肝疾病案例分析囊型肝包蟲病合并膽瘺的診療課件

匯報(bào)人:xxx20xx-03-15肝疾病案例分析囊型肝包蟲病合并膽瘺的診療ppt課件目錄CONTENCT引言病例介紹診斷與鑒別診斷治療方案及實(shí)施并發(fā)癥預(yù)防與處理總結(jié)與反思01引言目的背景目的和背景分析囊型肝包蟲病合并膽瘺的診療過(guò)程，提高對(duì)該病的認(rèn)識(shí)和診療水平。肝包蟲病是一種常見(jiàn)的寄生蟲病，而膽瘺則是手術(shù)后常見(jiàn)的并發(fā)癥之一。兩者合并出現(xiàn)時(shí)，病情復(fù)雜，治療難度大。是由棘球蚴的幼蟲寄生于人體或其他動(dòng)物的臟器內(nèi)引起的一種寄生蟲病，主要通過(guò)吞食被蟲卵污染的食物而感染。肝包蟲病是手術(shù)后膽汁沒(méi)有完全從膽總管或膽腸吻合口流入腸腔，而持續(xù)從膽道破損處流入腹腔、腹膜后，或經(jīng)引流管流到體外的現(xiàn)象。膽瘺的發(fā)生與手術(shù)操作、患者病情等因素有關(guān)。膽瘺肝包蟲病與膽瘺概述以下附贈(zèng)各項(xiàng)管理制度英文版（不需要可刪）急救藥品、器材管理制度:1.Rescuedrugsandequipmentshouldbe"fivefixed"(fixedquantityandvariety,designatedplacement,designatedpersonstorage,regulardisinfectionandsterilization,regularinspectionandmaintenance)and"twotimely"(timelyinspectionandmaintenance,timelyreceiptandsupplementation).Theitemisclearlymarkedandcannotbeusedarbitrarily.2.Thenecessaryrescueequipmentiscomplete,ingoodperformance,andinstandbycondition.3.Therescuedrugsarecomplete,withcleardruglabelsandnodiscoloration,deterioration,expiration,ordamage.Theyshouldbeplacedandusedintheorderofdrugexpirationdates(fromrighttoleft).4.Emergencydrugsanditemsforeachdepartment'srescuevehicleshallbeuniformlyequippedaccordingtorequirements.Specializedemergencydrugsanditemsmustbereviewedandapprovedbythedepartmentdirectortodeterminethetype,quantity,specifications,anddosagetobeequipped.Rescuevehiclesmustbeplacedindesignatedlocationsandmanagedbydesignatedpersonneltoensuresafetyandeaseofuse.5.Afterusingrescuedrugsandequipment,theyshouldbefullyreplenishedwithin24hours.Iftheycannotbereplenishedduetospecialreasons,theyshouldbenotedonthehandoverregistrationformandreportedtotheheadnurseforcoordinationandresolutiontoensuretimelyuseduringpatientrescue.6.Thereisaregistrationbookfortheprovisionofdrugsandequipment.Ensureconsistencybetweenaccountsandmaterials,andhandoverbetweenshifts.7.Managementofsealedrescuevehicles:Beforesealing,theheadnurse(ornurseincharge)andanothernurseshallcountthedrugsandequipmentaccordingtotheregistrationbookofdrugandequipmentequipment,verifytheiraccuracy,andsealthemwithaseal.Twopeopleshallsignandfillinthesealingtime.Nurseschecktheconditionofthesealsoncepershiftandcompletethehandover.Theresponsiblenursescheckonceaweek,andtheheadnurseandresponsiblenursesopenthesealsandinspectthedrugsandequipmentintheambulanceonceamonth,withrecordskept.8.Nonsealedrescuevehiclemanagement:Eachshiftshallcountthedrugsandequipmentaccordingtotheregistrationbookandcompletethehandover.Theresponsiblenurseshallinspectonceaweek,andtheheadnurseshallinspectonceeverytwoweeksandkeeprecords,ensuringthattheaccountsmatchthematerials.護(hù)理文書書寫制度:

