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Jingdong book

临床诊疗指南·普通外科分册

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临床诊疗指南·普通外科分册

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本书系卫生部委托中华医学会组织全国著名专家集体编写的权威性临床诊疗指南。全书共31章,对各种普通外科疾病的临床表现、诊断要点、治疗方案与原则进行了简明阐述。本书内容科学实用、可操作性强,对于规范普通外科诊疗、促进医疗质量的全面提高有着重要的指导作用。适用于普通外科医师和医疗行政管理人员使用。
Catalogue

第一章 外科感染
第一节 外科软组织感染
第二节 手部急性化脓性感染
第三节 全身化脓性感染
第四节 外科特异性感染
第二章 水、电解质代谢紊乱和酸碱平衡失调
第一节 水和电解质平衡紊乱
第二节 酸碱平衡失调
第三章 肠外营养
第四章 肠内营养
第五章 输血反应及其并发症
第一节 非溶血性发热反应
第二节 过敏反应
第三节 急性溶血反应
第四节 迟发性溶血反应
第五节 细菌污染反应
第六节 循环负荷过重
第七节 酸碱平衡失调
第八节 出血倾向
第六章 外科休克
第一节 失血失液性休克
第二节 创伤性休克
第三节 感染性休克
第七章 器官功能衰竭及多器官功能障碍综合征
第一节 急性肾衰竭
第二节 急性呼吸窘迫综合征’
第三节 急性肝功能衰竭
第四节 应激性胃黏膜病变
第五节 急性弥散性血管内凝血
第六节 多器官功能障碍综合征
第八章 甲状腺与甲状旁腺疾病
第一节 亚急性非化脓性甲状腺炎
第二节 慢性淋巴细胞性甲状腺炎(桥本病)
第三节 结节 性甲状腺肿
第四节 甲状腺腺瘤
第五节 甲状腺癌
第六节 甲状腺功能亢进
第七节 甲状腺舌管囊肿
第八节 原发性甲状旁腺功能亢进症
第九节 颈动脉体瘤
第十节 颈部淋巴结结核
第九章 乳房疾病
第一节 急性乳腺炎
第二节 乳腺导管扩张症(浆细胞性乳腺炎)
第三节 乳腺结核
第四节 乳腺囊性增生症
第五节 乳腺纤维腺瘤
第六节 乳腺导管内乳头状瘤
第七节 乳腺癌
第八节 男性乳腺癌
第十章 周围血管疾病
第一节 单纯性下肢静脉曲张
第二节 原发性深静脉瓣膜功能不全
第三节 下肢深静脉血栓形成
第四节 血栓闭塞性脉管炎
第五节 急性动脉栓塞
第六节 创伤性动静脉瘘
第十一章 动脉瘤
第一节 腹主动脉瘤
第二节 颈动脉瘤
第三节 髂动脉瘤
第四节 股动脉瘤
第五节 胭动脉瘤
第六节 锁骨下动脉瘤
第十二章 腹外疝
第一节 腹股沟疝
第二节 股疝
第三节 切口疝
第四节 脐疝
第十三章 腹部损伤
第一节 腹部闭合性损伤
第二节 腹部开放性损伤
第三节 腹腔脏器损伤
第四节 腹膜后血肿和大血管损伤
第十四章 腹膜炎
第一节 急性继发性弥漫性腹膜炎
第二节 膈下脓肿
第三节 盆腔脓肿
第十五章 外科急腹症
第十六章 原发性腹膜后肿瘤
第十七章 胃、十二指肠疾病
第一节 胃溃疡与外科治疗
第二节 十二指肠溃疡与外科治疗
第三节 胃、十二指肠溃疡外科合并症
第四节 胃、十二指肠溃疡术后并发症
第五节 应激性溃疡
第六节 十二指肠淤滞症
第七节 胃良性肿瘤
第八节 胃肉瘤
第九廿胃癌
第十节 十二指肠肿瘤
第十八章 小肠疾病
第一节 急性出血性肠炎
第二节 小肠肿瘤
第三节 小肠憩室疾病
第四节 短肠综合征
第十九章 炎症性结肠病
第一节 局限性肠炎
第二节 溃疡性结肠炎
第二十章 肠梗阻
第一节 机械性肠梗阻
第二节 血运障碍性肠梗阻
第三节 急性假性结肠梗阻
第四节 腹腔间隔室综合征
第二十一章 肠息肉及肠息肉病
第一节 结肠息肉
第二节 家族性腺瘤性息肉病
第三节 黑斑息肉病
第二十二章 结肠、直肠及肛管疾病
第一节 结肠癌
第二节 直肠癌
第三节 结肠憩室病
第四节 缺血性结肠炎
第五节 肛管、直肠损伤
第六节 先天性巨结肠症
第七节 直肠肛管周围脓肿
第八节 痔
第九节 肛瘘
第十节 肛裂
第十一节 直肠脱垂
第十二节 直肠息肉
第十三节 肛管及肛门周围恶性肿瘤
第二十三章 肠瘘
第二十四章 阑尾疾病
第一节 急性阑尾炎
第二节 慢性阑尾炎
第三节 阑尾周围炎及阑尾周围脓肿
第四节 阑尾类癌
第二十五章 急性消化道出血
第一节 急性上消化道出血
第二节 急性下消化道出血
第二十六章 肝脏疾病
第一节 细菌性肝脓肿
第二节 阿米巴性肝脓肿
第三节 肝棘球蚴病(肝包虫病)
第四节 原发性肝癌
第五节 转移性肝癌
第六节 肝血管瘤
第七节 肝腺瘤
第八节 肝囊肿
第二十七章 门静脉高压症
第二十八章 胆系疾病
第一节 慢性胆囊炎、胆囊结石
第二节 急性胆囊炎
第三节 肝外胆管结石
第四节 肝内胆管结石
第五节 重症急性胆管炎
第六节 胆道蛔虫症
第七节 胆囊癌
第八节 胆管癌
第九节 胆道出血
第二十九章 胰腺疾病
第一节 胰腺炎
第二节 胰腺肿瘤
第三节 壶腹周围肿瘤
第三十章 脾脏外科
第一节 脾脏脓肿
第二节 脾脏肿瘤
第三十一章 腹腔镜外科
Book Abstract

