College of Animal Science and Veterinary MedicineShandong 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 MedicineShandong Agricultural University内 容 提 纲l l第一节第一节第一节第一节 常用外科器械及其使用常用外科器械及其使用常用外科器械及其使用常用外科器械及其使用l l第二节显露第二节显露第二节显露第二节显露l l第三节第三节第三节第三节 止血止血止血止血l l第四节第四节第四节第四节 缝合缝合缝合缝合l l第五节第五节第五节第五节 拆线拆线拆线拆线l l第六节第六节第六节第六节 打结打结打结打结l l第七节第七节第七节第七节 引流引流引流引流College of Animal Science and Veterinary MedicineShandong Agricultural University（一）种类（一）种类4 4、6 6、8 8号刀柄配号刀柄配19192424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 MedicineShandong Agricultural UniversitySharp scalpel with disposable1 10 0号号号号小小小小圆圆圆圆刃刃刃刃1 11 1号号号号角角角角形形形形尖尖尖尖刃刃刃刃1 12 2号号号号号号号号弯弯弯弯形形形形尖尖尖尖刃刃刃刃1 15 5号号号号小小小小圆圆圆圆刃刃刃刃3 3号刀柄号刀柄号刀柄号刀柄8 8号刀柄号刀柄号刀柄号刀柄College of Animal Science and Veterinary MedicineShandong Agricultural UniversityHandlesCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityHandles 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 MedicineShandong Agricultural UniversityDisposable ScalpelCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityElectrosurgical scalpelCollege of Animal Science and Veterinary MedicineShandong 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026College of Animal Science and Veterinary MedicineShandong Agricultural University装装刀刀片片College of Animal Science and Veterinary MedicineShandong Agricultural UniversityThree basic grips for holding the scalpelPencil gripFingertip gripPalm gripCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityScalpels College of Animal Science and Veterinary MedicineShandong Agricultural UniversityThe scalpel is held with thumb, middle and ring finger while the index finger is placed on the upper edge to help guide the scalpel. Long gentle cutting strokes are less traumatic to tissue than short chopping motions. College of Animal Science and Veterinary MedicineShandong Agricultural UniversityThe 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 MedicineShandong Agricultural University二、二、 surgical scissors组组织织剪剪剪剪线线剪剪Commonly used surgical scissorsCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityClassification by type of pointsAll types of scissors can have blunt or sharp blades (A: Sharp:Sharp, B: Blunt:Blunt). College of Animal Science and Veterinary MedicineShandong Agricultural UniversityAll types can have either straight or curved blades College of Animal Science and Veterinary MedicineShandong Agricultural UniversityMayo and Metzenbaum College of Animal Science and Veterinary MedicineShandong Agricultural UniversityMayo scissors (B) are used for cutting heavy fascia and sutures. Metzenbaum scissors (A) are more delicate than Mayo scissors. Metzenbaum scissors are used to cut delicate tissues and scissors have a longer handle to blade ratio.College of Animal Science and Veterinary MedicineShandong 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 MedicineShandong Agricultural University三、三、 tissue forcepsA.Different tissue forcepsB.Pencil grip for thumb forcep in useC.Palmed position for thumb forcep being carriedCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityThumb forceps are held like a pencil College of Animal Science and Veterinary MedicineShandong Agricultural UniversityThumb Forceps are not held like a knife College of Animal Science and Veterinary MedicineShandong Agricultural University镊镊子子在在手手术术中中的的使使用用视频028 College of Animal Science and Veterinary MedicineShandong Agricultural University四四、止止血血钳钳五五、持持针针钳钳Hemostatic forcepsNeedle holderCollege of Animal Science and Veterinary MedicineShandong 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 MedicineShandong Agricultural UniversityClassification by size and shape and size of tipsHemostatic forceps and hemostats may be curved or straight. College of Animal Science and Veterinary MedicineShandong Agricultural UniversityKelly Hemostatic Forceps and Mosquito Hemostats Kelly Hemostatic 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 hemostatic forceps (B). than Kelly hemostatic forceps (B). College of Animal Science and Veterinary MedicineShandong Agricultural UniversityMosquito hemostats (A) have a smaller, finer tip Comparison of Kelly and Mosquito tips College of Animal Science and Veterinary MedicineShandong Agricultural UniversityCarmalt 视频029 College of Animal Science and Veterinary MedicineShandong Agricultural UniversityMayo-Hegar Heavy, with mildly tapered jaws. No cutting blades. Heavy, with mildly tapered jaws. No cutting blades. College of Animal Science and Veterinary MedicineShandong Agricultural UniversityOlsen-Hegar 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 MedicineShandong Agricultural University六、六、surgical needles1.needle point 2.needle body 3.needle length 4.needle diameter 5.needle chord length 6.needle ridusABC cutting cutting cutting cutting shape of the point and shape of the point and body of nocuttingbody of nocuttingCollege of Animal Science and Veterinary MedicineShandong