1、个人简历起止年月起止年月地点地点学习、工作单位学习、工作单位任职任职1987.91993.6.1993.71999.121994.91997.6.1999.122003.122000.92003.6.2003.102005.102003.122006.122006.121998.81998.122001.92001.102001.112002.72005.92006.102006.112008.6北京大学医学部广西南宁市广西南宁市广西南宁市四川成都市广西南宁市广西南宁市广西南宁市日本九州市日本九州市新加坡美国纽约市美国华盛顿DC北京大学医学部广西医科大学第一附属医院普外科广西医科大学广西医科大
2、学第一附属医院肝胆外科四川大学华西医学中心广西医科大学广西医科大学第一附属医院肝胆外科广西医科大学第一附属医院肝胆外科日本产业医科大学生态科学研究所日本产业医科大学生态科学研究所新加坡国立大学医学系美国纽约哥伦比亚大学医学中心美国国立健康研究院国立癌症研究所本科（六年制）住院医师硕士(肿瘤外科学)讲师博士（外科学）博士后(临床医学)副教授教授访问学者访问学者访问学者博士后博士后美国癌症协会（American Association of Cancer Research,AACR）Associate Member（会员号127245）Carcinogenesis杂志特约审稿人（IF2007=5.
3、366）Liver INT杂志特约审稿人（IF2004=2.344）研究方向：肝癌生物反应标志物与大分子损伤肝脏疾病本科彭涛肝脏疾病肝脏疾病彭涛彭涛 教授、博士生导师教授、博士生导师外科学教研室外科学教研室（肝胆血管外科）（肝胆血管外科）2011-10-17 肝脏疾病本科彭涛The liver lies in the right upper quadrant of the abdomen,under the protective rib cage,beneath the diaphragm and connected to the digestive tract by means of por
4、tal vein and biliary drainage system.Gilssons capsule,bare area,falciform lig.,coronary lig.,gastrohepatic lig.,hepatoduodenal lig.foramen1:liver;2:ribcage;3:spine;4:pelvis肝脏疾病本科彭涛3The American(lobar)system&the French(Couinaud segmental)system.肝脏疾病本科彭涛4肝脏疾病本科彭涛54-Cauinaud segmentation肝脏疾病本科彭涛65-left
5、 hepatic vein肝脏疾病本科彭涛76-middle hepatic vein肝脏疾病本科彭涛87-hepatic vein&portal vein肝脏疾病本科彭涛98-portal vein plane肝脏疾病本科彭涛10“精准肝脏外科时代”保留肝中静脉的左半肝切除肝脏疾病本科彭涛11“精准肝脏外科时代”保留肝右静脉的右后叶肝切除肝脏疾病本科彭涛121.双重血供双重血供(75%75%viavia 门静脉门静脉&25%25%viavia 肝动脉肝动脉)肝动脉携氧量占肝动脉携氧量占5050门静脉两端是毛细血管网，无功能性门静脉两端是毛细血管网，无功能性静脉瓣静脉瓣门静脉不可结扎或切断门静
6、脉不可结扎或切断肝脏血流阻断时间肝脏血流阻断时间15-20min15-20min9-circulation肝脏疾病本科彭涛13代谢代谢:bilirubin,carbohydrate,lipid,protein,vitamin,drugs&toxins,ect.凝血凝血免疫调节免疫调节再生再生肝功能指标肝功能指标:1.转氨酶:aspartate phosphatase(AST),alanine phosphatase(ALT)2.Alkaline phosphatases(ALP),Gamma-glutamyl transpeptidase(GGT)3.Albumin4.Child-Pugh肝功
7、能分级;ICG15min渚留率1010肝脏疾病本科彭涛14Hepatic TraumaHepatic Trauma 肝脏创伤肝脏疾病本科彭涛Hepatic traumaHepatic trauma-Classification and characteristics Penetrating hepatic-trauma1.Due to bullets,knives etc.less devitalization of liver parenchyma2.Due to missiles shatter massive parenchymaBlunt hepatic-trauma1.Due to
8、direct blow to the upper abdomen or lower right rib cage,or sudden deceleration.2.Might be explosive bursting wounds or linear lacerations.3.The posterior superior segment(SVII)is mostly vulnerable due to its location.4.Damage to the hepatic veins is catastrophic and difficult to expose during explo