1.Nursingstaffstrictlyfollowthelatestrequirementswhenwritingnursingmedicalrecords.2.Thecontentofnursingrecordsshouldbeobjective,truthful,accurate,timely,complete,andstandardized.3.Allnursingdocumentsshouldbewrittenwithablueblackorcarboninkpen.4.AllnursingdocumentsshouldbewritteninArabicnumeralsfordateandtime,withdatesinyears,months,anddays,usinga24-hoursystem,specifictominutes.5.WritingshoulduseChinese,medicalterminology,andcommonlyusedforeignlanguageabbreviations;Completerecorditems;Thetextisneat,thehandwritingisclear,andthelayoutisclean;Accurateexpression,fluentsentences,simpleandconcise:correctformatandpunctuation,notypos.6.Whenerrorsoccurduringthewritingprocess,doublelinethemonthewrongwords,keeptheoriginalrecordclearanddistinguishable,signthemodifier,indicatethemodificationtime,continuetowritethecorrectcontent,anddonotusescraping,sticking,paintingorothermethodstocoveruporremovetheoriginalhandwriting.Eachpageshouldbemodifiednomorethantwotimes,otherwisetheoriginalrecorderwillpromptlycopyagain(exceptformodificationsmadebysuperiors).7.Nursingrecordswrittenbyinternnurses,probationarynurses,orunregisterednursesshouldbereviewedandsignedbynurseswithlegalprofessionalqualificationsinthismedicalinstitution.8.Furthertrainingnursescanonlywritenursingdocumentsafterbeingrecognizedbythemedicalinstitutionreceivingthetrainingfortheirworkability.9.Superiornursingstaffhavetheresponsibilitytoreviewandmodifythewrittenrecordsofsubordinatenursingstaff.Whenmakingmodifications,reddoublelinesshouldbeusedtomarkerrors,writethemodifiedcontent,signandindicatethemodificationtime.10.Temperaturerecords,medicalorders,patientcarerecords,andsurgicalinventoryrecordsshouldbearchivedontime.02病例介紹姓名（匿名）性別女性年齡中年民族漢族職業(yè)農(nóng)民居住地牧區(qū)患者基本信息0102030405主訴現(xiàn)病史既往史個(gè)人史體格檢查病史及臨床表現(xiàn)上腹部脹痛，伴惡心、嘔吐患者于近期出現(xiàn)上腹部脹痛，呈持續(xù)性，伴惡心、嘔吐，嘔吐物為胃內(nèi)容物，無(wú)咖啡色液體。無(wú)發(fā)熱、黃疸等癥狀。否認(rèn)肝炎、結(jié)核等傳染病史，無(wú)手術(shù)及外傷史，無(wú)藥物過(guò)敏史。生于牧區(qū)，有犬、羊等動(dòng)物接觸史。腹部膨隆，上腹部壓痛陽(yáng)性，無(wú)反跳痛及肌緊張，移動(dòng)性濁音陰性，腸鳴音正常。超聲檢查CT檢查MRI檢查影像學(xué)檢查肝臟多發(fā)囊性低密度影，邊界清晰，密度均勻，增強(qiáng)掃描無(wú)強(qiáng)化。膽囊壁增厚，膽囊內(nèi)可見(jiàn)高密度影。