第七章眼部手术主要内容眼睑内翻矫正术眼睑外翻矫课件

College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 第 七 章 眼 部 手 术 主 要 内 容 一、眼睑内翻矫正术 二、眼睑外翻矫正术 三、第三眼睑腺摘除和复位术 四、四、 Excision of Eyelid TumorsExcision of Eyelid Tumors 五、眼球摘出术 六、眼睑损伤的修复 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 第七章第七章 眼部手术眼部手术 一、眼睑内翻矫正术一、眼睑内翻矫正术 【适应症适应症】下眼睑内翻。下眼睑内翻。 【保定和麻醉保定和麻醉】俯卧保定，全身麻俯卧保定，全身麻 醉或浸润麻醉。醉或浸润麻醉。 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* BlepharospasmBlepharospasm InturningInturning ExcoriationExcoriation Purulent Purulent dischargedischarge Secondary uveitis and Secondary uveitis and hypopyon if lesion is hypopyon if lesion is severesevere College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* Severe conjunctivitisSevere conjunctivitis edemaedema ulcerationulcerationblepharospasmblepharospasm MiosisMiosis（especially if the especially if the cornea is ulceratedcornea is ulcerated） epiphoraepiphora College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* epiphoraepiphora Dermis hydratedDermis hydrated College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* inturninginturning College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 用用镊子镊子距睑缘距睑缘24mm24mm提起皮肤，并用直止血钳或弯提起皮肤，并用直止血钳或弯止血钳止血钳 将其夹住将其夹住 【术式术式】 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 钳夹长度与内翻睑缘相等，宽度依内翻程度而钳夹长度与内翻睑缘相等，宽度依内翻程度而 定定( (钳夹时眼睑应有一定程度的外翻钳夹时眼睑应有一定程度的外翻) )。 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 用力钳压皮肤或用持针钳钳压止血钳，使去除用力钳压皮肤或用持针钳钳压止血钳，使去除 止血钳后皮肤仍皱起止血钳后皮肤仍皱起 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 沿止血钳压痕将其剪除沿止血钳压痕将其剪除 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 皮肤切口呈月牙形或椭圆形皮肤切口呈月牙形或椭圆形 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 用用4 4号丝线结节缝合皮肤创缘。缝合要密，号丝线结节缝合皮肤创缘。缝合要密， 保持针距保持针距2mm2mm。 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 【术后护理术后护理】 患眼涂布或滴入抗生素眼膏或抗生患眼涂布或滴入抗生素眼膏或抗生 素眼药水，素眼药水，3434次次/d/d。 颈部安装颈圈，防止自我损伤病眼颈部安装颈圈，防止自我损伤病眼 。 术后术后1014d1014d拆线。拆线。 术后数日局部肿胀可逐渐减轻术后数日局部肿胀可逐渐减轻 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 二、二、眼睑外翻矫正术眼睑外翻矫正术 【适应症适应症】下眼睑外翻。下眼睑外翻。 【保定和麻醉保定和麻醉】俯卧保定，全麻或俯卧保定，全麻或 浸润麻醉浸润麻醉 【术式一术式一】 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* outturningoutturning College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* Outturned lidOutturned lid epiphoraepiphora Conjunctival Conjunctival congestion and congestion and inflammationinflammation College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 距睑外距睑外 翻下缘翻下缘 23mm23mm 处切一处切一 “ “V”V”形形 切口切口 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 从其尖端从其尖端 向上分离向上分离 皮瓣，用皮瓣，用 镊子将皮镊子将皮 瓣提起，瓣提起， 再用剪刀再用剪刀 钝性分离钝性分离 “V”V”形皮形皮 肤切口周肤切口周 围皮下组围皮下组 织织 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 从尖端从尖端 向上作向上作 “Y”Y” 形缝合形缝合 。边缝。边缝 合边向合边向 上移动上移动 皮瓣，皮瓣， 直至外直至外 翻矫正翻矫正 为止。为止。 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 矫矫 正正 后后 的的 下下 眼眼 睑睑 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 【术式二术式二】 The lid The lid margin margin is is marked marked laterallylaterally Modified procedureModified procedure College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* An estimate of the amount of margin to be removed is An estimate of the amount of margin to be removed is mademade，and the lid is marked.The ventral end of the and the lid is marked.The ventral end of the triangle is marked 10to14mm below.triangle is marked 10to14mm below. College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* The The first first incision incision is is made made with with straight straight Mayo Mayo scissorsscissors College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* The second incision is madeThe second incision is made College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* The triangular The triangular piece is piece is removed.removed. Note that the Note that the conjunctival conjunctival defect is defect is smallersmaller， justifying one justifying one layer of sutures layer of sutures in the skin in in the skin in some cases.some cases. College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* The wound sutured with 60 silk.The wound sutured with 60 silk. College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 【术后护理术后护理】 患眼涂布或滴入抗生素眼膏或抗生素患眼涂布或滴入抗生素眼膏或抗生素 眼药水，眼药水，3434次次/d/d。 颈部安装颈圈，防止自我损伤病眼颈部安装颈圈，防止自我损伤病眼 术后术后1014d1014d拆线。拆线。 术后数日内局部肿胀可逐渐减轻术后数日内局部肿胀可逐渐减轻 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 三、第三眼睑腺摘除和复位术三、第三眼睑腺摘除和复位术 【适应症适应症】第三眼睑腺脱出（樱桃眼）第三眼睑腺脱出（樱桃眼） 图3-1 北京犬第三眼睑腺脱出北京犬第三眼睑腺脱出 图图3-23-2 斗牛犬第三眼睑腺脱出斗牛犬第三眼睑腺脱出 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 【保定和麻醉保定和麻醉】侧卧或胸侧卧保定。全身麻醉，先侧卧或胸侧卧保定。