9、ration.(The staging system is for your reference only,but pls pay attention to by what index it score the damage)肝脏疾病本科彭涛16Symptoms and signs:hypovolemic shock(hypotension,decreased urinary output,low central venous pressure)Laboratory findings:no detectable anemia due to rapid blood loss.Leukocytos
10、is is common.Imaging findings:1.CT scan is prior to other techniques among stable patients.It can estimate the type and severity of the injury,which is useful information for both triaging and exploration if necessary.2.Sonography is of limited value;angiography is diagnostic in hemobilia.Hepatic tr
11、aumaHepatic trauma-Clinical findings 肝脏疾病本科彭涛17Hepatic traumaHepatic trauma-imaging findings肝脏疾病本科彭涛18Hepatic trauma-imagingfindingsHydropsattheadrenalglandHepatictraumawithfractureofleftrib肝脏疾病本科彭涛19Hepatic trauma Hepatic trauma-Treatment In a review of 1842 liver injuries from 1975-1999 in USA,non
12、surgical therapy is used in more than 80%of blunt injuries.The death rates from both blunt and penetrating trauma have improved significantly due to decreased death from hemorrhage.J.David Richardson,et al.ANNALSOFSURGERY,232(3):324330.肝脏疾病本科彭涛20Hepatic traumaHepatic trauma-Treatment NonoperativeNon
13、operative management for patients with stable minor management for patients with stable minor injuriesinjuries 1.Contained subcapsular or intrahepatic hemotoma,2.Unilobar fracture3.Absence of devitalized liver4.Minimal intraperitoneal blood5.Absence of injuries to other intra-abdominal organs.Howeve
14、r,repeatedly examination should be carried out during the observation!肝脏疾病本科彭涛21Hepatic traumaHepatic trauma-Treatment ExplorationExploration for patients with active bleeding or a major for patients with active bleeding or a major injuryinjury Techniques include:1.Drainage for wounds without hemorr
15、hage2.Suture for bleeding vessels3.Massive injury may require lobectomy4.Subcapsular hematomas requie thoroughly exploration.5.Temporary clamping the inflow vessels in the hilum helps ligating bleeding vessels.6.Ancillary bypass,packing or absorbable gauze mesh may help in some cases.肝脏疾病本科彭涛22Hepat
16、ic traumaHepatic trauma-Complications and prognosis 1.Rebleeding2.Subhepatic sepsis3.Hemobilia-selective angiography and embolization4.Stress ulcersH2 receptor antagonists(Cimetidine,Ranitidine,Omeprazole etc)5.Mortalitydepends on the type and severity of injuries.肝脏疾病本科彭涛23肝脏肿瘤的分类肝脏肿瘤的分类 良性肿瘤：肝腺瘤，肝
17、血管瘤良性肿瘤：肝腺瘤，肝血管瘤 原发性肝癌原发性肝癌 恶性肿瘤：恶性肿瘤：继发性肝癌：转移性继发性肝癌：转移性肝脏疾病本科彭涛24Primary Liver Cancer 肝脏疾病本科彭涛组织病理类型:肝细胞癌肝细胞癌：Hepatocellular carcinoma(HCC);约约91%91%；胆管细胞癌胆管细胞癌：Cholangiocellular carcinoma(cholangiocarcinoma);7%8%7%8%；混合细胞型肝癌混合细胞型肝癌：Mixed form(hepatocholangioma).1%2%1%2%肝脏疾病本科彭涛26ICC即使病理诊断也要小心谨慎肝脏疾病