肝臟多發(fā)囊性長(zhǎng)T1長(zhǎng)T2信號(hào)影，邊界清晰，信號(hào)均勻，增強(qiáng)掃描無(wú)強(qiáng)化。膽囊壁增厚，膽囊內(nèi)可見(jiàn)短T1長(zhǎng)T2信號(hào)影。肝臟體積增大，形態(tài)失常，肝內(nèi)可見(jiàn)多個(gè)囊性回聲，邊界清晰，內(nèi)透聲差，可見(jiàn)點(diǎn)狀回聲漂浮。膽囊壁增厚，毛糙，膽囊內(nèi)可見(jiàn)點(diǎn)狀回聲沉積。03診斷與鑒別診斷臨床表現(xiàn)影像學(xué)檢查實(shí)驗(yàn)室檢查患者可能出現(xiàn)上腹部疼痛、黃疸、發(fā)熱等癥狀。B超、CT或MRI等影像學(xué)檢查可發(fā)現(xiàn)肝臟囊性占位，囊壁可能鈣化，囊內(nèi)可見(jiàn)子囊或頭節(jié)。肝功能檢查可能異常，嗜酸性粒細(xì)胞計(jì)數(shù)可能升高。診斷標(biāo)準(zhǔn)無(wú)寄生蟲感染史，影像學(xué)檢查表現(xiàn)為單發(fā)或多發(fā)圓形或橢圓形無(wú)回聲區(qū)，囊壁菲薄，光滑，囊內(nèi)無(wú)子囊或頭節(jié)。單純性肝囊腫有感染病史，臨床表現(xiàn)以寒zhan、高熱、肝區(qū)疼痛為主，影像學(xué)檢查可見(jiàn)單發(fā)或多發(fā)膿腫灶，膿腔內(nèi)可見(jiàn)氣體或氣液平面。肝膿腫有慢性肝病或肝硬化病史，臨床表現(xiàn)以肝區(qū)疼痛、消瘦、乏力等為主，影像學(xué)檢查可見(jiàn)肝臟實(shí)質(zhì)性占位，增強(qiáng)掃描可見(jiàn)快進(jìn)快出表現(xiàn)。肝癌鑒別診斷要點(diǎn)患者有牧區(qū)居住史，有犬羊等動(dòng)物接觸史。臨床表現(xiàn)：上腹部疼痛，黃疸，發(fā)熱。影像學(xué)檢查：B超顯示肝臟巨大囊性占位，囊壁鈣化，囊內(nèi)可見(jiàn)子囊；CT進(jìn)一步證實(shí)肝臟囊性占位，增強(qiáng)掃描囊壁及子囊有強(qiáng)化；MRI顯示肝臟囊性占位，T1WI呈低信號(hào)，T2WI呈高信號(hào)，囊壁及子囊有強(qiáng)化。實(shí)驗(yàn)室檢查：肝功能異常，嗜酸性粒細(xì)胞計(jì)數(shù)升高。術(shù)中見(jiàn)囊腫位于右肝葉，大小約10cmx8cmx8cm，囊壁較厚，內(nèi)含大量清亮囊液及多個(gè)子囊，符合囊型肝包蟲病表現(xiàn)。同時(shí)發(fā)現(xiàn)膽囊與肝囊腫相通，形成膽瘺。0102030405本例診斷依據(jù)04治療方案及實(shí)施01020304全面了解病史影像學(xué)檢查實(shí)驗(yàn)室檢查術(shù)前討論術(shù)前準(zhǔn)備與評(píng)估完善血常規(guī)、尿常規(guī)、肝功能、腎功能、凝血功能等相關(guān)實(shí)驗(yàn)室檢查，評(píng)估患者的全身狀況。進(jìn)行B超、CT或MRI等影像學(xué)檢查，明確肝包蟲病的位置、大小以及與周圍zu織的毗鄰關(guān)系。掌握患者的既往病史、家族病史以及藥物過(guò)敏史等，評(píng)估手術(shù)風(fēng)險(xiǎn)。zu織多學(xué)科專家進(jìn)行術(shù)前討論，制定詳細(xì)的手術(shù)方案和應(yīng)急預(yù)案。囊腫處理手術(shù)切口麻醉與體位膽瘺處理術(shù)中注意事項(xiàng)手術(shù)過(guò)程描述仔細(xì)分離肝包蟲囊腫與周圍zu織的粘連，完整切除囊腫，避免囊腫破裂引起感染。根據(jù)肝包蟲病的位置和大小，選擇合適的手術(shù)切口，充分暴露手術(shù)野。采用全身麻醉，患者取仰臥位，根據(jù)手術(shù)需要調(diào)整手術(shù)床角度。發(fā)現(xiàn)膽瘺后，及時(shí)用紗布或吸引器清除腹腔內(nèi)的膽汁，找到瘺口并用可吸收線縫合修補(bǔ)，放置引流管引流。嚴(yán)格遵循無(wú)菌操作原則，避免術(shù)中感染；密切觀察患者生命體征變化，及時(shí)處理異常情況。0102030405常規(guī)護(hù)理術(shù)后密切觀察患者的生命體征變化，給予心電監(jiān)護(hù)、吸氧等常規(guī)護(hù)理措施。引流管護(hù)理保持引流管通暢，定期觀察引流液的顏色、性質(zhì)和量，如有異常及時(shí)處理。藥物治療給予抗生素預(yù)防感染，根據(jù)患者病情給予保肝、利膽等藥物治療。飲食調(diào)整術(shù)后禁食水，待腸道功能恢復(fù)后逐漸給予流質(zhì)、半流質(zhì)飲食，避免油膩、辛辣食物刺激。并發(fā)癥預(yù)防與處理密切觀察患者病情變化，及時(shí)發(fā)現(xiàn)并處理術(shù)后出血、感染、膽汁漏等并發(fā)癥。術(shù)后處理措施05并發(fā)癥預(yù)防與處理80%80%100%常見(jiàn)并發(fā)癥類型由于囊型肝包蟲囊腫與膽道系統(tǒng)相通，手術(shù)或穿刺過(guò)程中可能導(dǎo)致膽汁外溢，形成膽瘺。囊型肝包蟲病合并膽瘺后，膽汁外溢易導(dǎo)致腹腔感染，嚴(yán)重時(shí)可引發(fā)全身性感染。手術(shù)過(guò)程中可能損傷周圍血管，導(dǎo)致術(shù)中或術(shù)后出血。膽瘺感染出血術(shù)前評(píng)估詳細(xì)詢問(wèn)病史，了解患者病情及手