外科專科醫師 - 劉庭軒

Blunt Trauma P.E.:較無診斷效果 Stable FAST 胸腹部X光 胸部or胸腹區：胸腔鏡or腹腔鏡(非第一線工具)=>穩定的鈍傷病人 Unstable 1.Diagnostic Peritonial Lavage, DPL：Positive=>轉外科 Negative=>CT double check Criteria：＞10ml blood or ＞10萬RBC or ＞500WBC or Food particle or Gram+ or billirubin+ 2.剖腹探查 FAST(實質器官) DPL(中空器官-首選) CT(實質器官-首選 + 後腹腔-首選 + 中空器官) Penatrating Trauma P.E.:較有準確 Stable 胸部or胸腹區：胸腔鏡or腹腔鏡=>穿刺傷病人 腹部：Local Wound Exploration局部傷口探查 腰背部：Triple Contrast CT KUB Unstable 剖腹探查 ----------------- FAST中空器官和後腹腔不能

本文內容： (1)整個內視鏡之診療 (2)上消化系統內視鏡 A 食道 B 胃 C ERCP (3)大腸鏡 (4)腹腔鏡 (5)小腸鏡 (6)內視鏡超音波EUS (7)出血Hemostasis (a)急性非曲張性出血Acute nonvariceal bleeding(潰瘍性) (b)肝門脈高壓性出血Portal hypertensive bleeding(高壓性) (8)消化道擴張和固定GI tract dilatation and stent insertion (9)Enteral Access (10)ERCP (11)Tumor resection --------------------------------------------------- 上消化系統內視鏡手術 UGI System Endoscopy 定義 Def ：從嘴巴＞食道＞胃＞十二指腸第二段(肝胰壺腹) by Harrison 食道Esophageal Varices GERD Esophageal Varices GERD Los Angeles Classification (1) Grade A, one or more mucosal breaks no longer than 5 mm, none of which extends between the tops of the mucosal folds; (2) Grade B, one or more mucosal breaks more than 5 mm long, none of which extends between the tops of two mucosal folds; (3) Grade C, mucosal breaks that extend between the tops of two or more mucosal folds, but are not circumferential; (4) Grade D, one or more circumferential mucosal breaks. Grade A 單個或多個長度 Grade B 單個或多個長...

Also named: keyhole surgery 中文名:內視鏡手術,微創手術 內視鏡手術在法國被視為二次革命，因為最早使用腹腔鏡手術的是法國的醫師Dr.Mouret，而他所進行的是膽囊切除術。

真正為了治療潰瘍而在腸胃上動手術是在1882年 Reference: eMedicine:Volvulus May 13, 2008 http://emedicine.medscape.com/article/932430-overview eMedicine:Intestinal Volvulus Sep 11, 2008 http://emedicine.medscape.com/article/930576-overview