全身麻醉，先 以以速眠新速眠新复合麻醉剂做复合麻醉剂做浅麻醉浅麻醉，再以加有青霉素，再以加有青霉素 液的注射用水液的注射用水( (每每l0mll0ml加青霉素加青霉素1010万万IUIU) )冲洗眼结冲洗眼结 膜膜，然后滴入加有肾上腺素的，然后滴入加有肾上腺素的局部麻醉剂局部麻醉剂。 图3-3 病犬健侧卧保定 图3-4 病犬健侧卧保定 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 【术式术式】 1. 1. 用生理盐水冲洗患眼，以消除眼内分泌物，用弯圆针用生理盐水冲洗患眼，以消除眼内分泌物，用弯圆针 系系4#4#丝线在脱出的第三眼睑腺体上穿系牵引线丝线在脱出的第三眼睑腺体上穿系牵引线 图3-5 在脱出物上系 牵引线，向外牵引， 显露根蒂缩细部 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* l l 2.2.轻轻牵引缝合线，显露腺体根蒂部，用止血钳轻轻牵引缝合线，显露腺体根蒂部，用止血钳 钳夹根蒂细缩部钳夹根蒂细缩部 （图（图3-63-6） l l 3.3.用手术刀紧贴止血钳切除腺体（图用手术刀紧贴止血钳切除腺体（图3-73-7） 图3-6 在缩细部钳夹止血钳 图3-7在止血钳背面切除脱出物 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 4. 4. 止血钳暂不松开，用烧烙法止血，其方法为：止血钳暂不松开，用烧烙法止血，其方法为： 将注射针头在酒精灯上烧红后，立即用针头将注射针头在酒精灯上烧红后，立即用针头 烧烙而使出血点止血。松开止血钳（图烧烙而使出血点止血。松开止血钳（图3-83-8） ，用，用3%3%氯霉素眼药水点入患眼结膜囊内，松氯霉素眼药水点入患眼结膜囊内，松 解保定。解保定。 图3-8 松解止血钳，手术完毕 【术后护理术后护理】术后术后3 3天内天内 应用应用3%3%氯霉素眼药水滴氯霉素眼药水滴 眼，每天眼，每天3 34 4次。手术次。手术 效果良好效果良好 。 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 四、四、Excision of Eyelid TumorsExcision of Eyelid Tumors Eyelid Eyelid tumors tumors are are common common in in the the dog.dog. The The tarsal tarsal gland gland adenoma adenoma is is the the most most frequently frequently diagnosed diagnosed eyelid eyelid tumor in the dog.tumor in the dog. Less commonly found areLess commonly found are adenocarcinomas,melanomas adenocarcinomas,melanomas and and papillomaspapillomas. . College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* The The tarsal tarsal gland gland adenoma, adenoma, as as with with most most tumors tumors of of the the canine canine eyelid,is eyelid,is clinically clinically benign,and benign,and surgical surgical excision is usually curative.excision is usually curative. Cryosurgery Cryosurgery using using 1iquid 1iquid nitrogen nitrogen at at -20-20 can can also also be be used used to to treat treat these these tumors.tumors. College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 【surgical methodsurgical method】 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* As the conjunctiva is not involved, it isAs the conjunctiva is not involved, it is not removed. Incisions are outlined by not removed. Incisions are outlined by dotted lines. The incisions are marked dotted lines. The incisions are marked on the patient with a plastic surgeryon the patient with a plastic surgery marking pen. The vertical sides of the marking pen. The vertical sides of the triangles are 20 per cent longer than thetriangles are 20 per cent longer than the vertical incisions adjacent to the tumor vertical incisions adjacent to the tumor to allow for wound contraction.to allow for wound contraction. College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* A A square square or or rectangular rectangular incision incision is is made made around around the the tumor. tumor. The The tumor tumor is is dissected dissected off off from from the the base base toward toward the the lid margin.lid margin. College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* The tumor is removed and placed in The tumor is removed and placed in fixative,and is pinned to a piece of fixative,and is pinned to a piece of cardboard to allow the ophthalmic cardboard to allow the ophthalmic pathologist to examine the margins for pathologist to examine the margins for evidence of tumor.evidence of tumor. NoteNote：If tumor is present in any If tumor is present in any margin, excision has been incomplete. margin, excision has been incomplete. The previously marked triangle is The previously marked triangle is elevated and excised. elevated and excised. College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* The triangles have been removed The triangles have been removed and all incisions completed.and all incisions completed. College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* To prevent tension on the wound, To prevent tension on the wound, the tissues surrounding the the tissues surrounding the triangles and the flap are triangles and the flap are undermined. The flap is undermined. The flap is advanced to the margin with no advanced to the margin with no tension on it.tension on it. College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* Simple marginal sutures of 6-Simple marginal sutures of 6- 0 silk are placed. Sutures are 0 silk are placed. Sutures are placed at the corners of the placed at the corners of the incision to assist in accurate incision to assist in accurate placement of subsequent placement of subsequent sutures.sutures. College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* Remaining sutures in place 