常用外科手术器械及其使用.ppt

College of Animal Science and Veterinary Medicine Shandong Agricultural University 第六章第六章 手术基本操作技术手术基本操作技术 手术种类繁多，范围、大小和复杂程手术种类繁多，范围、大小和复杂程 度不同，但基本操作技术是相同的度不同，但基本操作技术是相同的 手术顺利完成，一定意义上取决于基手术顺利完成，一定意义上取决于基 本操作的熟练程度及其理论的掌握本操作的熟练程度及其理论的掌握 理论指导下的不断实践，是唯一的正理论指导下的不断实践，是唯一的正 确途径。确途径。 稳、准、巧、轻、快是基本要求。稳、准、巧、轻、快是基本要求。 College of Animal Science and Veterinary Medicine Shandong Agricultural University 内内 容容 提提 纲纲 College of Animal Science and Veterinary Medicine Shandong Agricultural University （一）种类（一）种类 4 4、6 6、8 8号刀柄配号刀柄配1919 2424号刀片。号刀片。 3 3、5 5、7 7号刀柄配号刀柄配1010、1111、1212、1515号刀片号刀片 专用手术刀，如眼科刀等。专用手术刀，如眼科刀等。 高频电刀。高频电刀。 第一节第一节 常用外科器械及其使用常用外科器械及其使用 一、手术刀一、手术刀 College of Animal Science and Veterinary Medicine Shandong Agricultural University Sharp scalpel with disposableSharp scalpel with disposable 1010号小圆刃号小圆刃 1111号角形尖刃号角形尖刃 1212号号弯形尖刃号号弯形尖刃 1515号小圆刃号小圆刃 3 3号刀柄号刀柄 8 8号刀柄号刀柄 College of Animal Science and Veterinary Medicine Shandong Agricultural University HandlesHandles College of Animal Science and Veterinary Medicine Shandong Agricultural University Handles Blades Handles Blades Blades #10, 11, 12, 15 fit the #3 handle, #22, #23 fit Blades #10, 11, 12, 15 fit the #3 handle, #22, #23 fit the #4 handle , commonly used for large animals. the #4 handle , commonly used for large animals. College of Animal Science and Veterinary Medicine Shandong Agricultural University Disposable ScalpelDisposable Scalpel College of Animal Science and Veterinary Medicine Shandong Agricultural University Electrosurgical scalpelElectrosurgical scalpel College of Animal Science and Veterinary Medicine Shandong Agricultural University （二）手术刀的使用（二）手术刀的使用 装刀片法装刀片法 取刀片法取刀片法 视频026 College of Animal Science and Veterinary Medicine Shandong Agricultural University 装刀片装刀片 College of Animal Science and Veterinary Medicine Shandong Agricultural University Three basic grips for Three basic grips for holding the scalpelholding the scalpel Pencil gripPencil gripFingertip gripFingertip grip Palm gripPalm grip College of Animal Science and Veterinary Medicine Shandong Agricultural University Scalpels Scalpels College of Animal Science and Veterinary Medicine Shandong Agricultural University College of Animal Science and Veterinary Medicine Shandong Agricultural University The scalpel should never be used in a “stabbing“ motion The scalpel should never be used in a “stabbing“ motion College of Animal Science and Veterinary Medicine Shandong Agricultural University 二、二、 surgical scissorssurgical scissors 组织剪组织剪 剪线剪剪线剪 Commonly used surgical scissorsCommonly used surgical scissors College of Animal Science and Veterinary Medicine Shandong Agricultural University Classification by type of pointsClassification by type of points All All types types of of scissors scissors can can have have blunt blunt or or sharp sharp blades (A: blades (A: Sharp:SharpSharp:Sharp, B: , B: Blunt:BluntBlunt:Blunt). ). College of Animal Science and Veterinary Medicine Shandong Agricultural University All types can have either All types can have either straight or curved blades straight or curved blades College of Animal Science and Veterinary Medicine Shandong Agricultural University Mayo and Metzenbaum Mayo and Metzenbaum College of Animal Science and Veterinary Medicine Shandong Agricultural University Mayo Mayo scissors scissors (B) (B) are are used used for for cutting cutting heavy heavy fascia fascia and and sutures.sutures. Metzenbaum Metzenbaum scissors scissors (A) (A) are are more more delicate delicate than than Mayo Mayo scissors.scissors. Metzenbaum Metzenbaum scissors scissors are are used used to to cut cut delicate delicate tissues tissues and and scissors scissors have have a a longer longer handle to blade ratio.handle to blade ratio. College of Animal Science and Veterinary Medicine Shandong Agricultural University 执剪的方法执剪的方法剪线的方法剪线的方法 视频027 College of Animal Science and Veterinary Medicine Shandong Agricultural University 三、三、 tissue forcepstissue forceps A.Different tissue forceps B.Pencil grip for thumb forcep in use