特征,这就决定了解剖性肝段切除是治疗上述病变的理想术式。
Author Description

二村雄次教授(Prof.Yuji Nimura)1943年出生于日本爱知县,1969年毕业于名古屋大学医学部。曾在东京癌研究会附属病院研修,师从现代肿瘤外科的开拓者棍谷教授。返回名古屋后历任名古屋大学附属病院第一外科(后改名为肿瘤外科)助手、讲师、助教授、教授。现任爱知县癌中心总长。
二村教授是久负盛名的国际胆道外科的专家,在肝门部胆管癌、肝胆管结石等诸多领域取得了一系列国际公认的创新性成就。他领导的名大病院肿瘤外科是世界闻名的胆道外科中心,一直以“肝门部胆管癌的名大”而著称,在肝门部胆管癌的诊断、治疗方面进行了系统的研究,一直走在世界的最前沿。
二村教授现任世界肝胆胰外科协会主席及日本胆道学会理事长等学术职务,并曾担任日本外科学会会长,是欧洲外科学会、美国外科学会的名誉会员。
二村教授还是一位柔道高手,业余时间经常在竞技场上展示风采。无影灯下,他也是一位不懈的斗士,以“斗魂”的精神挑战肿瘤外科治疗的极限。他为人谦和,虚怀若谷,多次应邀来华讲学和手术演示,在中国的肝胆外科界享有崇高的威望,2005年曾获“中日文化奖”。
译者简介:
董家鸿教授,(Prof Dong Jiahong)1960年生于江苏省连云港市,师从著名肝胆外科学家黄志强院士,获得医学硕士和博士学位。曾作为访问学者或客座研究员先后访问过巴黎大学Paul Brollsse肝胆中心、匹兹堡大学移植研究所、加州大学洛杉矶分校外科、名古屋大学肿瘤外科、京都大学肝移植外科、香港大学玛丽医院肝胆胰外科等国际著名肝胆外科和肝移植中心,博采众家之长,形成了自己的学术流派。1998年任西南医院全军肝胆外科中心主任及全军肝胆外科研究所所长,2006年起历任解放军总医院肝胆外科主任、肝胆外科医院院长。
董家鸿教授是中国肝胆外科和肝脏移植领域年轻一代的领军人物,在肝脏移植及肝胆胰肿瘤、胆管结石及狭窄、肝硬化门静脉高压症、急性和慢性肝功能衰竭的外科治疗领域卓有建树。1996年开展了国内首例离体肝切除,2002年在国际上首创了针对复杂肝胆管结石的只保留尾状叶的肝脏次全切除术。
董家鸿教授现任美国外科学院院士、国际消化外科学会执行委员、中华外科学会常委、中华器官移植学会常委、中华外科学会胆道学组组长。担任《中华消化外科杂志》总编辑,同时担任30余种核心期刊的主编或编委。任山东大学、南开大学、厦门大学、昆明医学院和徐州医学院等多所大学的特聘教授或荣誉教授。曾获国家科技进步一等奖等多项奖励,多次代表中国肝胆外科界在国际学术会议上做特邀专题演讲。
Catalogue

Ⅰ 胆道夕卜科解剖的要点与盲点
1.肝内区域胆管支的外科解剖
2.从胆道造影来看肝脏的分段
3.肝门部的外科解剖
4.中下段胆管的外科解剖与胆囊的淋巴引流

Ⅱ 经皮经肝胆道引流(PTBD)的要点与盲点
1.超声波引导下穿刺法的实际操作
2.影像下直达法的实际操作
3.多处PTBD的技巧
4.胆管炎的处理方法
5.PTBD的并发症及其处理措施
6.经皮胆囊引流术、胆囊穿刺吸引术的实际操作

Ⅲ 内镜下胆管引流的要点与盲点
1.ENBD、ERBD的实际操作
2.多重EBS、ENBD的要点
3.ERBD、ENBD的并发症和处理措施
4.ENGBD的要点

Ⅳ 胆道镜检杳的要点与盲点
1.利用PTCS进行诊断的操作要点
2.PTCS治疗方法的要点
3.处理PTCS的并发症的要点
4.经口胆道镜的适应证与实际应用
5.术中胆道镜检查

Ⅴ 胆囊结石、胆总管结石手术的要点与盲点
1.胆囊摘除术的要点
2.胆总管切开术的要点
3.Mirizzi综合征的手术要点
4.残余结石和复发结石的对策
5.急性梗阻性化脓性胆管炎的处理
6.内镜下乳头切开术的要点
7.内镜下乳头球囊扩张术

