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实用肝胆胰脾手术学

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《实用肝胆胰脾手术学》是一部关于肝胆胰脾外科疾病手术方面的专著,吸收了多位外科学方面的专家多年临床实践总结出来包括解剖基础、麻醉、手术适应证、手术步骤与操作,以及可能出现的并发症预防和治疗等方面的知识,详细介绍了肝胆胰脾的常规手术规范和容易产生问题的方面,并在并发症的预防和治疗上做了详尽的介绍。《实用肝胆胰脾手术学》理论联系实际,可操作性强,具有很好的实用、参考价值。
《实用肝胆胰脾手术学》可供普通外科及相关学科的医师使用,尤其适用于从事该专业的中、青年医师参考使用。
Author Description

林擎天,主任医师、教授,享受国务院特殊津贴。1956年毕业于福建医科大学医疗系,曾任上海市第六人民医院(现为上海交通大学附属第六人民医院)外科主任,断肢再植四人小组成员之一(陈中伟、钱允庆、林擎天、鲍约瑟),中华医学会上海分会大外科委员会委员,美国新泽西医科大学Robert-Wood_Johnson医院工作一访问学者,上海胆道疾病会诊中心外科专家。《胰腺外科学》主编,《外科程序诊断》副主编,参加《胆道手术学》、《心脏血管外科学》以及《中国医学百科全书》外科学和《胆胰十二指肠区域临床外科学》的编写,发表论文90余篇。担任《中国实用外科杂志》、《肝胆胰外科杂志》、《外科理论与实践》、《世界华人消化杂志》、《中国现代外科学杂志》等编委。在长期从事普通外科临床、教学和科研工作中,积累了比较丰富经验,尤其是对消化系统外科临床有着深入的研究和经验体会。
郑起,主任医师、教授、博士生导师。1982年毕业于徐州医学院医疗系,1997年复旦大学附属一中山医院肝癌研究所外科博士毕业,师从汤钊猷院士,现任上海交通大学附属第六人民医院普外科主任、中华医学会上海市分会普外科专业委员会委员,上海市卫生专业高级职称评定委员会委员,上海市胰腺肿瘤专业委员会委员,全国肝癌协会委员,国际肝胆胰协会中国分会委员。担任《肿瘤》、《外科理论与实践》杂志编委。参加《胰腺外科学》编写,发表论文30余篇。从事普外科工作20余年,熟练掌握普外科常见病与危重疑难疾病的诊断和治疗,擅长肝胆胰肿瘤外科手术,肝移植手术和综合治疗。
Catalogue

第一篇 肝脏外科手术
第一章 肝脏局部解剖
第二章 先天性肝脏疾病
第一节 肝囊肿穿刺抽液术
第二节 肝囊肿开窗术
第三章 感染性肝脏疾病
第一节 肝脓肿手术
第二节 肝包虫囊肿手术
第四章 损伤性肝脏疾病
第一节 肝脏修补术
第二节 肝脏填塞术
第三节 部分肝切除术
第四节 肝外伤术后并发症的预防和治疗
第五章 肿瘤性肝脏疾病
第一节 肝脏肿瘤及手术概述
第二节 肝脏左外叶切除术
第三节 肝脏左侧半切除术
第四节 肝脏右侧半切除术
第五节 肝段切除术
第六节 术后并发症的预防和治疗
第六章 门静脉高压症
第一节 门奇静脉断流术
第二节 门一体静脉分流术
第三节 断流十分流联合手术
第七章 肝脏移植术
第一节 肝移植的适应证与禁忌证
第二节 肝移植供体
第三节 原位肝移植术
第四节 其他类型的肝移植术
第五节 肝移植的手术要点与术后处理
第六节 肝移植的并发症的预防和治疗

第二篇 胆道外科手术
第一章 胆道局部解剖
第二章 先天性胆道疾病
第一节 先天性胆道闭锁手术
第二节 先天性胆总管囊肿手术
第三章 炎症、结石性胆道疾病
第一节 胆囊造瘘术
第二节 胆囊切除术
第三节 胆总管切开探查引流术
第四节 胆一肠内引流术
第五节 奥狄括约肌切开成形术
第四章 损伤性胆道疾病
第一节 胆管损伤即时修复术
第二节 术后胆管狭窄修复术
第五章 肿瘤性胆道疾病
第一节 胆囊癌切除术
第二节 胆管癌切除术

第三篇 胰腺外科手术
第一章 胰腺局部解剖
第二章 先天性胰腺疾病
第一节 环状胰腺手术
第二节 异位胰腺手术
第三章 炎症性胰腺疾病
第一节 急性胰腺炎手术
第二节 慢性胰腺炎手术
第三节 胰腺囊肿手术
第四节 胰腺瘘管手术
第四章 损伤性胰腺疾病
第五章 肿瘤性胰腺疾病
第一节 胰腺内分泌肿瘤切除术
第二节 根治性胰头十二指肠切除术
第三节 保留幽门的胰头十二指肠切除术
第四节 区域性胰头十二指肠切除术
第五节 全胰十二指肠切除术
第六节 胰腺体尾部切除术
第七节 胰腺颈体部切除术
第八节 胆一肠T管架桥内引流术
第六章 胰腺移植手术

