站立牛的剖腹產(chǎn)術(shù)

1、站立牛的剖腹產(chǎn)術(shù)Caesarian Section on the Standing CowPrepared by: Dr. Terry Hunt傅小平博士征 兆 Indications胎兒不能順產(chǎn)Unable to deliver a live calf by vaginal deliver犢牛相對于母牛骨盆過大Over-sized calf for the pelvic size of the dam不能糾正胎位不正Unable to correct mal-presentation of fetus per-vagina胎兒異?；蚧蜦etal monster or abnormality

2、準(zhǔn)備Preparation手術(shù)位置在左側(cè)坎窩The site is the left para-lumbar fossa of the cow剃毛時(shí)應(yīng)該從背側(cè)到肋骨末端，切口前面是最后一個(gè)肋骨，后面為股骨The hair should be removed from the dorsal midline to the flank fold. The anterior landmark is last rib and the posterior landmark is the stifle剃毛后，再麻醉，同時(shí)要用淡碘酒溶液消毒兩遍After hair removal, a double scru

3、b procedure is done then after anesthesia, the skin is again scrubbed twice and the skin is painted with a tamed iodine solution麻醉Anesthesia硬膜外腔麻醉3ml Epidural 3ml椎旁神經(jīng)T 17, L 1, L 2 & L 3 Para-vertebral or modified Paravertebral - T 17, L 1, L 2 & L 3外科程序Surgical Procedure 切口位置在左側(cè)坎窩，皮膚切口長30cm左右Celiot

4、omy incision in left para-lumbar fossa about 30 cm in length接著分別切開外斜肌、內(nèi)斜肌、橫肌、腹膜Incise trough external abdominal oblique muscle then grid through internal oblique, transverse oblique and peritoneum剖腹后，直到將子宮取出再切開The uterus is not incised until it can be exteriorized through the celiotomy incision site

5、如果胎兒再左側(cè)子宮，可抓住子宮內(nèi)胎兒直接送到切口位置If the calf is in the left horn, grasp the uterus over the cannon bone of the calf and draw uterus to incision site. 如果胎兒在右側(cè)子宮，那么胎兒和子宮都需要旋轉(zhuǎn)位置（以便小牛接近子宮切口位置）If the calf is in the right horn, the calf and uterus must be rotated (the back of the calf will be closest to the inci

6、sion site)通過擠壓胎兒后背所產(chǎn)生的壓力旋轉(zhuǎn)子宮（子宮體中應(yīng)該保持右側(cè)的壓力高）Rotate the uterus and calf by applying rocking pressure on the back of the calf (the pressure should be applied high to rotate the right horn under the body of the uterus)一旦子宮體旋轉(zhuǎn)好后，要緊緊抓住胎兒脛骨移到切口位置Once the uterus has been rotated, grasp the uterus over the

7、cannon bone of the calf and draw uterus to incision site.如果胎兒位置仍是腿在前應(yīng)該將其頭部移至子宮切口位置進(jìn)行前面同樣的程序If calf is in posterior position, the same procedure is carried out to bring the uterus/cannon bone and head to the incision site.手術(shù)中將腹腔內(nèi)容物(腸等)遠(yuǎn)離切口是很重要的It is important to keep intestines back from the incision

8、 site.切開子宮時(shí)胎兒的腿到達(dá)子宮角時(shí)應(yīng)該避免卵巢及其相關(guān)的組織The leg of the calf will be in the horn of the uterus so incise the uterus over the cannon bone of the calf avoiding the ovary and related structures.這切口的長度應(yīng)該有胎兒腓關(guān)節(jié)到蹄趾間長The incision should be the length of the calfs leg from the hock to the tip of the hoof如果頭在切口位置應(yīng)用

9、同樣的方法將頭取出If the head is at the incision site use the same technique but then exteriorize the head of the calf如果切口不夠大應(yīng)該及時(shí)將切口增大If the incision is not long enough in the body wall, extend it at this time助產(chǎn)繩應(yīng)該系緊胎兒牛的腳同時(shí)沿著母牛反方向用力Chains/straps should be placed around the feet of the calf and the calf shoul

10、d be pulled out towards the back of the cow助手應(yīng)該配合助產(chǎn)An assistant should deliver the calf如果犢牛前后端同時(shí)出現(xiàn)，那么就比較困難將其從子宮切口拉出，此時(shí)可以用你的手去摸犢牛臀部If the front end is presented, sometimes it is difficult to get the hips of the calf through the incision site- guide the hips with your hand一旦胎兒取出接下來的工作主要由助手完成Once the c

11、alf has been delivered, it is the responsibility of the assistant從子宮內(nèi)移去胎盤和液體Remove excessive placenta and fluid from the uterus 用3號(hào)羊腸線進(jìn)行子宮兩層縫合Utilize a two-layer closure technique to close the uterus using # 3 catgut suture material兩層應(yīng)用連續(xù)倒置縫合法Both layers should use a continuous inverting pattern第一層縫

12、合應(yīng)該用倫伯特氏縫合First layer should be closed using the Utrecht or Lambert pattern接著用康乃爾縫合法This should be over sewn using a Connell pattern檢查密封性并將子宮送至原來位置，檢查有無撕裂處Check for leakage then return the uterus to is normal position in the abdomen (check for tears)腹膜連續(xù)縫合以及橫肌縫合Close the peritoneum and transverses m

13、uscle layer in one continuous pattern內(nèi)斜肌連續(xù)縫合Close the grid of the internal oblique with a continuous pattern外斜肌連續(xù)縫合Close the external oblique muscle with a continuous pattern 用3號(hào)不可以吸收縫線間斷十字交叉皮膚縫合Close the skin using # 3 non-absorbable interrupted cruciate pattern接著Follow up廣譜抗生素連用3天Broad-spectrum antibiotics for three days皮膚縫合3-4周拆線Remove