2 mm Remaining sutures in place 2 mm apart. If the conjunctiva is mobile it apart. If the conjunctiva is mobile it is sutured to the skin edge,filling the is sutured to the skin edge,filling the defect with a simple continuous defect with a simple continuous suture. This helps prevent suture. This helps prevent retraction of the advancement flap.retraction of the advancement flap. College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 【术后护理术后护理】 全身应用抗生素全身应用抗生素 局部温敷，以减轻肿胀和疼痛局部温敷，以减轻肿胀和疼痛 术后可能发生渗血，从创口或鼻腔术后可能发生渗血，从创口或鼻腔 流出血色液体，一般流出血色液体，一般34d34d后可逐渐后可逐渐 减少减少 术后术后710d710d拆线拆线 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 五、眼球摘除术五、眼球摘除术 【适应症适应症】严重眼穿孔、眼突出严重眼穿孔、眼突出 ，眼内肿瘤，难以治愈的青光眼，眼内肿瘤，难以治愈的青光眼， 眼内炎，全眼球炎等。眼内炎，全眼球炎等。 【保定保定】 多数采取侧卧保定多数采取侧卧保定 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 【术式术式】 主要有两种。一是经主要有两种。一是经 结膜眼球摘除术；二是经眼睑眼结膜眼球摘除术；二是经眼睑眼 球摘除术，尤其适用于全眼球化球摘除术，尤其适用于全眼球化 脓和眶内肿瘤蔓延到眼睑时。脓和眶内肿瘤蔓延到眼睑时。 【麻醉麻醉】大动物可采用全身麻醉大动物可采用全身麻醉 或球后麻醉或眼底封闭，小动物或球后麻醉或眼底封闭，小动物 通常采用全身麻醉。通常采用全身麻醉。 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* A lateral canthotomy is performed.A lateral canthotomy is performed. （一）（一）EnucleationEnucleation College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* The globe is dissected free from The globe is dissected free from the conjunctiva via a perilimbal the conjunctiva via a perilimbal incision.incision. Extraocular muscle insertions Extraocular muscle insertions and periorbita are dissected from and periorbita are dissected from the globe back to the optic nerve.the globe back to the optic nerve. College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* The optic nerve is transected and The optic nerve is transected and the eye removed.the eye removed. College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* The cavity is packed with The cavity is packed with sponges for temporary sponges for temporary hemostasis, and the third hemostasis, and the third eyelid is removed eyelid is removed pletely. College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* The lid margins are removedThe lid margins are removed. College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* The sponges are removed, and the The sponges are removed, and the conjunctiva is sutured with 3-0 Vicryl or conjunctiva is sutured with 3-0 Vicryl or chromic gut.chromic gut. College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* The entire lid incision is sutured The entire lid incision is sutured with 3-0 silk.with 3-0 silk. College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* （二）（二）Transpalpebral Transpalpebral enucleation.enucleation. College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* The eyelids are sutured with The eyelids are sutured with a simple continuous suture a simple continuous suture tied at either end tied at either end and are held with hemostats and are held with hemostats. College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* A periocular A periocular incision is incision is made and made and dissection dissection carried carried down outside down outside the the extraocular extraocular muscles to muscles to the apex of the apex of the orbit.the orbit. College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* The optic The optic nerve and nerve and associated associated vessels are vessels are clamped clamped and and ligated ligated and and transectedtransected. . College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* The optic nerve and associated vessels are The optic nerve and associated vessels are clamped and ligated and transected.clamped and ligated and transected. College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* Conjunctiva and Tenons Conjunctiva and Tenons capsule are sutured with 3-0 capsule are sutured with 3-0 chromic gut or Vicryl, and the chromic gut or Vicryl, and the skin is closed with simple skin is closed with simple interrupted sutures of a interrupted sutures of a nonabsorbable material nonabsorbable material appropriate for the size and appropriate for the size and environment of the patient environment of the patient College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* 六、眼睑损伤的修复六、眼睑损伤的修复 College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* Wound after debridement Wound after debridement and ready for suturing. and ready for suturing. College of Animal Science and Veterinary Medicine , SDAU Copyright All reserved, MA WM PhD* The conjunctiva is sutured with 6-0 Vicryl The conjunctiva is sutured with 6-0 Vicryl in a simple, continuous