18、本科彭涛27背景背景（肝细胞癌，肝细胞癌，HCCHCC）1.西方国家少见,有地理分布特异性（非洲撒哈拉地区、东南亚、日本、太平洋岛国、希腊、意大利）2.曾被认为是“癌肿之王”、“不可治愈”3.临床症状隐匿，发现多已晚期4.近2030年诊断和治疗获得了长足的进步5.根治性切除后5-yrs存活率 3070%.肝脏疾病本科彭涛28背景背景-病因一览病因一览1.病毒性肝炎病毒性肝炎(HBV,HCV et al.)2.真菌毒素真菌毒素(黄曲霉毒素aflatoxins)3.饮水污染饮水污染(池塘或沟渠水)4.Other causes1)遗传遗传2)酗酒酗酒3)Alpha-antitrypsin defic
19、iency4)Hemochromatosis5)Plant alkaloid6)Oral contraceptives7)Androgens8)Vinyl chloride9)Trace elements(?):Cu,Zn,Ni and Co10)Parasites:Clonorchis sinensis 肝脏疾病本科彭涛2920/100,00040/100,000NPCHCC肝脏疾病本科彭涛30中国是中国是HCCHCC高发地区高发地区Global Cancer Statistics,2002.CA Cancer J Clin 2005;55;74-108n20022002年全球新发年全球新发
20、病例病例 626,162626,162n中国病例占中国病例占5555，约约344,000344,000n男性高发于女性男性高发于女性 (2.67:1)(2.67:1)肝脏疾病本科彭涛31背景背景 中国流行病学中国流行病学1.1995 全国肿瘤普查1)死亡率 20.40/100,0002)29.07/100 000(男)11.23/100,000(女)2.自1990s,NO 2.肿瘤杀手(城市次于肺癌，农村次于胃癌；15 34岁国人的头号肿瘤杀手）3.中国的地理分布特征：东南沿海4.高发区(30/100 000)：广西扶绥、江苏启东、浙江舟山、福建同安 肝脏疾病本科彭涛32病理要点病理要点 大体
21、病理类型:1.巨块型:2.结节型:3.弥漫型:分化程度:包膜：（+）预后相对较好(Fibrolamellar hepatoma)转移:1.淋巴结(hilar,celiac)2.肺3.腹腔4.门静脉、肝静脉 肝脏疾病本科彭涛33早期肝癌早期肝癌是指没有临床症状和体征的肝癌，是指没有临床症状和体征的肝癌，亦即亚临床肝癌。亦即亚临床肝癌。微小肝癌微小肝癌：2.0cm2.0cm小肝癌小肝癌：2.0cm 2.0cm 5.0cm 5.0cm大肝癌大肝癌：5.0cm 5.0cm 10.0cm10.0cm肝脏疾病本科彭涛34Hepatocellular carcinoma,liver,grossHepatoc
22、ellular carcinoma,liver,grossA 2.0 cm HCC arising in a chronic viral hepatitis;the tumor,which had a predominant acinar architecture,produced abundant bile.肝脏疾病本科彭涛35Hepatocellular carcinoma,liver,grossHepatocellular carcinoma,liver,grossNodule of hepatocellular carcinoma in chronic hepatitis C;the
23、pale golden yellow color is common.肝脏疾病本科彭涛36Hepatocellular carcinoma,liver,gross Hepatocellular carcinoma,liver,gross The neoplasm is large and bulky and has a greenish cast because it contains bile.To the right of the main mass are smaller satellite nodules.The satellite nodules of this hepatocell
24、ular carcinoma represent either intrahepatic spread of the tumor or multicentric origin of the tumor.肝脏疾病本科彭涛37Hepatocellular carcinoma,liver,grossHepatocellular carcinoma,liver,grossAnother hepatocellular carcinoma with a greenish yellow hue.Such masses may also focally obstruct the biliary tract a
25、nd lead to an elevated alkaline phosphatase 肝脏疾病本科彭涛38HCC(fibrolamellar carcinoma),grossHCC(fibrolamellar carcinoma),grossWell demarcated fibrolamellar carcinoma with central scar;the surrounding liver is normal.Coarselamellarfibrosisischaracteristichistologically;notethepalebodyinthelargeeosinophil