C.Palmed position for thumb forcep being carried College of Animal Science and Veterinary Medicine Shandong Agricultural University Thumb forceps are held like a pencilThumb forceps are held like a pencil College of Animal Science and Veterinary Medicine Shandong Agricultural University Thumb Forceps are not held like a knifeThumb Forceps are not held like a knife College of Animal Science and Veterinary Medicine Shandong Agricultural University 镊子在手术中的使用镊子在手术中的使用 视频028 College of Animal Science and Veterinary Medicine Shandong Agricultural University 四、止血钳四、止血钳 五、持针钳五、持针钳 HemostaticHemostatic forcepsforceps Needle Needle holderholder College of Animal Science and Veterinary Medicine Shandong Agricultural University 持针钳在手术持针钳在手术 中的应用中的应用 College of Animal Science and Veterinary Medicine Shandong Agricultural University Classification by size and shape and size of tipsClassification by size and shape and size of tips HemostaticHemostatic forceps and hemostats forceps and hemostats may be curved or straight. may be curved or straight. College of Animal Science and Veterinary Medicine Shandong Agricultural University Kelly Kelly HemostaticHemostatic Forceps and Mosquito Hemostats Forceps and Mosquito Hemostats Both are transversely serrated Both are transversely serrated Mosquito hemostats (A) are more delicate Mosquito hemostats (A) are more delicate than Kelly than Kelly hemostatichemostatic forceps (B). forceps (B). College of Animal Science and Veterinary Medicine Shandong Agricultural University Mosquito hemostats (A) have a smaller, finer tip Mosquito hemostats (A) have a smaller, finer tip Comparison of Kelly and Mosquito tips Comparison of Kelly and Mosquito tips College of Animal Science and Veterinary Medicine Shandong Agricultural University CarmaltCarmalt 视频029 College of Animal Science and Veterinary Medicine Shandong Agricultural University Mayo-Mayo-HegarHegar Heavy, with mildly tapered jaws. No cutting blades. Heavy, with mildly tapered jaws. No cutting blades. College of Animal Science and Veterinary Medicine Shandong Agricultural University Olsen-Olsen-HegarHegar Includes both needle holding jaw and scissors blades. Includes both needle holding jaw and scissors blades. The disadvantage to having blades within the needle The disadvantage to having blades within the needle holder is the suture material may be accidentally cut.holder is the suture material may be accidentally cut. College of Animal Science and Veterinary Medicine Shandong Agricultural University 六、六、surgical needlessurgical needles 1.needle point 2.needle body 3.needle length 4.needle diameter 5.needle chord length 6.needle ridus A B C B.conventionalB.conventional cutting cutting C.reverseC.reverse cutting cutting A.TheA.The shape of the point shape of the point and body of and body of nocuttingnocutting College of Animal Science and Veterinary Medicine Shandong Agricultural University 七、七、retractorretractor Rib retractorRib retractor AbdominalAbdominal PerinealPerineal College of Animal Science and Veterinary Medicine Shandong Agricultural University SennSenn Blades at each end. Blades at each end. Blades can be blunt Blades can be blunt (delicate)(delicate) or sharp (more traumatic, used for or sharp (more traumatic, used for fascia). fascia). College of Animal Science and Veterinary Medicine Shandong Agricultural University HohmanHohman Levers tissue away from bone Levers tissue away from bone during orthopedic procedures. during orthopedic procedures. College of Animal Science and Veterinary Medicine Shandong Agricultural University WeitlanerWeitlaner Ends can be blunt or sharp. Ends can be blunt or sharp. Has rake Has rake tips.tips. Ratchet to hold tissue apart. Ratchet to hold tissue apart. College of Animal Science and Veterinary Medicine Shandong Agricultural University GelpiGelpi Has single point tips. Ratchet to hold tissue apart. Has single point tips. Ratchet to hold tissue apart. College of Animal Science and Veterinary Medicine Shandong Agricultural University 创钩在手术中的应用创钩在手术中的应用 视频030 College