Agricultural University七、七、retractorRib retractorRib retractorAbdominalAbdominalPerinealPerinealCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversitySenn 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 MedicineShandong Agricultural UniversityHohmanLevers tissue away from bone during orthopedic procedures. College of Animal Science and Veterinary MedicineShandong Agricultural UniversityWeitlaner Ends can be blunt or sharp. Has rake tips. Ratchet to hold tissue apart. College of Animal Science and Veterinary MedicineShandong Agricultural UniversityGelpiHas single point tips. Ratchet to hold tissue apart. Has single point tips. Ratchet to hold tissue apart. College of Animal Science and Veterinary MedicineShandong Agricultural University创创钩钩在在手手术术中中的的应应用用视频030 College of Animal Science and Veterinary MedicineShandong Agricultural University创钩的使用创钩的使用College of Animal Science and Veterinary MedicineShandong Agricultural University创钩的使用创钩的使用College of Animal Science and Veterinary MedicineShandong Agricultural University创钩的使用创钩的使用College of Animal Science and Veterinary MedicineShandong Agricultural University八、八、towel forcep视频031 College of Animal Science and Veterinary MedicineShandong Agricultural University九、九、tissue forcepsCollege of Animal Science and Veterinary MedicineShandong Agricultural UniversityForceps: Forceps: consist consist of of two two tines tines held held together together at at one one end end with with a a spring spring device device that that holds holds the the tines tines open. open. Forceps Forceps can can be be either either tissue tissue or or dressing dressing forceps. forceps. Dressing Dressing forceps forceps have have smooth smooth or or smoothly smoothly serrated serrated tips. tips. Tissue Tissue forceps forceps have have teeth teeth to to grip grip tissue. tissue. Many Many forceps forceps bear bear the the name name of of the the originator originator of of the the design, such as Adson tissue forceps.design, such as Adson tissue forceps.College of Animal Science and Veterinary MedicineShandong Agricultural UniversityRat Tooth: A Tissue ForcepsInterdigitating teeth hold tissue without slipping. Used to hold skin/dense tissue College of Animal Science and Veterinary MedicineShandong Agricultural UniversityAdson Tissue ForcepsSmall serrated teeth on edge of tips. The Adsons tissue forceps has delicate serrated tips designed for light, careful handling of tissue College of Animal Science and Veterinary MedicineShandong Agricultural UniversityAllis: An Intestinal Tissue ForcepsInterdigitating short teeth to grasp and hold bowel or tissue. Slightly traumatic, use to hold intestine, fascia and skin College of Animal Science and Veterinary MedicineShandong Agricultural UniversityBabcock: 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 atraumatically hold viscera (bowel and bladder).atraumatically hold viscera (bowel and bladder). College of Animal Science and Veterinary MedicineShandong Agricultural UniversitySponge ForcepsSponge 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 atraumatically hold viscera (bowel and atraumatically hold viscera (bowel and bladder). bladder). College of Animal Science and Veterinary MedicineShandong Agricultural University十、肠钳十、肠钳College of Animal Science and Veterinary MedicineShandong Agricultural UniversityDoyen Intestinal ForcepsNon-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 MedicineShandong Agricultural UniversityPayr Pylorus ClampsA crushing intestinal instrument. Used to occlude the end of bowel to be resected. College of Animal Science and Veterinary MedicineShandong Agricultural UniversityThe 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 MedicineShandong Agricultural UniversityThis 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 MedicineShandong Agricultural UniversityThis is also the This is also the wrong waywrong way to hold the scissors. The to hold the scissors. The tips of the scissors should be pointing upwards tips of the scissors should be pointing upwards College of Animal Science and Veterinary MedicineShandong Agricultural University十一、器械的传递十一、器械的传递手术剪的传递手术剪的传递College of Animal Science and Veterinary MedicineShandong Agricultural University持针钳的传递持针钳的传递College of Animal Science and Veterinary MedicineShandong Agricultural UniversityAn acceptable hand signal for a needle holder with suture An acceptable hand signal for thumb forcepCollege of Animal Science and Veterinary MedicineShandong Agricultural University.An acceptable signal for scalpelA. An acceptable hand signal for a hemostat返回College of Animal Science and Veterinary MedicineShandong Agricultural UniversityA A、 an instrument pack to a an instrument pack to a scrubbed member of the scrubbed member of the operating teamoperating team AB acceptable way of changing acceptable way of changing positions during a surgical positions during a surgical procedureprocedure C返回