26、icmalignanthepatocyte(X40).肝脏疾病本科彭涛39Hepatocellular carcinoma,liver,Hepatocellular carcinoma,liver,microscopic microscopic The malignant cells of this HCC(seen mostly on the right)are well differentiated and interdigitate with normal,larger hepatocytes(seen mostly at the left)ThisHCCiscomposedoflive
27、rcordsthataremuchwiderthanthenormalliverplatethatistwocellsthick.Thereisnodiscernablenormallobulararchitecture,thoughvascularstructuresarepresent.肝脏疾病本科彭涛40临床表现临床表现 症状、体征症状、体征n早期无明显症状：早期无明显症状：即亚临床肝癌（无症状和体征）n肝区疼痛肝区疼痛：常见的首发症状，持续性钝痛、刺痛、胀痛；可伴牵涉痛n肝肿大肝肿大：中、晚期肝癌常见n消化道症状：消化道症状：腹胀、食欲减退、恶心呕吐、腹泻、出血n全身症状：全身症状：乏
28、力、消瘦、低热n晚期肝癌症状：晚期肝癌症状：贫血、黄疸、腹水、浮肿、恶液质n癌肿转移部位的相应症状：癌肿转移部位的相应症状：肺、骨、脑n伴癌综合症伴癌综合症：低血糖症、红细胞增多症、女性男性化 肝脏疾病本科彭涛41临床表现临床表现 实验室检查实验室检查Serum bilirubin:nonspecificAlkaline phosphatase:nonspecificHBsAg,HCV-Ab:nonspecificAFPAFP (甲胎蛋白):1.7080%HCCs升高;2.假阳性 见于慢活肝、急性肝炎、生殖腺肿瘤、妊娠.3.术后复发监测(半衰期约67天).4.正常上限 20ng/ml;200n
29、g/ml 拟诊 HCC.肝脏疾病本科彭涛42临床表现临床表现 影像学影像学要点：要点：大小、数量、位置、毗邻、门静脉癌栓、肝硬化、门静脉高压X线：肝影增大、膈肌升高、胃横结肠受压超声：适于筛查；分辨率2cmCT(平扫+增强)：分辨率 12cm；有助于鉴别血管瘤MRI：分辨率 12cm；有助于鉴别血管瘤.选择性腹腔动脉或肝动脉造影：分辨率 12cm1.HCC较相邻肝实质血管丰富2.胆管细胞癌相对乏血供3.血管瘤有特征性的血管池动态影像4.静脉期可显示门静脉占位5.CT碘油造影可显示微小HCC.肝脏疾病本科彭涛43HCC-Imaging HCC-Imaging findingsfindings(D
30、SA)(DSA)肝脏疾病本科彭涛44HCC-Imaging findingsHCC-Imaging findings介入前n介入后肝脏疾病本科彭涛45HCC-Imaging findingsCT scan Arterialphase Portalveinphase肝脏疾病本科彭涛46肝癌MRI表现肝脏疾病本科彭涛47活检&筛查肝活检肝活检:经皮细针细针肝肝穿刺活检穿刺活检(出血？针道种植？)筛查筛查:US+AFP 高危人群筛查可发现早期 HCC，提高治疗效果 肝脏疾病本科彭涛48HCC is amenable to biopsy by percutaneous needle HCC is am
31、enable to biopsy by percutaneous needle biopsybiopsyThe architectural distortion due to cirrhosis is evident;at one end the tissue appears quite fragmented(X8).ThepresenceofmacrotrabeculararchitectureinthisfragmentedareaallowedforestablishingthediagnosisofHCC(X40).肝脏疾病本科彭涛49原发性肝癌的诊断原发性肝癌的诊断1.高危人群:男性
32、,40yrs,HBV/HCV(+),酗酒,肝硬化,家族史2.症状&体征:3.甲胎蛋白:RI-AFP400ng/ml,8weeks,exclusion of pregnancy,active hepatitis,embryonic tumors4.影像学:B-US,CT,MRI,DSA5.活检:肝脏疾病本科彭涛50原发性肝癌的鉴别诊断原发性肝癌的鉴别诊断继发性肝癌继发性肝癌：寻找原发灶；：寻找原发灶；肝硬化肝硬化：肝局限性增生结节；：肝局限性增生结节；肝的良性肿瘤肝的良性肿瘤：最常见的是肝海绵状血管瘤；：最常见的是肝海绵状血管瘤；肝非肿瘤性良性占位肝非肿瘤性良性占位：肝脓肿、肝囊肿：肝脓肿、肝囊
33、肿肝毗邻器官肿瘤肝毗邻器官肿瘤：胃癌、结肠癌、肾癌、胰腺癌。：胃癌、结肠癌、肾癌、胰腺癌。肝脏疾病本科彭涛51极早期极早期(0)PS 0,CPA早期早期(A)PS 0,CPA-B中期中期(B)PS 0,CPA-B晚期晚期(C)PS 1-2,CPA-B终末期终末期(D)PS 2,CPCHCC随机对照试验（随机对照试验（50%）中位生存时间中位生存时间11-20月月 对症对症(20%)生存期生存期3月月HCCHCC BCLC staging and treatmentBCLC staging and treatmentSem Liv Dis 1999 to J Hepatol 2008;48:S2
