外科手术基本操作技术.ppt

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1、College of Animal Science and Veterinary MedicineCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University外科手术基本操作技术 Still waters run deep.流静水深流静水深,人静心深人静心深 Where there is life,there is hope。有生命必有希望。有生命必有希望College of Animal Science and Veterina

2、ry MedicineCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University第二节显露第二节显露 指指手手术术视视野野的的暴暴露露要要清清楚楚。切切开开组组织织，打打开开手手术术通通路路是是显显露露的的主主要要内内容容。既既要要有有利利于于显显露露术术野野，又又不不能能造造成成过过多多的的组组织损伤。织损伤。Copyright All reserved,MA WM PhDCollege of Animal Science a

3、nd Veterinary MedicineCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural UniversityP麻醉方法麻醉方法P保定体位保定体位P照明条件照明条件P辅助器械辅助器械P止血措施止血措施一、充分显露手术视野的影响因素一、充分显露手术视野的影响因素Copyright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege o

4、f Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University二、切口的部位、大小、方向二、切口的部位、大小、方向 切口下最好能直接暴露或接近病变部切口下最好能直接暴露或接近病变部 位，必要时便于延长扩大切口。位，必要时便于延长扩大切口。切口部位尽可能避开大血管、神经和切口部位尽可能避开大血管、神经和 腺体的输出管。腺体的输出管。切口应有利于创液、脓汁等排出。切口应有利于创液、脓汁等排出。二次手术时，应避免在瘢痕上切开二次手术时，应避免在瘢痕上切开。

5、Copyright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University切切口口的的大大小小、形形状状、方方向向除除考考虑虑到到便便于于主主手手术术操操作作外外，还还应应考考虑虑到到术术创创愈愈合合的的牢牢固固，不不影影响响局局部部的的生生理理功功能能或或动动物物的的容容貌貌，并并在

6、在此此前前提提下下，尽尽可可能能选选择择组组织织结结构构简简单单、有有利利于于少少损损伤伤无无关关组组织织的部位做切口。的部位做切口。Copyright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University三、注意事项三、注意事项按解剖层次分层切开组织，并注意保按解剖层次分层切开组织

7、，并注意保 持切口从外到内的大小相同。持切口从外到内的大小相同。力求一次切开组织，必要时可补充用力求一次切开组织，必要时可补充用 刀，不可反复多次在同一平面上切割刀，不可反复多次在同一平面上切割切开腹膜、胸膜时，防止内脏损伤。切开腹膜、胸膜时，防止内脏损伤。避免损伤大血管、神经、腺体分泌管避免损伤大血管、神经、腺体分泌管 Copyright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege of Animal Science and Veterinary MedicineShandong

8、 Agricultural UniversityShandong Agricultural University第三节第三节 组织切开和分离组织切开和分离 一、方法一、方法1.锐性锐性切开切开 用用刀刀或或剪剪对对组组织织进进行行准准确确、精精细细的的切切割割。必必须须熟熟悉悉解解剖剖，在直视条件下进行。在直视条件下进行。Copyright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege of Animal Science and Veterinary MedicineShandong

9、 Agricultural UniversityShandong Agricultural University2.2.钝钝性性分分离离 用用刀刀柄柄、止止血血钳钳或或手手指指等等进进行行。适适于于正正常常肌肌肉肉、筋筋膜膜和和良良性性肿肿瘤瘤等等的的分分离离。钝钝性性分分离离时时，组组织织损损伤伤较较重重，往往往往残残留留许许多多失失去去活活性性的的组组织织细胞，术后组织反应较重，愈合较慢。细胞，术后组织反应较重，愈合较慢。Copyright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineColl

10、ege of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University（一）皮肤切开法（一）皮肤切开法1.紧张切开紧张切开 两掌紧张、指指紧张两掌紧张、指指紧张 2.皱皱壁壁切切开开 切切口口下下有有大大血血管管、神神经经、分分泌泌管管和和重重要要器器官官，而而皮皮下下组组织织甚甚为疏松时适用。为疏松时适用。二、种类二、种类Copyright All reserved,MA WM PhDCollege of Animal Science and V

11、eterinary MedicineCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University术者指指紧张，锐性切开牛腹壁皮肤术者指指紧张，锐性切开牛腹壁皮肤视频033 Copyright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege of Animal Science and Veterinary MedicineS

12、handong Agricultural UniversityShandong Agricultural University躺卧保定时的皮肤切口躺卧保定时的皮肤切口Copyright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University皱壁切开牛脐疝皱壁切开牛脐疝视频034 Cop

13、yright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University 食管阻塞时颈部皮肤皱壁切开食管阻塞时颈部皮肤皱壁切开Copyright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineC

14、ollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University3.皮肤切口的形状皮肤切口的形状梭形切口梭形切口 用于切除如肿瘤、瘘管、放用于切除如肿瘤、瘘管、放线菌病灶、过多皮肤等。线菌病灶、过多皮肤等。“丅丅”和和“十十”字形切口字形切口 需暴露深需暴露深部组织和摘除时使用。部组织和摘除时使用。“”“”切口切口 最常用的直线形切口最常用的直线形切口“U”“U”和和“”字形切口字形切口 脑部和副鼻脑部和副鼻窦圆锯术时使用。窦圆锯术时使