第四篇 脾脏外科手术
第一章 脾脏局部解剖
第二章 脾脏手术
第一节 脾脏切除术
第二节 脾外伤手术
第三节 脾血的回输
Book Abstract

1.开腹后吸除积血,立即用手指捏住肝十二指肠韧带,暂时阻断肝脏血运,然后用橡胶止血带绕过肝十二指肠韧带束扎肝蒂控制出血。
2.切断并缝扎肝圆韧带再剪开镰状韧带,将近侧肝圆韧带向下或向上牵拉,探查确定损伤肝脏的切除范围,再相应地游离切断左或右三角韧带和冠状韧带以达到良好的暴露。
3.根据肝脏损伤的情况决定下步手术方式。
(1)切除性扩创引流术:在正常肝组织与已失活、缺血的肝组织之间,用手指钝性分离并将后者切除;对分离过程中所遇到的管状结构(胆管、血管)都必须仔细加以牢固结扎或缝扎;然后清洗肝脏伤口而不必将其缝合,但要在创口内应放置引流管,或放置在管旁带有冲洗细管的引流管,以备术后作滴注抗菌溶液和抽吸引流;若为肝脏贯通伤则应在切除清创后,创口两端均要放置引流。
(2)非规则性部分肝切除术:
①若肝脏伤灶在左外叶,可作左外叶切除术。游离和切断结扎左侧三角韧带后托出肝叶,于镰状韧带左旁1cm处切开肝包膜,然后用刀柄或血管钳做钝性分离肝实质,见到血管或胆管均要予以钳夹、切断、结扎或缝扎。在膈顶处特别要注意钳夹、切断和缝扎左肝静脉后切除肝脏,松开肝门止血带观察肝面无出血后,将肝镰状韧带或大网膜覆盖缝合于肝脏断面。
②倘若为右肝外、后叶损伤,则可做右外后叶切除术。分离右侧三角韧带和部分冠状韧带以及肝结肠韧带或肝肾韧带后,术者用左手将肝脏托出(图1—4—11),然后用手术刀在距伤灶0.5~1.0cm处切开正常肝包膜,再用刀柄或血管钳钝性分离肝实质(图1—4—12),每遇到血管和胆管均应予以钳夹、切断和缝扎直至切除肝脏,松开肝门止血带观察肝脏断面,或需用细丝线作“8”字补充缝合以防出血或胆漏(图1—4—13),再用7号丝线对肝脏断面施行间断褥式缝合(图1—4—14),用或不用大网膜再覆盖肝断面缝合。
③倘若为左内叶或右前叶损伤,则可做楔状形肝切除术。在全面游离、切断、结扎肝周韧带后,将近侧肝圆韧带向下或向上牵拉,可清楚显露肝脏膈面或脏面;距肝损伤两侧正常肝脏0.5cm处切开肝包膜,用刀柄或血管钳对一侧肝实质做钝性分离,并钳夹、切断和缝扎肝内血管和胆管后,再对另一侧肝实质做钝性分离直至完全切除毁损的肝组织;松开肝门部阻断钳或止血带,观察两侧肝切面,必要时用细丝线做补充缝扎止血,再用7号丝线对两侧做一排水平褥式缝合,其进针边距为1tin,间距为1.0~1.5cm,然后将两侧肝组织靠拢再一一各做结扎,或在其间嵌人大网膜后再做结扎。
Introduction

外科医师是将大脑和双手能力高度结合在一起的工作者,不但要有扎实的理论知识基础,还需要熟练的手术技巧。手术是临床外科医师治疗疾病的一种主要手段;随着医学科学的不断发展,对疾病的认识不断提高以及手术技术的不断进步,外科手术从简单的脓肿切开引流术、体表肿瘤的切除术、腹股沟疝的修补术等向体腔内发展,如阑尾切除术、胆囊切除术、胃大部切除术、脾切除术,甚至肝叶切除术和胰腺手术等;尤其近数十年来,还开展了肝、胰、脾、肾等移植手术,手术从单纯到复杂并逐渐成熟起来。临床经验的积累和手术操作的规范是取得手术成功关键。手术学则是通过临床实践总结出来的包括解剖基础、麻醉、手术适应证、手术步骤与操作,以及可能发生的并发症预防和治疗等知识,是每一位外科医师应该熟练掌握的一门学科。
由于医学科学的迅速发展、诊断水平的大幅提高、麻醉技术的快速进步、手术操作的日趋完善、手术并发症的逐渐减少、重症监护病房的建立,手术安全性和治疗效果也有明显提高。在普通外科领域中,腹部外科是其重要组成部分;随着现代外科部门的分科越来越细的情况下,肝胆胰脾外科专业也逐步形成,我们特组织了临床上有丰富实践经验的有关专家、教授,参考国内、外文献,以常用、实用、易用为目的,编写出这本《实用肝胆胰脾手术学》。本书共约40万字,插图260余幅,书中以手术操作步骤与并发症的防治为重点,内容全面、简洁、易懂,图文并茂。希望对腹部外科医师,尤其是对该专业的中、青年外科医师有所参考和帮助。
本书编写者均在繁忙的医、教、研工作中执笔和反复修改,而后经汤钊猷教授和施维锦教授作序,在此我们对编写人员的辛勤工作和两位教授的大力支持致以深切的谢意。同时对参考文献和部分插图的作者以及上海交通大学出版社的支持表示感谢。由于我们的认识、实践和写作水平的局限,书中不足之处,敬希读者批评、指正。

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周销量 600+

$1.66 $1.99 83折
Yami
欣葉
2种选择
欣叶 御大福 芋头麻薯 180g

周销量 600+

$1.66 $1.99 83折

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