34、0-S37治愈性治疗（治愈性治疗（3030）5 5年生存率年生存率40%-70%40%-70%肝移植肝移植RF/PEI切除术切除术伴随疾病伴随疾病有有无无3 个结节个结节,3cm上升上升正常正常单发结节单发结节,50yrs2.并存肝硬化3.血管侵犯4.门静脉癌栓5.位置深在6.包膜侵犯7.跨肝叶播散 8.多结节 肝脏疾病本科彭涛55治疗治疗 部分肝切除部分肝切除 预后预后:1.5yrs 复发率70%,单中心或多中心起源.2.US+AFP 随访可早期发现复发灶，再次手术可使部分病人获益.3.中国：总体5年生存率30%;早期HCC 5年生存率60%*4.许多病人死于肝硬化而非肿瘤复发（肝功能衰竭、
35、出血）.*中华医学杂志中华医学杂志,2003,83(12):1053-7.肝脏疾病本科彭涛56治疗治疗 肝脏移植肝脏移植优点:1.适用于巨大或多结节肝癌2.适用于肝硬化病人3.适用于肝炎病毒感染者4.可保证肝硬化患者的术后生活质量对早期HCCs,肝移植与肝切除生存率相仿 肝脏疾病本科彭涛57治疗治疗 辅助治疗辅助治疗经皮消融治疗：Percutaneous ethanol injection(PEI)or radiofrequency ablation(RFA):物理或化学方法造成HCC坏死。适用于周边男性(6:1).（雌激素）3.绝大多数无症状，偶然发现 4.(4cm)可能出现腹痛或包块；自发
36、性出血罕见 5.核素显像,CE-CT,MRI,血管造影有典型的影像学特点：“早出晚归”6.疑诊血管瘤禁忌穿刺活检 7.有症状、5cm、婴幼儿病例可以考虑结扎、肝叶切除、栓塞、放疗等措施 8.避免服用口服避孕药肝脏疾病本科彭涛74HemangiomasMultiple cavernous hemangiomas in a young woman with episodic abdominal pain;white tissue in the largest lesion represents fibrosis indicating some degree of involution.Thehon
37、eycombappearanceandvascularnatureofthisgiantcavernoushemangiomaarereadilyapparentfromthecapsularsurface.肝脏疾病本科彭涛75HemangiomasSequentialchangesduringangiograpgy:avascularlesionwithdelayedclearingofthecontrastmedium.肝脏疾病本科彭涛76HemangiomasHemangioma showing characteristic sharp demarcation from the surr
38、ounding liver and spongy texture.The cut surface of this hemangioma varies from honeycomb to spongy to fibrotic(photograph courtesy of S.Goetz,M.D.).肝脏疾病本科彭涛77肝囊肿 肝脏疾病本科彭涛肝囊肿1.通常单发、无症状2.牧区旅居史者需与肝包虫病鉴别3.多囊肝病常合并多囊肾病（常染色体显性遗传病）4.临床表现:上腹不适、包块、梗阻性黄疸5.有症状者：开腹或腔镜下囊壁切除或去顶减压 肝脏疾病本科彭涛79Hepatic cystsHepatic cy
39、stsMultiple cysts are visible on cut surface of liver;the cyst walls are thin,translucent,and grey.This is from a case with polycystic disease;note the small green bile duct hamartomas in the surrounding liver.Polycystic liver and kidney diseaseat autopsy;the liver was completely normal functionally
40、(photograph courtesy of Chris Reuter,M.D.).肝脏疾病本科彭涛80Hepatic cysts-imagingfindingsHepaticcystswithintra-abdominalhydrops肝脏疾病本科彭涛81The wall of this simple cyst is composed of a thin layer of fibrous connective tissue;the surrounding liver is unremarkable(X10).Hepatic cystsHepatic cysts肝脏疾病本科彭涛82肝脏腺瘤
41、肝脏疾病本科彭涛肝脏腺瘤1.口服避孕药是危险因素2.绝大多数是女性；半数无症状3.症状&体征:右上腹痛、自发性瘤内出血（伴随月经）、包块4.实验室:肝功能、AFP 正常5.影像学:US,CT-局部占位;angiography-乏血供富血供;biopsy 有助于诊断但有风险6.治疗:难以绝对除外恶性，切除几乎是唯一选择.7.避免服用口服避孕药.肝脏疾病本科彭涛84Liver adenoma肝脏疾病本科彭涛85Hepatic adenomaAt the upper right is a well-circumscribed neoplasm that is arising in liver.Thi
42、s is an hepatic adenoma.Thecutsurfaceoftheliverrevealsthehepaticadenoma.Notehowwellcircumscribeditis.Theremainingliverisapaleyellowbrownbecauseoffattychangefromchronicalcoholism.肝脏疾病本科彭涛86Sharply demarcated hepatic adenoma,which is somewhat paler than the surrounding liver;there is an area of fresh