Ⅵ 腹腔镜胆囊摘除术的要点与盲点
1.术前检查的注意点
2.LC的必要器械
3.气腹法与悬吊法的实际操作
4.胆总管取石的要点
5.急性胆囊炎手术的要点
6.并发症的处理
7.严重并发症的治疗

Ⅶ 肝胆管结石治疗的要点与盲点
1.治疗方针的决定
2.胆固醇结石的处理
3.选择性胆管造影的要点
4.经皮经肝胆道镜取石的实际操作
5.经口胆道镜取石术
6.胆道重建法的要点
7.肝切除技术的特点和要点
8.结石复发的对策

Ⅷ 胆道癌术前诊断的要点与盲点
1.临床检查与肿瘤标志物
2.进展程度诊断的步骤
3.利用MDCT进行进展程度诊断的实际操作
4.利用超声波进行外科进展程度诊断的技巧:肝门部胆管癌的局部进展的诊断
5.中下段胆管癌进展程度的诊断
6.肝门部胆管癌进展程度的诊断
7.尾状叶胆管支浸润的诊断
8.粘液产生性胆管癌诊断的要点
9.较早期胆囊癌进展程度的诊断
10.进展期胆囊癌进展程度的诊断
11.内镜检查与活检的诊断价值和局限性

Ⅸ 恶性胆道梗阻患者围手术期管理的要点与盲点
1.经皮经肝胆道引流(PTBD)后的围手术期管理
2.伴有肝脏损害病例的处理对策
3.抗生素的使用方法
4.围手术期合生素的使用
5.根据IGG检查评价肝脏的储备功能
6.各种肝脏储备功能评价法的意义和局限性

Ⅹ 静脉支栓塞术的要点与盲点
1.经皮经肝入路的实际操作(健侧穿刺法)
2.经皮经肝人路的实际操作(同侧穿刺法)
3.栓塞术后肝脏再生的评价方法
4.栓塞术后多普勒超声检查的意义
5.门静脉支栓塞术后的并发症
……
Ⅺ 中下段胆管癌的胰十二指肠切除术的要点与盲点
Ⅻ 肝门部胆管癌手术的要点与盲点
ⅩⅢ 胆囊癌手术的要点与盲点
ⅩⅣ 先天性胆管扩张诊断和手术的要点与盲点
ⅩⅤ 术后管理的要点与盲点
ⅩⅥ 术后并发症处理的要点与盲点
索引
一点建议
●非常少见的胆管变异
●PTBD前必要的临床检查
●PTBD窦道扩张的技巧
●何为肝再生的触发器(1)
●何为肝再生的触发器(2)
●何为肝再生的触发器(3)
●PTBD窦道的处理
●乳头功能和胆总管结石
●胆源性胰腺炎和重症胆管炎
●急性胆囊炎处理的注意点
●T管插入的要点
●术中胆道造影的要点
●胆囊动脉、胆囊管处理的要点
●术中胆道探查的要点
●周围神经的侵犯及预后
●肝门部胆管癌的微转移
●胆管切除断端的病理
●胆管内胆固醇沉着病和胆管癌
●胆囊癌的微小转移
●胆道活检标本的病理诊断一所谓“描述性”病理诊断
●胆汁引流和肝再生
●梗阻性黄疸与肝再生
●梗阻性黄疸与肝脏血流
●减黄不良的病理机制
●胆汁回输的意义
●胆汁分泌的机制:CO(一氧化碳)的作用
●细菌感染和胆汁分泌
●关于胆汁中细菌的基础知识
●各种栓塞物质的长处和短处
●门静脉支结扎与肝线粒体功能
●门静脉分支结扎与肝再生(1)
●门静脉分支结扎与肝再生(2)
●门静脉支结扎与梗阻性黄疸时的肝再生
●门静脉支结扎和扩大肝切除术
●血管钳和内膜损害
●大网膜瓣法
●保留胃右动脉的PPPD的术式和意义
●消化道重建和消化道激素
●消化道功能检查方法
●引流法
●胆汁引流管的术中管理
●切断肝短静脉的要点
●切断尾状叶门静脉支的要点
●缺血再灌注和肝损害
●Arantius管的解剖和切断的要点
●扩大的淋巴结清扫是否有效?
●肝切除术后腹腔引流的要点
●间断缝合还是连续缝合?
……
咖啡时间
Book Abstract