【治疗方案及原则】
1.轻型急性胰腺炎的治疗轻型急性胰腺炎的治疗原则是尽量减少胰液分泌,即胰腺休息疗法。防止感染,防止向重症发展。
(1)禁食、胃肠减压。
(2)抑制胰液分泌及抗胰酶的药物应用。
(3)镇痛和解痉。
(4)支持治疗:每日输液应根据液体出入量及热量需求计算,有计划供给,保证水与电解质平衡。
(5)预防感染:采用能通过血胰屏障的抗生素静脉滴注,如喹诺酮类、头孢他啶、亚胺培南、甲硝唑等。真菌预防,可采用氟康唑。
(6)中药治疗:在呕吐基本控制的情况下,通过胃管注入“复方清胰汤”,注入后夹胃管1小时。或者应用生大黄15g,胃管内灌注或直肠内滴注,每天两次。中药皮硝全腹外敷,500g每天两次。
2.急性胆源性胰腺炎的治疗
(1)胆道无梗阻并以胆道疾病为主的类型:主要先采用非手术治疗,方法与治疗轻型急性胰腺炎相同。待急性炎症消退后,再计划处理胆道病变,如作择期胆囊手术,避免再次发作。
(2)胆道有梗阻并以胆道疾病为主的类型:应急诊手术解除胆道梗阻,处理胆道病变,如胆总管切开取出结石,T形管引流,若胆囊未切除,同时切除胆囊。手术中在处理好胆道病变后,再沿胃结肠韧带打开小网膜腔,探查胰腺,作小网膜腔灌洗引流。若有条件,这种病例适合做内镜下Oddi括约肌切开、取石和鼻胆管引流术。有时胆道梗阻的表现不典型,胆道轻度扩张以及肝功能指标轻度升高均应引起注意。
(3)临床症状以胰腺炎为主的类型:这类胰腺病变往往都属于重症急性胰腺炎伴有感染病例,常需要作手术治疗。其胰腺病变的处理方法与下述非胆源性重症急性胰腺炎相同。不过,在处理胰腺病变以后,同时要处理胆道病变,探查胆总管,并作胆道引流。
3.非胆源性重症急性胰腺炎的治疗
(1)急性反应期:先行非手术治疗,纠正血流动力学异常,防治休克、肺水肿、ARDS、急性肾功能障碍及脑病等严重并发症。对治疗中出现感染者应转手术治疗。在非手术治疗中,病情发展极快、腹胀及腹膜刺激症状严重、生命体征不稳、在72小时左右很快出现多器官功能不全者,属于暴发性急性胰腺炎,应加强脏器功能支持,反应不良者应作腹腔和腹膜后减压引流手术。如病人无手术条件可以先采用腹腔灌洗治疗。
(2)全身感染期:
1)有针对性地选择敏感的、能透过血胰屏障的抗生素。警惕深部真菌感染,根据菌种选用氟康唑或两性霉素B。注意有无导管相关性感染。加强全身支持治疗。
2)结合临床征象作动态CT监测,明确感染灶所在的部位,对感染病灶进行积极的手术处理。针对坏死感染病灶的手术治疗,基本措施是作坏死清除术和局部有效持续灌洗引流。
3)对于估计病程较长的病例,要作减压性胃造瘘和营养性空肠造瘘,这为病人术后的支持和康复会带来很大的便利,有利于合成代谢的恢复,减少静脉补液、降低真菌感染和混合感染的发生率。
(3)腹膜后残余感染期:通过窦道造影明确感染残腔的部位、范围及毗邻关系,注意有无胰瘘、胆瘘及消化道瘘的存在。应加强全身支持疗法,改善营养状况,创造条件作残腔扩创引流。
4.局部并发症的治疗原则
(1)急性液体积聚:多会自行吸收,无须手术,也不必穿刺,使用中药皮硝外敷可加速其吸收,500g皮硝装在棉布袋内作腹部大面积外敷,每天更换两次。
(2)胰腺及胰周组织坏死:坏死感染需作手术,手术为坏死组织清除术加局部灌洗引流;对无临床症状的无菌坏死应严密观察,不要急于穿刺或手术,可能吸收,也可能包裹,如果出现感染症状即应行手术治疗。
(3)急性胰腺假性囊肿:囊肿小于6cm,无症状,不作处理,随访观察;若出现症状、体积增大或继发感染,则需要行手术引流;囊肿经过3个月仍不吸收者,需作内引流术。
(4)胰腺脓肿:临床及CT证实有脓肿形成者,应立即作手术引流。
……

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欣叶 御大福 芋头麻薯 180g

周销量 600+

$1.66 $1.99 83折

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