手术操作技能课件

TheSkillofProcedure

手术操作基本技能LangxiaoouHalsted’sPrinciplesofsurgeryHandletissuesgently，处理组织轻柔。Controlhaemorrhagecarefully控制出血小心。Preservebloodsupplytotissues保护组织血运Observestrictaseptictechnique严格无菌操作Applyminimumtensiontotissue减少组织张力Ensuretissuesareaccuratelyopposed确保组织准确地对合Eliminatedeadspace不留死腔

Incision切开:scalpel手术刀Haemostasis止血:

handpressure指压法hemostasiswithpacks压迫法clamp钳夹法Tourniquet止血带法ligation结扎法Electriccoagulation:电凝法

Suture缝合:Aimat目的:Closingdeadspace关闭死腔.Supportingandstrengtheningwoundsuntilhealing促进组织愈合.Keepingfunctionaspossible尽量保存功能.Minimizingtherisksofbleedingandinfection减少出血和感染.TheBasicSuturingKitIncludes:

缝合包：Needleholder持针器Finesuturescissors线剪Toothedtissueforceps+/-skinhook有齿镊Appropriatesuturematerial缝线SutureMaterial缝线和缝针Absorbablesuture可吸收Non-absorbablesuture不可吸收Cuttingneedle角针Taper-pointneedle(non-cuttingroundneedle)圆针SutureSize缝线型号Smaller-------------------------------------Larger.....”3-0”...”2-0”...”1-0”...”0”...”1”...”2”...”3”.....Suture

间断缝合Figure-of-eightsuture：8字缝合oneinwhichthethreadsfollowthecontoursofthefigure8VerticalMattressSuture：垂直褥式缝合Decreasesdeadspace,andprovidessuperiorwoundedgeeversion.HorizontalMattressSuture水平入式缝合

TensionSuture

减张缝合EspeciallygoodfordistributingwoundtensionacrosslargerwoundsThedisadvantageistheriskofstrangulationofthedermalbloodsupplyandsubsequentedgenecrosis.Runningsubcuticularsuture：皮内连续缝合IntradermalhorizontalbitesThebenefitofthissutureistheminimalepidermalpuncturepointsallowingthesuturetobeleftinplacelongerwithoutsuture-trackscarring.Sutureremoval拆线SutureforGastrointestinalTract：

消化道的缝合方法Lock-stitch连续锁边缝合Acontinuoushemostaticsutureusedinintestinalsurgery,inwhichtheneedleis,aftereachstitch,passedthroughtheloopoftheprecedingstitch.SutureforGastrointestinalTractserousmembrane浆膜层缝合:interruptedverticallyinvertingsuture(Lembert)间断垂直内翻缝合

interruptedparallelinvertingsuture(Halsted)间断水平内翻缝合Purse-stringsuture荷包缝合continousparallelinverting连续水平内翻缝合suture(Cushing)Lembert间断垂直内翻缝合Cushing：连续水平内翻缝合Invertingsuture内翻缝合ContinuousCushing,ConnellInterruptedLembert,Halsted,purse-stringEvertingsuture外翻缝合Continuous/interrup