更换PTBD引流管之前必须行胆管造影。在透视下将新的引流管置于身体表面的相应位置,参照先前的造影片在合适的位置剪侧孔,确保其能位于胆管内。在最后一个侧孔刻一条线作为标记(不透x线),便于确认交换后的引流管的位置。
导丝和导管的选择
多使用0.035英寸的亲水性导丝(泰尔茂公司等),有适当的顺滑度、硬度及扭转度,便于通过胆道狭窄的部分。多使用氯乙烯材料的导管(住友酚醛塑料公司的PTCS导管等)。头端经加工后有一定的锥度,对窦道扩张很有用。实际上在进行扩张时,一次扩张过度可能会破坏窦道,因此要每次增加1~2F,使其逐渐变大。
导管插入法——基本篇
插入导管时,注意不要让它弯曲,比起直接向里插入导管,一边来回捻转一边向里插入导管则更容易。经验上,从左肝侧插入时逆时针捻转,从肝右叶侧插入时顺时针捻转则容易插入。若能一直插至目标位置,便不能继续捻转。若导管的大小超过12F,通过PTBD刺入部位的胆管壁时会很费力,很难行窦道扩张。换用0.038英寸导丝或将两根0.035英寸导丝并用,则操作会比较容易。还有一点要记住,在窦道扩张时会伴有疼痛,除使用足够量的局麻药物外,还要使用镇静剂。
导管插入法——应用篇
经过胆管狭窄部位,一边插入导管、一边扩张窦道时,有时连最细的9F的PTCS导管都插不进去,这时,用打火机(最近因院内全面禁烟很少有)或是热水的蒸气加热使其尖端拉长之后,用生理盐水尽快冷却,可使已有的导管的头端变细且有一定的锥度,便于通过胆管狭窄的部位(图1)。若能使这种头端有一定锥度的导管通过一次,之后一般的导管多能顺利通过。
窦道扩张的标准
若只需引流胆汁,插入9F的导管便可,不必用更粗的导管。当要插入经皮经肝胆道镜时,即使使用胆道纤维镜CHF.P20,扩张至16F便足够了。向患者交代病情,每周行2~3次的窦道扩张。若用直径约3mm的T管行胆汁内引流,扩张至12F时便能顺利插入。

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Service Guarantee

Yami Free Shipping over $49
Yami Easy Returns
Yami Ships from United States

Shipping

  • United States

    Standard Shipping is $5.99 (Excluding Alaska & Hawaii). Free on orders of $49 or more.

    Local Express is $5.99 (Available in Parts of CA, NJ, MA & PA). Free on orders of $49 or more.

    2-Day Express (Includes Alaska & Hawaii) starts at $19.99.

Return Policy

You may return product within 30 days upon receiving the product. Items returned must be new in it's original packing, including the original invoice for the purchase. Customer return product at their own expense.

Sold by JD@CHINA

Service Guarantee

Yami Cross-store Free Shipping over $69
Yami 30-days Return

Yami-China FC

Yami has a consolidation warehouse in China which collects multiple sellers’ packages and combines to one order. Our Yami consolidation warehouse will directly ship the packages to your door. Cross-store free shipping over $69.

Return Policy

You may return products within 30 days upon receiving the products. Sellers take responsibilities for any wrong shipment or missing items. Packing needs to be unopened for any other than quality issues return. We promise to pack carefully, but because goods are taking long journey to destinations, simple damages to packaging may occur. Any damages not causing internal goods quality problems are not allowed to return. If you open the package and any quality problem is found, please contact customer service within three days after receipt of goods.

Shipping Information

Yami Consolidation Service Shipping Fee $9.99(Free shipping over $69)

Sellers in China will ship their orders within 1-2 business days once the order is placed. Packages are sent to our consolidation warehouse in China and combined there. Our Yami consolidation warehouse will directly ship the packages to you via UPS. The average time for UPS to ship from China to the United States is about 10 working days and it can be traced using the tracking number. Due to the pandemic, the delivery time may be delayed by about 5 days. The package needs to be signed by the guest. If the receipt is not signed, the customer shall bear the risk of loss of the package.

Sold by JD@CHINA

Service Guarantee

Free shipping over 69
Genuine guarantee

Shipping

Yami Consolidated Shipping $9.99(Free shipping over $69)


Seller will ship the orders within 1-2 business days. The logistics time limit is expected to be 7-15 working days. In case of customs clearance, the delivery time will be extended by 3-7 days. The final receipt date is subject to the information of the postal company.

Yami Points information

All items are excluding from any promotion or points events on Yamibuy.com

Return Policy

You may return product within 30 days upon receiving the product. Items returned must be new in it's original packing, including the original invoice for the purchase. Customer return product at their own expense.

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About the brand

Jingdong book

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About the brand

Jingdong book