全科中級輔導(dǎo)外科和急救

全科中級輔導(dǎo)外科急救內(nèi)容精選課件精選課件精選課件精選課件多根多處肋骨骨折——連枷胸形成精選課件精選課件精選課件精選課件兒童:頭面頸=9+(12-年齡）

雙下肢=46-(12-年齡）女性：雙側(cè)臀部=雙足=6%精選課件精選課件精選課件精選課件精選課件精選課件精選課件精選課件精選課件精選課件精選課件精選課件精選課件精選課件精選課件精選課件精選課件精選課件精選課件精選課件隱神經(jīng)鞘瘤精選課件精選課件neurofibroma精選課件capillaryhemangioma精選課件精選課件精選課件精選課件精選課件dermoidcyst

精選課件精選課件精選課件sebaceouscyst

精選課件精選課件epidermoidcyst精選課件精選課件精選課件thyroidadenoma

精選課件papillarythyroidcarcinoma精選課件精選課件精選課件精選課件精選課件精選課件治療：乳房纖維腺瘤雖屬良性，但亦有惡變可能，一經(jīng)發(fā)現(xiàn)，應(yīng)予手術(shù)切除。CalcifiedFibroadenoamaFibroadenoma精選課件Breastcancercausing“orangepeel”skinintheleftbreastandthathasspreadtotheleftarmpit.Thisspreadhascausedalargelumpinthetailoftheleftbreast/leftarmpitregion.精選課件精選課件精選課件傳統(tǒng)張力手術(shù)(tensionoperation)無張力手術(shù)(tension-freeoperation)顯著地降低了手術(shù)后疝的復(fù)發(fā)率有效地減少了術(shù)后患者的不適感精選課件急性闌尾炎--病理SuppurativeappendicitisSimpleappendicitisGangrenousappendicitisAppendixperforation精選課件精選課件膽囊結(jié)石膽固醇結(jié)石含膽固醇為主，多呈橢圓形（單發(fā)者）或多面形（多發(fā)者），表面平滑或稍呈結(jié)節(jié)狀，淡灰色，質(zhì)硬，剖面呈放射狀線紋，X線平片上不顯影。此種結(jié)石多在膽囊內(nèi)。膽色素性結(jié)石以膽紅素為主要成分，多為泥沙樣，質(zhì)軟而脆，有的如泥團(tuán)狀，有的如沙粒，為棕黑或棕紅色。大小不等，因含鈣少，X線平片上多不顯影。多在肝內(nèi)、外膽管中。精選課件精選課件精選課件精選課件(forty,fat.female,fruitful4F)精選課件精選課件精選課件精選課件精選課件精選課件精選課件精選課件精選課件精選課件（A）病人站立，大腿上1/3扎上止血帶；（B）交替伸屈膝關(guān)節(jié)10余次或行走；（C）靜脈曲張益形明顯，小腿脹痛，即為深靜脈通暢試驗(yàn)陽性精選課件精選課件精選課件精選課件Thisisarenalcellcarcinomaarisinginthelowerpoleofthekidney.Itisfairlycircumscribed.Thecutsurfacedemonstratesavariegatedappearancewithyellowishareas,whiteareas,brownareas,andhemorrhagicredareas.Thoughtheseneoplasmsareusuallyslow-growing,theycanoftenreachaconsiderablesizebeforedetectionbecausethereisalotofroomtoenlargeintheretroperitoneum,andthereisanotherkidneytoproviderenalfunction.Thus,presentingsymptomsandsignsusuallyincludeflankpain,masseffect,andhematuria.精選課件Thisisamuchmoreadvancedrenalcellcarcinomainvolvingtheleftkidney(top).Noticeahugemassofnecroticyellowishbrownmaterialreplacingthelowerpoleofthekidney.Alsonoticethatthevenacavainthecenterofthepictureisfilledwithtumor.Thisistypicalofthisneoplasm.Intheupperpoleofthiskidneyisawellcircumscribedtumorwhichhasayellowish-browncolorandshowscentralnecrosis.Thisisarenalcellcarcinoma.精選課件精選課件精選課件膀胱癌Tis膀胱癌Ta-1膀胱癌臨床分類分期精選課件膀胱癌臨床分類分期膀胱癌T2-3膀胱癌T4精選課件精選課件膀胱腫瘤治療手術(shù)治療為主。（一）表淺膀胱腫瘤原位癌細(xì)胞分化不良、已經(jīng)有浸潤的應(yīng)及早行膀胱全切術(shù)；細(xì)胞分化良好的可行經(jīng)尿道手術(shù)。（二）浸潤性膀胱腫瘤1、分化良好、局限的T2期腫瘤可行經(jīng)尿道手術(shù)。2、一般根據(jù)腫瘤浸潤范圍、大小、數(shù)目選擇膀胱全切術(shù)或膀胱部分切除術(shù)，部分切除范圍應(yīng)包括距離腫瘤2cm以內(nèi)的全層膀胱壁。3、膀胱全切術(shù)后的尿流改道4、浸潤性腫瘤的新輔助化療：MVAC方案，若結(jié)合髂內(nèi)動