of Animal Science and Veterinary Medicine Shandong Agricultural University 创钩的使用创钩的使用 College of Animal Science and Veterinary Medicine Shandong Agricultural University 创钩的使用创钩的使用 College of Animal Science and Veterinary Medicine Shandong Agricultural University 创钩的使用创钩的使用 College of Animal Science and Veterinary Medicine Shandong Agricultural University 八、八、towel towel forcepforcep 视频031 College of Animal Science and Veterinary Medicine Shandong Agricultural University 九、九、tissue forcepstissue forceps College of Animal Science and Veterinary Medicine Shandong Agricultural University College of Animal Science and Veterinary Medicine Shandong Agricultural University Rat Tooth: A Tissue ForcepsRat Tooth: A Tissue Forceps InterdigitatingInterdigitating teeth hold tissue without teeth hold tissue without slipping. Used to hold skin/dense tissue slipping. Used to hold skin/dense tissue College of Animal Science and Veterinary Medicine Shandong Agricultural University Adson Tissue Forceps Small Small serrated serrated teeth teeth on on edge edge of of tips. tips. The The AdsonsAdsons tissue tissue forceps forceps has has delicate delicate serrated serrated tips tips designed for light, careful handling of tissue designed for light, careful handling of tissue College of Animal Science and Veterinary Medicine Shandong Agricultural University Allis: An Intestinal Tissue ForcepsAllis: An Intestinal Tissue Forceps InterdigitatingInterdigitating short short teeth teeth to to grasp grasp and and hold hold bowel bowel or or tissue. tissue. Slightly Slightly traumatic, traumatic, use use to to hold hold intestine, fascia and skin intestine, fascia and skin College of Animal Science and Veterinary Medicine Shandong Agricultural University Babcock: An Intestinal Tissue Forceps Babcock: An Intestinal Tissue Forceps More More delicate delicate than than Allis, Allis, less less directly directly traumatic. traumatic. Broad, Broad, flared flared ends ends with with smooth smooth tips.tips. Used Used to to atraumaticallyatraumatically hold viscera (bowel and bladder). hold viscera (bowel and bladder). College of Animal Science and Veterinary Medicine Shandong Agricultural University Sponge ForcepsSponge Forceps Sponge forceps can be straight or curved, can Sponge forceps can be straight or curved, can have smooth or serrated jaws. Used to have smooth or serrated jaws. Used to atraumaticallyatraumatically hold viscera (bowel and hold viscera (bowel and bladder). bladder). College of Animal Science and Veterinary Medicine Shandong Agricultural University 十、肠钳十、肠钳 College of Animal Science and Veterinary Medicine Shandong Agricultural University Doyen Intestinal ForcepsDoyen Intestinal Forceps Non-crushing Non-crushing intestinal intestinal occluding occluding forceps forceps with with longitudinal longitudinal serrations. serrations. Used Used to to temporarily temporarily occlude lumen of bowel occlude lumen of bowel College of Animal Science and Veterinary Medicine Shandong Agricultural University PayrPayr Pylorus Clamps Pylorus Clamps A A crushing crushing intestinal intestinal instrument. instrument. Used Used to to occlude the end of bowel to be occlude the end of bowel to be resectedresected. . College of Animal Science and Veterinary Medicine Shandong Agricultural University The The thumb thumb and and ring ring finger finger are are inserted inserted into into the the rings rings of of the the scissors scissors while while the the index index and and middle middle finger finger are are used used to guide the instrument. to guide the instrument. The The instrument instrument should should remain remain at at the the tips tips of of the the fingers fingers for for maximum control. maximum control. College of Animal Science and Veterinary Medicine Shandong Agricultural University This is the This is the wrong waywrong way to hold the scissors. The to hold the scissors. The ring finger should be inserted into the ring ring finger should be inserted into the ring College of Animal Science and Veterinary