15、用。Copyright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University1.皮下疏松结缔组织的分离皮下疏松结缔组织的分离 皮皮下下结结缔缔组组织织内内分分布布有有许许多多小小血血管管，故故多多用用钝钝性性分分离离。中中小小动动物物常常与与皮皮肤肤一一次次切切开开，然后止血。然后止

16、血。（二）皮下组织及其他组织的分离（二）皮下组织及其他组织的分离Copyright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University2.筋膜和腱膜的分离筋膜和腱膜的分离 用用刀刀在在其其中中央央作作一一小小切切口口，然然后后用用弯弯止止血血钳钳在在此此切切口口上上、下下将将筋筋膜

17、膜下下组组织织与与筋膜分开，沿分开线剪开筋膜。筋膜分开，沿分开线剪开筋膜。筋膜的切口应与皮肤切口等长。筋膜的切口应与皮肤切口等长。若若筋筋膜膜下下有有神神经经血血管管，则则用用手手术术镊镊将将筋筋膜膜提提起起，用用反反挑挑式式执执刀刀法法作作一一小小孔孔，插入有沟探针，沿针沟外向切开。插入有沟探针，沿针沟外向切开。Copyright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege of Animal Science and Veterinary MedicineShandong Agr

18、icultural UniversityShandong Agricultural University切开腹直肌，暴露腹黄筋膜切开腹直肌，暴露腹黄筋膜Copyright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University切开腹黄筋膜，切口应与张力线平行切开腹黄筋膜，切口应与张力线

19、平行Copyright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University 3.肌肉的分离肌肉的分离 一般是沿肌纤维方向作钝性分离。一般是沿肌纤维方向作钝性分离。必要时可作锐性切开，最好顺肌纤维必要时可作锐性切开，最好顺肌纤维方向，不得已时，也可横短肌纤维。方向，不得已时，也可横短

20、肌纤维。方法是顺肌纤维方向用刀柄、止血钳方法是顺肌纤维方向用刀柄、止血钳或手指剥离，扩大到所需要的长度。或手指剥离，扩大到所需要的长度。Copyright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University用刀柄对羊腹壁肌肉做钝性分离用刀柄对羊腹壁肌肉做钝性分离Copyright

21、All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University用手指对牛腹壁肌肉做钝性分离用手指对牛腹壁肌肉做钝性分离Copyright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege

22、 of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University羊腹壁肌肉的锐性切开羊腹壁肌肉的锐性切开Copyright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agr

23、icultural University4.腹膜的分离腹膜的分离切开腹壁，暴露腹膜切开腹壁，暴露腹膜Copyright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University用用止止血血钳钳和和镊镊子子分分两两次次将将腹腹膜膜提提起起，用用剪刀剪开一小孔。剪刀剪开一小孔。将将镊镊子子或

24、或有有沟沟探探针针插插入入腹腹膜膜与与内内脏脏之之间间，用用剪剪刀刀或或手手术术刀刀（反反挑挑式式）切切开腹膜。开腹膜。止血钳止血钳止血钳止血钳镊子镊子镊子镊子钝头手术剪钝头手术剪钝头手术剪钝头手术剪Copyright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University用手指将腹膜

25、与内脏隔离后剪开用手指将腹膜与内脏隔离后剪开Copyright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University 肠肠管管侧侧壁壁切切开开时时，一一般般于于肠肠管管纵纵带带上上纵纵行行切切开开，并并应应避避免免损损伤伤对对侧肠管。侧肠管。5.肠管的切开肠管的切开Copyright

26、 All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University牛肠梗阻牛肠梗阻肠管切开肠管切开Copyright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege of Animal

27、Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University6.索状组织的分离索状组织的分离 索索状状组组织织(如如精精索索)的的分分割割，除除应应用用手手术术刀刀(剪剪)作作锐锐性性切切割割外外，尚尚可可用用刮刮断断、拧拧断断等等方方法，以减少出血。法，以减少出血。Copyright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege of Animal Sc

28、ience and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University二、二、骨组织的分割骨组织的分割 首先应分离骨膜，尽可能完善地保首先应分离骨膜，尽可能完善地保存健康部分；然后再分离骨组织存健康部分；然后再分离骨组织 分离骨组织常用的器械有圆锯、线分离骨组织常用的器械有圆锯、线锯、骨钻、骨凿、骨钳、骨剪、骨锯、骨钻、骨凿、骨钳、骨剪、骨匙及骨膜剥离器等。匙及骨膜剥离器等。Copyright All reserved,MA WM PhDCollege of Animal Sci

29、ence and Veterinary MedicineCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural UniversityA.“工工”字形切开肋骨骨字形切开肋骨骨膜膜B.骨膜剥离器剥离骨膜骨膜剥离器剥离骨膜C.骨剪剪短肋骨骨剪剪短肋骨ABCCopyright All reserved,MA WM PhDCollege of Animal Science and Veterinary MedicineCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityShandong Agricultural University三、蹄和角质的分离三、蹄和角质的分离 属于硬组织的分离。属于硬组织的分离。蹄角质可用蹄刀、蹄刮挖除。蹄角质可用蹄刀、蹄刮挖除。浸软的蹄壁可用柳叶刀切开。浸软的蹄壁可用柳叶刀切开。闭合蹄壁上的裂口可用骨钻、锔闭合蹄壁上的裂口可用骨钻、锔 子钳和锔子。子钳和锔子。截断牛羊角时可用骨锯或断角器截断牛羊角时可用骨锯或断角器 Copyright All reserved,MA WM PhD