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Jingdong book

胸外科手册

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Books Medical Science Surgery
Jingdong book

胸外科手册

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《胸外科手册》重点介绍了胸外科常见病、多发病的诊断与治疗，内容包括胸外科疾病的常见症状及胸壁、气管、肺、食管、纵隔各部位重要疾病的诊断及治疗操作技术、术前准备及术后处理、胸部创伤的常规处理，此外，对肺移植术及电视胸腔镜手术亦作了介绍。
《胸外科手册》内容简洁、编排合理、查阅方便，具有很强的实用性及指导性，适合于胸外科医师及研究生参考使用。
Catalogue

第一章 症状学
第一节 咳嗽与咳痰
第二节 咯血
第三节 胸痛
第四节 胸膜腔积液
第五节 呼吸困难
第六节 咽下困难

第二章 肺部疾病
第一节 肺大疱
第二节 支气管扩张的外科治疗
第三节 肺结核的外科治疗
第四节 肺包虫病
第五节 肺肿瘤

第三章 食管疾病
第一节 食管的解剖
第二节 先天性食管闭锁及食管气管瘘
第三节 贲门失弛缓症
第四节 食管穿孔及破裂
第五节 损伤性食管狭窄
第六节 食管憩室
第七节 食管裂孔疝
第八节 食管良性肿瘤
第九节 食管癌

第四章 纵隔疾病
第一节 纵隔的解剖
第二节 原发性纵隔肿瘤
第三节 纵隔炎
第四节 纵隔气肿
第五节 纵隔疝
第六节 纵隔淋巴结核与结节 病

第五章 胸部创伤
第一节 胸部创伤概述
第二节 胸壁损伤
第三节 创伤性气胸及血胸
第四节 胸腹联合伤
第五节 肺实质损伤
第六节 气管及支气管损伤
第七节 食管损伤
第八节 膈肌损伤
第九节 心脏损伤
第十节 创伤性胸主动脉破裂
第十一节 其他胸部损伤
第十二节 胸部创伤后肺部并发症的防治

第六章 胸壁胸膜疾病
第一节 先天性胸壁畸形
第二节 非特异性肋软骨炎
第三节 胸壁结核
第四节 胸壁肿瘤
第五节 脓胸
第六节 胸膜肿瘤
第七节 胸壁手术后并发症

第七章 胸外科的腔镜技术
第一节 电视胸腔镜
第二节 纵隔镜

第八章 胸外科并发症
第一节 循环系统监测和并发症处理
第二节 肺切除术后并发症
第三节 食管手术并发症

第九章 胸外科常规操作
第一节 胸腔穿刺术
第二节 胸腔闭式引流术
第三节 纤维支气管镜检查
第四节 经皮肺活检术

第十章 肺移植
第一节 肺移植的适应证和禁忌证
第二节 肺移植受、供体的选择
第三节 移植肺的摘取与保存
第四节 肺移植手术技术选择
第五节 肺移植管理
第六节 肺移植术后并发症
第七节 肺移植的现状与展望
Book Abstract

第一章 症状学
第三节 胸痛
二、临床表现
1. 既往病史 有无呼吸系统疾病、心血管系统疾病、消化系统疾病、血液系统疾病、肿瘤及神经精神系统疾病等病史，有无外伤、手术或中毒等，了解疼痛经过及演变，所用药物及治疗反应等。
2. 发病年龄 老年人胸痛，应考虑心绞痛、心肌梗死等；青壮年胸痛，应考虑胸膜炎、自发性气胸、风湿性心脏病、心肌病、肿瘤等。
3. 胸痛的性质 带状疱疹呈阵发性刀割样痛、灼痛或触电样痛；心绞痛伴压榨、紧缩及窒息感；心肌梗死则为剧痛伴濒死感；肺癌早期为隐痛或闷痛，后期疼痛难忍。
4. 胸痛的部位 胸壁的病变常有局部体征（如红、肿、热、明显压痛等）；心绞痛常在胸骨后或心前区，且可放射到左肩及左上臂内侧；胸膜炎引起的胸痛则在病侧下部或前部；膈肌病变的胸壁常在肋缘及斜方肌处；神经官能症的胸痛部位不固定，可随时变化。
5. 胸痛的时间和诱因 胸膜炎的疼痛发生于咳嗽及深呼吸时，停止咳嗽及呼吸，则疼痛减弱或消失；心绞痛常为劳累后或兴奋过度时发作或加重，持续数分钟，休息后和含硝酸甘油司缓解；食管病变于吞食后发生或加重；食管裂孔疝为餐后胸骨后钝痛，过饱后用力或俯身时加重，直立或坐位可减轻；脊神经根疼痛发生于体位改变时。
6. 伴随症状 伴有发热者多提示肺炎；气管-支气管疾病伴有咳嗽、咳痰等；肺癌、肺梗死常伴有咯血；伴有出汗、虚脱、恐惧感、呼吸困难、血压下降或休克表现时，多提示心肌梗死、夹层动脉瘤、主动脉窦瘤破裂或大面积肺栓塞等；食管疾病常有吞咽困难及食物反流；伴明显呼吸困难多提示病变范围较大，如气胸、大叶性肺炎、渗出性胸膜炎等。
7. 实验室检查 白细胞总数增加和（或）中性粒细胞比例增高提示感染性病灶或合并感染，血红蛋白明显降低，则应考虑与贫血相关的疾病。心肌酶谱检查有助于诊断心肌病变。痰微生物学及细胞学检查，可确定感染性疾病的病因（包括结核病）和排除肺肿瘤。
8. 其他检查 胸片常可提示多种呼吸系统疾病（如肺炎、支气管肺炎、肺肿瘤、肺心病、气胸、胸腔积液等）、纵隔疾病以及部分心血管疾病（如风心病、心肌病、动脉瘤、心包疾病等）。必要时行CT或磁共振检查以明确病变部位、性质和范围等。对疑有支气管和肺部疾病者，可考虑行纤支镜检查，或经纤支镜造影或肺活检明确诊断。疑为消化道疾病可行纤维胃镜检查。对周围性肺疾病或胸膜疾病可经皮穿刺活检以获得病理诊断。ECG及超声心动图检查有助于确定是否为心血管疾病引起的胸痛，必要时可行心导管检查等。腹部CT有助于肝、脾、胆疾病及膈下病变的诊断。

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