43、hemorrhage,as well as some fibrosis from earlier episode of hemorrhage.Hepatic adenomaHepaticadenomascanbecomesolargeastobelife-threatening.Thisestrogenrelatedadenoma,benignhistologically,replacedmuchoftheliver,leadingtothepatientsdemise.肝脏疾病本科彭涛87HepaticadenomaNormallivertissuewithaportaltractissee
44、nontheleft.Thehepaticadenomaisontherightandiscomposedofcellsthatcloselyresemblenormalhepatocytes,buttheneoplasticlivertissueisdisorganizedhepatocytecordsanddoesnotcontainanormallobulararchitecture.Thehemorrhagicarearepresentsthepeliosislikechangecommonlyseeninestrogenrelatedadenomas(X3.3).肝脏疾病本科彭涛88
45、局灶性结节性增生Focal nodular hyperplasia(FNH)肝脏疾病本科彭涛局灶性结节性增生1.良性病变；女性多于男性2.口服避孕药是危险因素.3.大多数病人无症状：右上腹包块或不适；生长缓慢，出血罕见.4.肝功能、AFP 正常.5.CT：星芒状的斑痕；动脉相富血供.6.治疗:难以绝对除外恶性，切除几乎是唯一选择.7.避免服用口服避孕药.肝脏疾病本科彭涛90Focal nodular hyperplasiaAclassicfocalnodularhyperplasia,palerthanthesurroundingliver,andwithadistinctcentralste
46、llatescar.Thebandsoffibrosisimpartanappearancemimickingthatofmacronodularcirrhosis(Klatskin,X5).肝脏疾病本科彭涛91肝脓肿肝脓肿Hepatic Abscess 肝脏疾病本科彭涛肝脓肿肝脓肿病原菌：细菌、寄生虫、真菌原发灶：腹腔内或隐匿性感染灶胆道门静脉肝动脉淋巴引流肝脏疾病本科彭涛93肝脓肿-症状&体征 一般情况差（不适、疲乏）、寒战、弛张热、黄疸 右上腹痛、右肩牵涉痛、肝肿大、触痛、胸膜渗出肝脏疾病本科彭涛94肝脓肿-实验室检查1.白细胞升高见于绝大多数病例2.贫血、Hematocrit3.Bil
47、irubin,ALP 肝脏疾病本科彭涛95肝脓肿-影像学1.平片(右胸):基底段不张、胸膜渗出、右膈上抬、运动度2.平片(腹):肝肿大、气液平面、胃形态改变3.US,CT scans:提供病灶位置、大小、数目的准确信息肝脏疾病本科彭涛96A case Hepatic Abscess from A case Hepatic Abscess from Streptococcis MilleriStreptococcis Milleri A 58-year-old male complained about rash over the legs and lower back,arthralgias
48、and soaking night sweats which had started about one week before his clinic visit.An ultrasound examination demonstrated multiple hypoechoic lesions in the liver measuring up to 4.3x3.3 cm with increased blood flow to the periphery.On contrast-enhanced CT scan,these lesions appeared hypodense.(Klaus
49、 Bielefeldt,et al.)肝脏疾病本科彭涛97肝脓肿 鉴别诊断 其他引起不适、消瘦、贫血、发热的疾病 阿米巴肝脓肿（Amebic abscess）:1.流行区旅居史A history to endemic area 2.单发Solitary abscess 3.疼痛、触痛、腹泻、肝肿大、血清学 amebiasis(+).细菌性肝脓肿（Pyogenic abscess）:1.常见于老年患者 2.黄疸、搔痒、脓毒血症、包块、bilirubin,ALP 肝脏疾病本科彭涛98肝脓肿 并发症 1.肝内播散（多发脓肿）2.破裂（胸腔、腹腔）3.败血症,感染中毒性休克4.肝功能衰竭5.胆道出血 肝脏疾病本科彭涛99肝脓肿 治疗 1.抗生素：usually aminoglycoside,clindamycin or metronidazole and ampicilin,应覆盖E Coli,K pneumoniae,Bacteroides,enterococcus,and anaerobic streptococci,and be modified according to cultures.2.US or CT引导下经皮穿刺置管引流适用于大多数病例3.部分病人需要开腹引流或肝叶切除 肝脏疾病本科彭涛100Thank You！肝脏疾病本科彭涛
